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Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis

Background: Acute kidney injury (AKI) is a well-established complication of extra-corporal membrane oxygenation (ECMO) in the adult population. The data in the pediatric and neonatal population is still limited. Moreover, the mortality risk of AKI among pediatric patients requiring ECMO remains uncl...

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Autores principales: Hansrivijit, Panupong, Lertjitbanjong, Ploypin, Thongprayoon, Charat, Cheungpasitporn, Wisit, Aeddula, Narothama Reddy, Salim, Sohail Abdul, Chewcharat, Api, Watthanasuntorn, Kanramon, Srivali, Narat, Mao, Michael A., Ungprasert, Patompong, Wijarnpreecha, Karn, Kaewput, Wisit, Bathini, Tarun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963279/
https://www.ncbi.nlm.nih.gov/pubmed/31683968
http://dx.doi.org/10.3390/medicines6040109
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author Hansrivijit, Panupong
Lertjitbanjong, Ploypin
Thongprayoon, Charat
Cheungpasitporn, Wisit
Aeddula, Narothama Reddy
Salim, Sohail Abdul
Chewcharat, Api
Watthanasuntorn, Kanramon
Srivali, Narat
Mao, Michael A.
Ungprasert, Patompong
Wijarnpreecha, Karn
Kaewput, Wisit
Bathini, Tarun
author_facet Hansrivijit, Panupong
Lertjitbanjong, Ploypin
Thongprayoon, Charat
Cheungpasitporn, Wisit
Aeddula, Narothama Reddy
Salim, Sohail Abdul
Chewcharat, Api
Watthanasuntorn, Kanramon
Srivali, Narat
Mao, Michael A.
Ungprasert, Patompong
Wijarnpreecha, Karn
Kaewput, Wisit
Bathini, Tarun
author_sort Hansrivijit, Panupong
collection PubMed
description Background: Acute kidney injury (AKI) is a well-established complication of extra-corporal membrane oxygenation (ECMO) in the adult population. The data in the pediatric and neonatal population is still limited. Moreover, the mortality risk of AKI among pediatric patients requiring ECMO remains unclear. Thus, this meta-analysis aims to assess the incidence of AKI, AKI requiring renal replacement therapy and AKI associated mortality in pediatric/neonatal patients requiring ECMO. Methods: A literature search was performed utilizing MEDLINE, EMBASE, and the Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring renal replacement therapy (RRT) and the risk of mortality among pediatric patients on ECMO with AKI. Random-effects meta-analysis was used to calculate the pooled incidence of AKI and the odds ratios (OR) for mortality. Results: 13 studies with 3523 pediatric patients on ECMO were identified. Pooled incidence of AKI and AKI requiring RRT were 61.9% (95% confidence interval (CI): 39.0–80.4%) and 40.9% (95%CI: 31.2–51.4%), respectively. A meta-analysis limited to studies with standard AKI definitions showed a pooled estimated AKI incidence of 69.2% (95%CI: 59.7–77.3%). Compared with patients without AKI, those with AKI and AKI requiring RRT while on ECMO were associated with increased hospital mortality ORs of 1.70 (95% CI, 1.38–2.10) and 3.64 (95% CI: 2.02–6.55), respectively. Conclusions: The estimated incidence of AKI and severe AKI requiring RRT in pediatric patients receiving ECMO are high at 61.9% and 40.9%, respectively. AKI among pediatric patients on ECMO is significantly associated with reduced patient survival.
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spelling pubmed-69632792020-02-26 Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis Hansrivijit, Panupong Lertjitbanjong, Ploypin Thongprayoon, Charat Cheungpasitporn, Wisit Aeddula, Narothama Reddy Salim, Sohail Abdul Chewcharat, Api Watthanasuntorn, Kanramon Srivali, Narat Mao, Michael A. Ungprasert, Patompong Wijarnpreecha, Karn Kaewput, Wisit Bathini, Tarun Medicines (Basel) Article Background: Acute kidney injury (AKI) is a well-established complication of extra-corporal membrane oxygenation (ECMO) in the adult population. The data in the pediatric and neonatal population is still limited. Moreover, the mortality risk of AKI among pediatric patients requiring ECMO remains unclear. Thus, this meta-analysis aims to assess the incidence of AKI, AKI requiring renal replacement therapy and AKI associated mortality in pediatric/neonatal patients requiring ECMO. Methods: A literature search was performed utilizing MEDLINE, EMBASE, and the Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring renal replacement therapy (RRT) and the risk of mortality among pediatric patients on ECMO with AKI. Random-effects meta-analysis was used to calculate the pooled incidence of AKI and the odds ratios (OR) for mortality. Results: 13 studies with 3523 pediatric patients on ECMO were identified. Pooled incidence of AKI and AKI requiring RRT were 61.9% (95% confidence interval (CI): 39.0–80.4%) and 40.9% (95%CI: 31.2–51.4%), respectively. A meta-analysis limited to studies with standard AKI definitions showed a pooled estimated AKI incidence of 69.2% (95%CI: 59.7–77.3%). Compared with patients without AKI, those with AKI and AKI requiring RRT while on ECMO were associated with increased hospital mortality ORs of 1.70 (95% CI, 1.38–2.10) and 3.64 (95% CI: 2.02–6.55), respectively. Conclusions: The estimated incidence of AKI and severe AKI requiring RRT in pediatric patients receiving ECMO are high at 61.9% and 40.9%, respectively. AKI among pediatric patients on ECMO is significantly associated with reduced patient survival. MDPI 2019-11-01 /pmc/articles/PMC6963279/ /pubmed/31683968 http://dx.doi.org/10.3390/medicines6040109 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hansrivijit, Panupong
Lertjitbanjong, Ploypin
Thongprayoon, Charat
Cheungpasitporn, Wisit
Aeddula, Narothama Reddy
Salim, Sohail Abdul
Chewcharat, Api
Watthanasuntorn, Kanramon
Srivali, Narat
Mao, Michael A.
Ungprasert, Patompong
Wijarnpreecha, Karn
Kaewput, Wisit
Bathini, Tarun
Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis
title Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis
title_full Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis
title_fullStr Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis
title_full_unstemmed Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis
title_short Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis
title_sort acute kidney injury in pediatric patients on extracorporeal membrane oxygenation: a systematic review and meta-analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963279/
https://www.ncbi.nlm.nih.gov/pubmed/31683968
http://dx.doi.org/10.3390/medicines6040109
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