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Background <p>Acute kidney injury (AKI) is common in children treated with extracorporeal membrane oxygenation (ECMO) and is associated with increased morbidity and mortality. AKI may also increase the risk of long-term chronic kidney disease (CKD) and persistent kidney dysfunction. Hospital discharge kidney dysfunction (HDKD) or the need for antihypertensive medication may further be associated with long-term CKD risk. This study aims to determine, in children treated with ECMO, the prevalence of HDKD and the use of antihypertensive medication at hospital discharge, as well as their associations with AKI during ECMO.</p> Methods <p>Retrospective cohort study, including 6 pediatric centers. Children on ECMO between 2007–2011 (“KIDMO” cohort) surviving hospital discharge.</p> Results <p>354 children included, median age 25&#xa0;days ([IQR] 2–457); ECMO mode: 61.2% veno-arterial (VA), 38.8% veno-venous (VV); ECMO indication: pulmonary (62.1%), cardiac (20.9%), extracorporeal cardiopulmonary resuscitation (ECPR) (17%). AKI occurred in 66.1%; 53.4% had ≥ Stage 2 AKI, including kidney support therapy (KST) and 35% received KST. 12.1% had HDKD and 33.2% were treated with anti-hypertensive medication at discharge. In patients with HDKD or treatment with anti-hypertensive medication, AKI was more frequent (HDKD: <i>p</i> &lt; 0.0001; anti-hypertensive medication: <i>p</i> &lt; 0.0001). In multivariable analysis, AKI and pediatric (<i>vs.</i> neonatal) age were associated with HDKD; cardiac or ECPR indication for ECMO and older age were associated with the need for anti-hypertensive medication at discharge.</p> Conclusions <p>HDKD and anti-hypertensive medication at hospital discharge are common in pediatric ECMO survivors and associated with AKI. AKI is a known risk for long-term CKD and hypertension; systematic kidney health follow-up should be considered in these children.</p> Graphical abstract <p></p>

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Kidney and blood pressure sequelae after pediatric extracorporeal membrane oxygenation: a secondary analysis of the Kidney Injury During Membrane Oxygenation pediatric ECMO cohort

  • 期刊论文

  • 发表日期：

    2026年1月21日

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  • Stephanie Reynaud,
  • Jennifer G. Jetton,
  • Rashmi D. Sahay,
  • David T. Selewski,
  • David J. Askenazi,
  • Heidi J. Steflik,
  • Brian C. Bridges,
  • David S. Cooper,
  • Matthew L. Paden,
  • Rajit K. Basu,
  • Stephen M. Gorga,
  • Eileen King,
  • Katja M. Gist

摘要

Background

Acute kidney injury (AKI) is common in children treated with extracorporeal membrane oxygenation (ECMO) and is associated with increased morbidity and mortality. AKI may also increase the risk of long-term chronic kidney disease (CKD) and persistent kidney dysfunction. Hospital discharge kidney dysfunction (HDKD) or the need for antihypertensive medication may further be associated with long-term CKD risk. This study aims to determine, in children treated with ECMO, the prevalence of HDKD and the use of antihypertensive medication at hospital discharge, as well as their associations with AKI during ECMO.

Methods

Retrospective cohort study, including 6 pediatric centers. Children on ECMO between 2007–2011 (“KIDMO” cohort) surviving hospital discharge.

Results

354 children included, median age 25 days ([IQR] 2–457); ECMO mode: 61.2% veno-arterial (VA), 38.8% veno-venous (VV); ECMO indication: pulmonary (62.1%), cardiac (20.9%), extracorporeal cardiopulmonary resuscitation (ECPR) (17%). AKI occurred in 66.1%; 53.4% had ≥ Stage 2 AKI, including kidney support therapy (KST) and 35% received KST. 12.1% had HDKD and 33.2% were treated with anti-hypertensive medication at discharge. In patients with HDKD or treatment with anti-hypertensive medication, AKI was more frequent (HDKD: p < 0.0001; anti-hypertensive medication: p < 0.0001). In multivariable analysis, AKI and pediatric (vs. neonatal) age were associated with HDKD; cardiac or ECPR indication for ECMO and older age were associated with the need for anti-hypertensive medication at discharge.

Conclusions

HDKD and anti-hypertensive medication at hospital discharge are common in pediatric ECMO survivors and associated with AKI. AKI is a known risk for long-term CKD and hypertension; systematic kidney health follow-up should be considered in these children.

Graphical abstract