• Aaron Wightman, Miranda C Bradford, Jordan Symons, and Thomas V Brogan.
• 1Division of Nephrology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2Children's Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA. 3Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 4Division of Nephrology, Seattle Children's Hospital, Seattle, WA. 5Division of Pediatric Critical Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 6Division of Critical Care, Seattle Children's Hospital, Seattle, WA.
• Pediatr Crit Care Me. 2015 Jul 1;16(6):576-82.

ObjectiveTo investigate the prevalence and survival to discharge of neonates with kidney disease who received extracorporeal life support.DesignWe analyzed the Extracorporeal Life Support Organization international registry of neonates (< 30 d old) who received extracorporeal life support from 1989 to 2012. We used International Classification of Diseases and Related Health Problems, 9th Revision, Clinical Modification, codes to identify neonates with kidney disease at time of cannulation for extracorporeal life support.SettingParticipating Extracorporeal Life Support Organization centers.PatientsAll neonates who received extracorporeal life support at an Extracorporeal Life Support Organization center from 1989 to 2012.InterventionsWe performed bivariate logistic regression to estimate associations between survival and covariates. We used unadjusted and adjusted logistic regression to compare survival to discharge between neonates with and without kidney disease. Odds ratios were estimated separately for three groups based on extracorporeal life support indication: pulmonary indication without congenital diaphragmatic hernia, pulmonary indication with congenital diaphragmatic hernia, and cardiac indication. Adjusted models included covariates identified as significant in bivariate models for each group.Measurements And Main ResultsThe primary outcome measure was survival to discharge from hospitalization. Of the 28,755 neonates who received extracorporeal life support, 405 had kidney disease (extracorporeal life support indication: 210 pulmonary indication without congenital diaphragmatic hernia, 65 pulmonary indication with congenital diaphragmatic hernia, and 130 cardiac indication). Survival was lower in neonates with kidney disease than those without (49% vs 82% pulmonary indication without congenital diaphragmatic hernia, 25% vs 51% pulmonary indication with congenital diaphragmatic hernia, 21% vs 41% cardiac indication). Kidney disease was associated with reduced survival in adjusted models (95% CI for odds ratio 0.31-0.59 pulmonary indication without congenital diaphragmatic hernia, 0.27-0.89 pulmonary indication with congenital diaphragmatic hernia, 0.31-0.77 cardiac indication).ConclusionsNeonates with kidney disease who receive extracorporeal life support have poorer survival to discharge compared with other neonates who receive extracorporeal life support, suggesting that kidney disease should be considered when making extracorporeal life support initiation decisions.

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