Analysis of factors associated with the initiation of renal replacement therapy in patients on veno-arterial extracorporeal membrane oxygenation: a case–control study

Abstract Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a therapeutic strategy for refractory cardiogenic shock. However, it is associated with a high risk of complications, including acute kidney injury (AKI), which increases the need of renal replacement therapy (RRT) and is linked to worse clinical outcomes. Objective To identify clinical and biochemical factors independently associated with the initiation of renal replacement therapy (RRT) in adult patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods A retrospective case–control study that included patients who received VA-ECMO and were admitted to the intensive care unit between 2019 and 2023. The incidence of RRT, along with associated severity and mortality scores, was analyzed using multivariate analysis. Results A total of 279 patients were included, among whom 98 received VA-ECMO support. Of these, 26.5% required RRT, and the mortality rate was 57.7%. The majority of patients were male (62.2%), with a mean age of 45.3 years (SD ± 13.8). Factors associated with the need for RRT included the duration of mechanical ventilation (OR, 1.03; 95% CI, 1.00–1.06), history of hypothyroidism (OR, 4.05; 95% CI, 1.27–12.86), and elevated creatinine levels prior to ECMO initiation (OR, 1.54; 95% CI, 1.12–2.09). Additionally, the APACHE II score (OR, 1.04; 95% CI, 0.98–1.10) and renal angina index (OR, 5.29; 95% CI, 1.77–15.77) were predictors of mortality. Conclusions Patients undergoing VA-ECMO who require RRT have a high mortality risk. Associated factors include hypothyroidism, elevated creatinine levels before ECMO initiation, and a higher renal angina index. The early identification of these factors may facilitate the early detection of AKI risk and optimize clinical management. Clinical trial number Not applicable.