renal dysfunction is common in neonates on extra corporeal membrane oxygenation alexandra j.m....
TRANSCRIPT
![Page 1: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/1.jpg)
Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation
Alexandra J.M. Zwiers
Pediatric Nephrology & Intensive Care Erasmus MC - Sophia Children’s Hospital
Rotterdam, The Netherlands
![Page 2: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/2.jpg)
Erasmus MC – Sophia Children’s Hospital
Extra Corporeal Membrane Oxygenation (ECMO) facility since 1993
All age groups of children & diagnoses
Total number of ECMO runs > 460
Annual number of ECMO runs ± 35
![Page 3: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/3.jpg)
Rationale I
Decreased blood pressure
Insufficient tissue perfusion
Hypoxia/Ischemia
Nephrotoxic drugs
Incidence Acute Kidney Injury in critically ill infants ranges from
8% to 60%¹ ² ³
Incidence of renal dysfunction in ECMO patients..?
¹Andreoli et al. Pediatr Nephrol 2009 24:253-263
²Askenazi DJ et al. Pediatr Nephrol. 2009 24;265-274
³Akcan-Arikan A et al. Kidney Int. 2007 May;71(10):1028-35
Renal dysfunction
![Page 4: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/4.jpg)
Rationale II
Early detection of renal dysfunction has implications for the child’s
treatment in the short term
50% of the survivors of childhood Acute Kidney Injury on the ICU
have signs of Chronic Kidney Disease 3 to 5 years after the initial
event4
4Askenazi DJ et al. Kidney Int. 2006 Jan;69(1):184-9
![Page 5: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/5.jpg)
Aim of the study
To determine the incidence of renal dysfunction in neonates
treated with ECMO using two methods:
Maximal serum creatinine per patient during ECMO treatment
Mean serum creatinine level per patient by means of a Z-score
Compared with recently collected serum creatinine reference values in our
hospital.4
4Boer et al. Pediatr Nephrol 2010, In press
![Page 6: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/6.jpg)
Methods
All patients treated with ECMO before routine use of CVVH
Inclusion Criteria: Treated with ECMO in our center Age at start of ECMO max 30 days
Exclusion Criteria: Died within one week after ECMO Pre-existent renal anomalies
Statistics: Z-score, ANOVA
Clinical data from our patient data management system (PDMS) over a 6-
year period, from 1996 until 2002
![Page 7: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/7.jpg)
Results l
Patient characteristics (n=90)
Female/Male (n) 38/52 42% / 58%
Median Range
Age (days) 4.8 1.6 – 24.4
Weight (kg) 3.4 2.2 – 4.8
ECMO duration (days) 5.6 1.8 – 21.3
125 Neonates treated with ECMO of whom 90 survived (72%)
![Page 8: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/8.jpg)
Results ll
Primary Diagnosis
Patient characteristics (n=90)
Meconium Aspiration Syndrome* 46
Congenital Diaphragmatic Hernia* 15
Primary Persistent Pulmonary Hypertension 12
Sepsis 12
Pneumonia 3
Other 2
*Majority of the patients had severe Persistent Pulmonary Hypertension
![Page 9: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/9.jpg)
Results llI - Maximal level of creatinine
Forty patients (44%) showed at least one serum creatinine level
(median value 62 [10 -166]) above P97.5 for age
Median time of 43
hours [5 - 222 hours]
after start of ECMO
Compared with:
Serum creatinine
reference values4
4Boer et al. Pediatr Nephrol 2010, In press
![Page 10: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/10.jpg)
Results IV - Individual Z-scores of Creatinine
Z-scores are calculated, based on serum reference values4
Z-score:
Tells how the data-
point compares to
normal data
4Boer et al. Pediatr Nephrol 2010, In press
![Page 11: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/11.jpg)
Results V – ANOVA Serum Creatinine
Mixed Model ANOVA with 95% Confidence Interval
Z-score:
Mean Z-values
per ECMO day
![Page 12: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/12.jpg)
Results VII - Serum creatinine ≥ 2 SD
N=84 N=80 N=72 N=68 N=58 N=37 N=35 N=3N=17 N=14 N=12 N=8 N=3N=27
![Page 13: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/13.jpg)
Conclusion
Renal dysfunction is common in neonates
treated with ECMO!
![Page 14: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/14.jpg)
Limitations
Retrospective cohort study
Renal dysfunction is diagnosed by measuring serum
creatinine, which is not considered the golden standard
![Page 15: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/15.jpg)
Discussion
“Awareness” of renal dysfunction may result into rapid adjustment of dosage of drugs eliminated by the kidneys:
Studying Chronic Kidney Disease in children with renal dysfunction during ECMO treatment is indicated
To avoid accumulation
To avoid nephrotoxic drugs
![Page 16: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/16.jpg)
Acknowledgements
S.N. de Wildt¹, MD PhD
W.C.J. Hop², MSc PhD
K. Cransberg¹, MD PhD
D. Tibboel¹, MD PhD
¹Pediatric Nephrology & Intensive Care, ErasmusMC - Sophia Children’s Hospital
²Department of Biostatistics, ErasmusMC, Rotterdam, The Netherlands
Funding:
Sophia Foundation Scientific Research, Grant application number: 633
![Page 17: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/17.jpg)
![Page 18: Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC](https://reader038.vdocuments.mx/reader038/viewer/2022110303/5513f5bc55034646298b629c/html5/thumbnails/18.jpg)
Statistics lV
Mean Z-scores of all patients who have been treated with ECMO
Died during ECMO
Survived ECMO