Acute kidney injury (AKI) in COVID-19 patients treated by Extracorporeal Membrane Oxygenation (ECMO)

Background: Acute kidney injury commonly occurs in patients with severe COVID-19 illness required treatment of ECMO, due to cytokine storm and vasodilatory shock. The extent of its occurrence, severity and methods of treatment are yet to be studied.

Objective: The main objective of this study is to determine the prevalence and significance of AKI in COVID-19 patients treated with ECMO as well as the efficacy of CRRT for survival rates in these patients.

Methods: We performed observational study in two Israeli hospitals, Sheba Medical Center and Baruch Padeh Medical Center between 3.2020 and 2.2021. Data from all Covid-19 patients treated with ECMO regarding kidney function and treatment as well as survival rates were analyzed.

Results: 56 COVID-19 patients treated with ECMO. Average age was 53±10. 43 patients (76%) were men. 18 patients (32%) survived. 33 patients (59%) experienced AKI staged 2-3 (AKI group) and 23 patient (41%) did not (non AKI group).

Pre ECMO: Differences between the groups were found in base Creatinine levels (1.03±0.58 AKI group, 0.63±0.25 non AKI group, P=0.001) and in Creatinine levels in 24 hours pre-ECMO (1.71±1.55 AKI group, 0.57±0.38 non AKI group, P=0.000). There were no other significant differences between the groups.

Post ECMO: In the AKI group 27 patients (82%) received CRRT while 4 patients (17%) in the non AKI group (P=0.00). 5 patients (15%) weaned from ECMO in the AKI group and 15 patients (52%) in the non AKI group (P=0.007). Mortality rate was 94% (31 patients) in the AKI group and 30% (7 patients) in the non AKI group (P=0.00).

Conclusions: AKI is a major risk factor and a predictor for mortality in COVID-19 patients on ECMO