National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease
Background: Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney dise...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-06-01
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| Series: | Surgery Open Science |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589845025000375 |
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| author | Oh Jin Kwon Esteban Aguayo Kevin Tabibian Jeffrey Balian Arjun Chaturvedi Dariush Yalzadeh Joseph Hadaya Yas Sanaiha Peyman Benharash |
| author_facet | Oh Jin Kwon Esteban Aguayo Kevin Tabibian Jeffrey Balian Arjun Chaturvedi Dariush Yalzadeh Joseph Hadaya Yas Sanaiha Peyman Benharash |
| author_sort | Oh Jin Kwon |
| collection | DOAJ |
| description | Background: Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established. Methods: A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019–2021 Nationwide Readmissions Database. Patients were stratified into non-CKD, CKD 1–2, and CKD 3–5 based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications. Results: Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as CKD 3–5. Following risk adjustment, CKD 3–5 was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10–1.59) and overall complications (AOR 1.72, 95%CI 1.09–2.72) compared to non-CKD. Additionally, both CKD 1–2 and CKD 3–5 were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, CKD 3–5 was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support. Conclusions: Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes. |
| format | Article |
| id | doaj-art-9549f3fb0d2e40d4b5791ee9a3c2b452 |
| institution | OA Journals |
| issn | 2589-8450 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery Open Science |
| spelling | doaj-art-9549f3fb0d2e40d4b5791ee9a3c2b4522025-08-20T02:07:31ZengElsevierSurgery Open Science2589-84502025-06-0126879310.1016/j.sopen.2025.04.011National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney DiseaseOh Jin Kwon0Esteban Aguayo1Kevin Tabibian2Jeffrey Balian3Arjun Chaturvedi4Dariush Yalzadeh5Joseph Hadaya6Yas Sanaiha7Peyman Benharash8Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of AmericaCardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of AmericaCardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of AmericaCardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of AmericaCardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of AmericaCardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of AmericaCardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of AmericaCardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of AmericaCardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Corresponding author at: UCLA Division of Cardiac Surgery, 64-249 Center for Health Sciences, Los Angeles, CA 90095, United States of America.Background: Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established. Methods: A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019–2021 Nationwide Readmissions Database. Patients were stratified into non-CKD, CKD 1–2, and CKD 3–5 based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications. Results: Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as CKD 3–5. Following risk adjustment, CKD 3–5 was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10–1.59) and overall complications (AOR 1.72, 95%CI 1.09–2.72) compared to non-CKD. Additionally, both CKD 1–2 and CKD 3–5 were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, CKD 3–5 was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support. Conclusions: Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes.http://www.sciencedirect.com/science/article/pii/S2589845025000375 |
| spellingShingle | Oh Jin Kwon Esteban Aguayo Kevin Tabibian Jeffrey Balian Arjun Chaturvedi Dariush Yalzadeh Joseph Hadaya Yas Sanaiha Peyman Benharash National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease Surgery Open Science |
| title | National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease |
| title_full | National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease |
| title_fullStr | National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease |
| title_full_unstemmed | National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease |
| title_short | National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease |
| title_sort | national outcomes of venoarterial extracorporeal life support in patients with chronic kidney disease |
| url | http://www.sciencedirect.com/science/article/pii/S2589845025000375 |
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