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2015 ; 6
(1
): 50-60
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Extracorporeal Membrane Oxygenation and the Kidney
#MMPMID27194996
Villa G
; Katz N
; Ronco C
Cardiorenal Med
2015[Dec]; 6
(1
): 50-60
PMID27194996
show ga
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an effective therapy
for patients with reversible cardiac and/or respiratory failure. Acute kidney
injury (AKI) often occurs in patients supported with ECMO; it frequently evolves
into chronic kidney damage or end-stage renal disease and is associated with a
reported 4-fold increase in mortality rate. Although AKI is generally due to the
hemodynamic alterations associated with the baseline disease, ECMO itself may
contribute to maintaining kidney dysfunction through several mechanisms. SUMMARY:
AKI may be related to conditions derived from or associated with extracorporeal
therapy, leading to a reduction in renal oxygen delivery and/or to inflammatory
damage. In particular, during pathological conditions requiring ECMO, the
biological defense mechanisms maintaining central perfusion by a reduction of
perfusion to peripheral organs (such as the kidney) have been identified as
pretreatment and patient-related risk factors for AKI. Hormonal pathways are also
impaired in patients supported with ECMO, leading to failures in mechanisms of
renal homeostasis and worsening fluid overload. Finally, inflammatory damage, due
to the primary disease, heart and lung crosstalk with the kidney or associated
with extracorporeal therapy itself, may further increase the susceptibility to
AKI. Renal replacement therapy can be integrated into the main extracorporeal
circuit during ECMO to provide for optimal fluid management and removal of
inflammatory mediators. KEY MESSAGES: AKI is frequently observed in patients
supported with ECMO. The pathophysiology of the associated AKI is chiefly related
to a reduction in renal oxygen delivery and/or to inflammatory damage. Risk
factors for AKI are associated with a patient's underlying disease and
ECMO-related conditions.
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