End-stage Renal Disease and Long-term Survival Among Survivors of Extracorporeal Membrane Oxygenation

Abstract

We aimed to investigate the prevalence and associated factors of newly diagnosed end-stage renal disease (ESRD) requiring renal-replacement therapy (RRT) among survivors of extracorporeal membrane oxygenation (ECMO) and determine whether newly diagnosed ESRD is associated with poorer long-term survival outcomes. All adult patients who underwent ECMO between 2005 and 2018 were included, and ECMO survivors were those who survived more than 365 days after ECMO support. ECMO survivors with a history of pre-ECMO RRT were excluded. A total of 5,898 ECMO survivors were included in the analysis. At the 1-year post-ECMO follow-up, 447 patients (7.6%) were newly diagnosed with ESRD requiring RRT. Preexisting renal disease (odds ratio [OR]: 2.83), increased duration of continuous RRT during hospitalization (OR: 1.16), the cardiovascular group ( vs. respiratory group; OR: 1.78), and the postcardiac arrest group ( vs . respiratory group; OR: 2.52) were associated with newly diagnosed ESRD. Moreover, patients with newly diagnosed ESRD were associated with a 1.56-fold higher risk of 3-year all-cause mortality than those in the control group (hazard ratio: 1.56). At the 1-year post-ECMO follow-up, 7.6% of ECMO survivors were newly diagnosed with ESRD requiring RRT. Moreover, post-ECMO ESRD was associated with poorer long-term survival among ECMO survivors.