Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Ophthalmology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
ASH 2024 Annual Meeting 2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on adolescent vaping

LIVE: Wednesday 29th January, 18:00-19:30 CET

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?
ADVANCED SEARCH
Log in
Top
Clinical and Experimental Nephrology

Open Access 28-09-2024 | ECMO | Review article

Research progress on the pathogenesis of AKI complicated by ECMO

Authors: Keke Sun, Congcong Yao, Guowu Xu, Jinxiang Wang, Songtao Shou, Heng Jin

Published in: Clinical and Experimental Nephrology

Login to get access

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) stands as a pivotal intervention for patients grappling with cardiopulmonary insufficiency. However, alongside its therapeutic benefits, ECMO carries the risk of complications, with acute kidney injury (AKI) emerging as a significant concern. The precise pathophysiological underpinnings of AKI in the context of ECMO remain incompletely elucidated.

Methods

A comprehensive literature review was conducted to explore the epidemiology and pathophysiological mechanisms underlying the utilization of ECMO in the management of AKI.

Results

ECMO initiates a multifaceted cascade of inflammatory reactions, encompassing complement activation, endothelial dysfunction, white blood cell activation, and cytokine release. Furthermore, factors such as renal hypoperfusion, ischemia–reperfusion injury, hemolysis, and fluid overload exacerbate AKI. Specifically, veno-arterial ECMO (VA-ECMO) may directly induce renal hypoperfusion, whereas veno-venous ECMO (VV-ECMO) predominantly impacts pulmonary function, indirectly influencing renal function.

Conclusion

While ECMO offers significant therapeutic advantages, AKI persists as a potentially fatal complication. A thorough comprehension of the pathogenesis underlying ECMO-associated AKI is imperative for effective prevention and management strategies. Moreover, additional research is warranted to delineate the incidence of AKI secondary to ECMO and to refine clinical approaches accordingly.
Literature
1.
2.
Teijeiro-Paradis R, Del Sorbo L. VV-ECMO in severe COVID-19: multidimensional perspectives on the use of a complex treatment. Lancet Respir Med. 2023;11(2):113–5.PubMedPubMedCentralCrossRef
3.
Bernhardt AM, et al. Extracorporeal membrane oxygenation. Dtsch Arztebl Int. 2022;119(13):235–44.PubMed
4.
Jenks C, Raman L, Dhar A. Review of acute kidney injury and continuous renal replacement therapy in pediatric extracorporeal membrane oxygenation. Indian J Thorac Cardiovasc Surg. 2021;37(Suppl 2):254–60.PubMedCrossRef
5.
Jenks CL, et al. High hemoglobin is an independent risk factor for the development of hemolysis during pediatric extracorporeal life support. J Intensive Care Med. 2019;34(3):259–64.PubMedCrossRef
6.
Gbadegesin R, et al. Significance of hemolysis on extracorporeal life support after cardiac surgery in children. Pediatr Nephrol. 2009;24(3):589–95.PubMedCrossRef
7.
8.
Thongprayoon C, et al. Incidence and impact of acute kidney injury in patients receiving extracorporeal membrane oxygenation: a meta-analysis. J Clin Med. 2019;8(7):981.PubMedPubMedCentralCrossRef
9.
Hansrivijit P, et al. Acute kidney injury in pediatric patients on extracorporeal membrane oxygenation: a systematic review and meta-analysis. Medicines. 2019;6(4):109.PubMedPubMedCentralCrossRef
10.
Surjit A, et al. Acute kidney injury in patients undergoing extracorporeal membrane oxygenation: a retrospective cohort study. Indian J Crit Care Med. 2024;28(1):26–9.PubMed
11.
Mou Z, Guan T, Chen L. Risk factors of acute kidney injury in ECMO patients: a systematic review and meta-analysis. J Intensive Care Med. 2022;37(2):267–77.PubMedCrossRef
12.
Mou Z, et al. Acute kidney injury during extracorporeal membrane oxygenation: VA ECMO versus VV ECMO. J Intensive Care Med. 2022;37(6):743–52.PubMedCrossRef
13.
14.
Chen W, et al. Independent risk factors of acute kidney injury among patients receiving extracorporeal membrane oxygenation. BMC Nephrol. 2023;24(1):81.PubMedPubMedCentralCrossRef
15.
16.
Ekdahl KN, et al. Therapeutic regulation of complement activation in extracorporeal circuits and intravascular treatments with special reference to the alternative pathway amplification loop. Immunol Rev. 2023;313(1):91–103.PubMedCrossRef
17.
Vallhonrat H, et al. Rapid activation of the alternative pathway of complement by extracorporeal membrane oxygenation. ASAIO J. 1999;45(1):113–4.PubMedCrossRef
18.
Moen O, et al. Roller and centrifugal pumps compared in vitro with regard to haemolysis, granulocyte and complement activation. Perfusion. 1994;9(2):109–17.PubMedCrossRef
19.
DePuydt LE, Schuit KE, Smith SD. Effect of extracorporeal membrane oxygenation on neutrophil function in neonates. Crit Care Med. 1993;21(9):1324–7.PubMedCrossRef
20.
Plötz FB, et al. Blood activation during neonatal extracorporeal life support. J Thorac Cardiovasc Surg. 1993;105(5):823–32.PubMedCrossRef
21.
Siegel PM, et al. The serum proteome of VA-ECMO patients changes over time and allows differentiation of survivors and non-survivors: an observational study. J Transl Med. 2023;21(1):319.PubMedPubMedCentralCrossRef
22.
De Silva RJ, et al. APT070 inhibits complement activation during in vitro cardiopulmonary bypass. Eur J Cardiothorac Surg. 2006;30(1):72–6.PubMedCrossRef
23.
Ki KK, et al. Current understanding of leukocyte phenotypic and functional modulation during extracorporeal membrane oxygenation: a narrative review. Front Immunol. 2020;11: 600684.PubMedCrossRef
24.
Mc IRB, et al. Plasma concentrations of inflammatory cytokines rise rapidly during ECMO-related SIRS due to the release of preformed stores in the intestine. Lab Invest. 2010;90(1):128–39.CrossRef
25.
Mildner RJ, et al. Cytokine imbalance in infants receiving extracorporeal membrane oxygenation for respiratory failure. Biol Neonate. 2005;88(4):321–7.PubMedCrossRef
26.
Caprarola SD, et al. Pediatric ECMO: unfavorable outcomes are associated with inflammation and endothelial activation. Pediatr Res. 2022;92(2):549–56.PubMedCrossRef
27.
Zayat R, et al. Role of extracorporeal membrane oxygenation in critically Ill COVID-19 patients and predictors of mortality. Artif Organs. 2021;45(6):E158–70.PubMedCrossRef
28.
Risnes I, et al. Interleukin-6 may predict survival in extracorporeal membrane oxygenation treatment. Perfusion. 2008;23(3):173–8.PubMedCrossRef
29.
30.
31.
Lieberum JN, et al. Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis. BMC Infect Dis. 2023;23(1):19.PubMedPubMedCentralCrossRef
32.
Grins E, et al. Interleukin-10: a potential pre-cannulation marker for development of acute kidney injury in patients receiving veno-arterial extracorporeal membrane oxygenation. Blood Purif. 2023;52(7–8):631–41.PubMedCrossRef
33.
Chandler WL. Coagulation activation during extracorporeal membrane oxygenation (ECMO). Thromb Res. 2022;211:154–60.PubMedCrossRef
34.
Martucci G, et al. Anticoagulation and bleeding during veno-venous extracorporeal membrane oxygenation: insights from the PROTECMO study. Am J Respir Crit Care Med. 2024;209(4):417–26.PubMedCrossRef
35.
Jiritano F, et al. Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis. Intensive Care Med. 2020;46(6):1154–69.PubMedPubMedCentralCrossRef
36.
Hvas CL, Hvas AM, Christensen S. Platelets and fibrinogen matter when bleeding on ECMO. Intensive Care Med. 2023;49(12):1565–6.PubMedCrossRef
37.
Forman DE, et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol. 2004;43(1):61–7.PubMedCrossRef
38.
Pinsky MR. My paper 20 years later: effect of positive end-expiratory pressure on right ventricular function in humans. Intensive Care Med. 2014;40(7):935–41.PubMedPubMedCentralCrossRef
39.
Salahuddin N, et al. Fluid overload is an independent risk factor for acute kidney injury in critically Ill patients: results of a cohort study. BMC Nephrol. 2017;18(1):45.PubMedPubMedCentralCrossRef
40.
Chen YC, et al. Acute kidney injury in adults receiving extracorporeal membrane oxygenation. J Formos Med Assoc. 2014;113(11):778–85.PubMedCrossRef
41.
42.
43.
Stoppe C, et al. The protective role of macrophage migration inhibitory factor in acute kidney injury after cardiac surgery. Sci Transl Med. 2018;10(441):eaan4886.PubMedCrossRef
44.
45.
Garg M. Intravascular hemolysis and complications during extracorporeal membrane oxygenation. NeoReviews. 2020;21(11):e728–40.PubMedCrossRef
46.
Aksu U, Demirci C, Ince C. The pathogenesis of acute kidney injury and the toxic triangle of oxygen, reactive oxygen species and nitric oxide. Contrib Nephrol. 2011;174:119–28.PubMedCrossRef
47.
Haase M, Bellomo R, Haase-Fielitz A. Novel biomarkers, oxidative stress, and the role of labile iron toxicity in cardiopulmonary bypass-associated acute kidney injury. J Am Coll Cardiol. 2010;55(19):2024–33.PubMedCrossRef
48.
Moussavian MR, et al. Hemoglobin induces cytotoxic damage of glycine-preserved renal tubules. Transpl Int. 2007;20(10):884–94.PubMedCrossRef
49.
50.
Nasr VG, et al. Highlights from the extracorporeal life support organization registry: 2006–2017. ASAIO J. 2019;65(6):537–44.PubMedCrossRef
51.
O’Neil ER, et al. Pediatric highlights from the extracorporeal life support organization registry: 2017–2022. ASAIO J. 2024;70(1):8–13.PubMed
52.
Rali AS, et al. Adult highlights from the extracorporeal life support organization registry: 2017–2022. ASAIO J. 2024;70(1):1–7.PubMed
53.
54.
Thiagarajan RR, et al. Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63(1):60–7.PubMedCrossRef
55.
Selewski DT, Wille KM. Continuous renal replacement therapy in patients treated with extracorporeal membrane oxygenation. Semin Dial. 2021;34(6):537–49.PubMedPubMedCentralCrossRef
56.
Novy E, et al. Population pharmacokinetics of fluconazole in critically ill patients receiving extracorporeal membrane oxygenation and continuous renal replacement therapy: an ASAP ECMO study. Antimicrob Agents Chemother. 2024;68(1): e0120123.PubMedCrossRef
57.
Askenazi DJ, et al. Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation. Clin J Am Soc Nephrol. 2012;7(8):1328–36.PubMedCrossRef
58.
Bagshaw SM, Zappitelli M, Chawla LS. Novel biomarkers of AKI: the challenges of progress ‘Amid the noise and the haste.’ Nephrol Dial Transplant. 2013;28(2):235–8.PubMedCrossRef
59.
Haase-Fielitz A, Haase M, Devarajan P. Neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury: a critical evaluation of current status. Ann Clin Biochem. 2014;51(Pt 3):335–51.PubMedPubMedCentralCrossRef
60.
Kilburn DJ, Shekar K, Fraser JF. The complex relationship of extracorporeal membrane oxygenation and acute kidney injury: causation or association? Biomed Res Int. 2016;2016:1094296.PubMedPubMedCentralCrossRef
61.
Foti L, et al. Acute kidney injury and extracorporeal membrane oxygenation: review on multiple organ support options. Int J Nephrol Renovasc Dis. 2021;14:321–9.PubMedPubMedCentralCrossRef
62.
Hoover NG, et al. Enhanced fluid management with continuous venovenous hemofiltration in pediatric respiratory failure patients receiving extracorporeal membrane oxygenation support. Intensive Care Med. 2008;34(12):2241–7.PubMedCrossRef
63.
Gorga SM, et al. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy: a multicenter retrospective cohort study. Pediatr Nephrol. 2020;35(5):871–82.PubMedPubMedCentralCrossRef
64.
Dado DN, et al. Outcomes among patients treated with renal replacement therapy during extracorporeal membrane oxygenation: a single-center retrospective study. Blood Purif. 2020;49(3):341–7.PubMedCrossRef
65.
Antonucci E, et al. The impact of renal failure and renal replacement therapy on outcome during extracorporeal membrane oxygenation therapy. Artif Organs. 2016;40(8):746–54.PubMedCrossRef
66.
Ostermann M, Connor M Jr, Kashani K. Continuous renal replacement therapy during extracorporeal membrane oxygenation: why, when and how? Curr Opin Crit Care. 2018;24(6):493–503.PubMedCrossRef
67.
Wu MY, et al. Impact of preexisting organ dysfunction on extracorporeal life support for non-postcardiotomy cardiopulmonary failure. Resuscitation. 2008;79(1):54–60.PubMedCrossRef
Metadata
Title
Research progress on the pathogenesis of AKI complicated by ECMO
Authors
Keke Sun
Congcong Yao
Guowu Xu
Jinxiang Wang
Songtao Shou
Heng Jin
Publication date
28-09-2024
Publisher
Springer Nature Singapore
Published in
Clinical and Experimental Nephrology
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-024-02559-7

Keynote webinar | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the broader systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

  • Live
  • Webinar | 29-01-2025 | 18:00 (CET)

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Watch it live: Wednesday 29th January, 18:00-19:30 CET
 

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Join the webinar

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more
Image Credits