Early continuous renal replacement therapy in cardiogenic shock patients with severe acute kidney injury undergoing extracorporeal membrane oxygenation

Background: Continuous renal replacement therapy (CRRT) may benefit patients requiring extracorporeal membrane oxygenation (ECMO). However, the clinical benefits and timing of CRRT have not been fully elucidated for these patients. Methods: This study was conducted retrospectively at the Taipei Medical University Hospital between January 2008 and December 2010. We included patients who had Acute Kidney Injury Network (AKIN) stage 3 disease at the initiation of ECMO and subsequently underwent CRRT. We excluded patients aged <18 years or those who were chronic dialysis patients. Early dialysis was defined as receiving CRRT <24 h after the initiation of ECMO. The primary outcome was mortality before weaning from ECMO. Results: The median age of the 15 patients included in the study was 72 years. The median interval between ECMO and CRRT was 16 h. No significant difference in survival was observed between the early- and late-dialysis patients (p = 0.58, log-rank test). However, a trend toward a shorter mean duration of ECMO therapy was observed in the early-dialysis patients (124 vs. 169 h, p = 0.16). The median follow-up glomerular filtration rate for the survivors was 38.9 ml/min/1.73 m². Conclusion: No survival benefit is conferred by the use of CRRT within 24 h after initiating ECMO in patients with severe acute kidney injury according to AKIN criteria.