Acute Kidney Injury in Adult Patients Receiving Extracorporeal Membrane Oxygenation: A Systematic Review

Introduction. Acute kidney injury (AKI) is a frequent and clinically important complication in adults receiving extracorporeal membrane oxygenation (ECMO), yet reported incidence and associated outcomes vary widely due to differences in populations, ECMO configuration, and AKI definitions. We systematically reviewed full-text studies reporting AKI and related outcomes in adult patients supported with veno-arterial (VA) and/or venovenous (VV) ECMO.Methods. A systematic search of PubMed identified ۶۶۱ records; ۶۶۰ remained after deduplication. Full texts available for assessment were screened for eligibility (n = ۱۲۶). We included original adult ECMO/ECLS studies reporting extractable AKI and/or renal replacement therapy (RRT/CRRT) outcomes.Results. Forty-five studies were included in qualitative synthesis. AKI incidence was extractable in ۲۹ studies and ranged from ۲.۳% to ۸۹.۰% (median ۵۰.۵%). RRT/CRRT use was extractable in ۲۹ studies and ranged from ۱.۸% to ۹۱.۰% (median ۵۳.۳%). Mortality was extractable in ۳۷ studies (ICU, in-hospital, or ۳۰day) and ranged from ۶.۰% to ۹۵.۰% (median ۵۳.۳%). KDIGO was the most frequently referenced AKI definition (reported in ۲۶ studies), followed by RIFLE (۱۹) and AKIN (۱۱), with overlap across studies.Conclusions. AKI and RRT/CRRT use are common in adults receiving ECMO, with substantial variability driven by clinical heterogeneity and inconsistent AKI definitions and outcome reporting. Standardized AKI definitions and harmonized reporting of renal and mortality outcomes are needed to improve comparability and guide future ECMO–kidney research.Introduction. Acute kidney injury (AKI) is a frequent and clinically important complication in adults receiving extracorporeal membrane oxygenation (ECMO), yet reported incidence and associated outcomes vary widely due to differences in populations, ECMO configuration, and AKI definitions. We systematically reviewed full-text studies reporting AKI and related outcomes in adult patients supported with veno-arterial (VA) and/or venovenous (VV) ECMO.Methods. A systematic search of PubMed identified ۶۶۱ records; ۶۶۰ remained after deduplication. Full texts available for assessment were screened for eligibility (n = ۱۲۶). We included original adult ECMO/ECLS studies reporting extractable AKI and/or renal replacement therapy (RRT/CRRT) outcomes.Results. Forty-five studies were included in qualitative synthesis. AKI incidence was extractable in ۲۹ studies and ranged from ۲.۳% to ۸۹.۰% (median ۵۰.۵%). RRT/CRRT use was extractable in ۲۹ studies and ranged from ۱.۸% to ۹۱.۰% (median ۵۳.۳%). Mortality was extractable in ۳۷ studies (ICU, in-hospital, or ۳۰day) and ranged from ۶.۰% to ۹۵.۰% (median ۵۳.۳%). KDIGO was the most frequently referenced AKI definition (reported in ۲۶ studies), followed by RIFLE (۱۹) and AKIN (۱۱), with overlap across studies.Conclusions. AKI and RRT/CRRT use are common in adults receiving ECMO, with substantial variability driven by clinical heterogeneity and inconsistent AKI definitions and outcome reporting. Standardized AKI definitions and harmonized reporting of renal and mortality outcomes are needed to improve comparability and guide future ECMO–kidney research.

کلیدواژه ها:

extracorporeal membrane oxygenation ، ECMO ، acute kidney injury ، renal replacement therapy ، CRRT ، mortality