• Yuan Teng, Yuan Li, KunYu Li, Qiang Hu, Shujie Yan, Gang Liu, Bingyang Ji, and Guodong Gao.
• Department of Cardiopulmonary Bypass, National Center for Cardiovascular Diseases & Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
• J. Cardiothorac. Vasc. Anesth. 2024 Oct 1; 38 (10): 223122372231-2237.

ObjectiveTo investigate the incidence and risk factors of acute kidney injury (AKI) stage 3 in adult patients under veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support.DesignA retrospective case-control study.SettingSingle center, Fuwai Hospital.ParticipantsAdult VA-ECMO patients age ≥18 years and older treated between January 2020 and December 2022 were included.InterventionsThe patients were grouped by whether they developed AKI Kidney Disease: Improving Global Outcomes (KDIGO) stage 3 or <3. Multivariate logistic regression was performed t"o evaluate risk factors of AKI stage 3.Measurements And Main ResultsAmong enrolled patients, 40 (53.3%) developed AKI stage 3. The in-hospital mortality of AKI stage 3 patients was significantly higher than that of AKI stage <3 patients (67.5% vs 34.3%; p = 0.004). Multivariate logistic regression analysis revealed that concomitant hypertension (odds ratio [OR], 0.250; 95% confidence interval [CI], 0.063, 0.987), p = 0.048), pre-ECMO hemoglobin (OR, 0.969; 95% CI, 0.947-0.992; p = 0.009), pre-ECMO lactate (OR, 1.173; 95% CI, 1.028-1.339; p = 0.018), and pre-ECMO creatinine (OR, 1.014; 95% CI, 1.003-1.025; p = 0.011) were independent risk factors for AKI stage 3.ConclusionsThis study found a high incidence (53.3%) of AKI stage 3 in adult patients with VA-ECMO support and an association with increased in-hospital mortality. Concomitant hypertension, low pre-ECMO hemoglobin, and elevated pre-ECMO lactate and pre-ECMO creatinine were independent risk factors for AKI stage 3 in patients receiving VA-ECMO. It is imperative to identify and adjust these risk factors to enhance outcomes for those supported by VA-ECMO.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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