J Extra Corpor Technol 2025 , 57 , 14 – 17 Ó The Author ( s ), published by EDP Sciences , 2025 https :// doi . org / 10.1051 / ject / 2024041
Available online at : ject . edpsciences . org
ORIGINAL ARTICLE
Limiting the gamble : Risk and predictability for renal replacement therapy in patients receiving mechanical circulatory support w
Kelsey Gore ( MA , BSRT , RRT ) 1 ,* , Dean Linder Jr . ( CCP , LP ) 1 , Juan José Martinez Duque ( MD ) 2 , Junxi Wang ( BS ) 3 , Brett Wester ( DO ) 4 , Tiffany Otero ( MD ) 4 , Shaun Yockelson ( MD ) 4 , Adrian Alexis Ruiz ( MD ) 4 , and Bobby D . Nossaman ( MD ) 4
1 Department of Cardiovascular Perfusion and Extracorporeal Technology , Ochsner Health , 1514 Jefferson Highway , New Orleans , Louisiana 70121 , USA 2 CES University , Cl 10A # 22-04 , El Poblado , Medellin , Antioquia , Columbia 3 The University of Queensland Medical School , 288 Herston Road , Herston , QLD 4006 , Australia 4 Critical Care Section , Anesthesiology & Perioperative Medicine , Ochsner Health , 1514 Jefferson Highway , New Orleans ,
Louisiana 70121 , USA Received 22 April 2024 , Accepted 13 December 2024
Abstract – Background : Patients receiving mechanical circulatory support ( MCS ) frequently require renal replacement therapy ( RRT ). Examining risk factors for requiring RRT in patients receiving MCS may allow improved understanding of these comorbidities and enhance patient outcomes . Methods : Following IRB approval , patient characteristics , comorbidities , and the need for RRT were studied in 129 patients who received MCS from January 2017 to October 2023 . The clinical variables underwent machine learning to examine their relationships to the outcome of interest , the need for RRT . Results : In this study , the incidence of RRT was 36 % with a 95 % confidence interval ranging from 29 % to 44 %. Following machine learning , patients with a history of immunologic therapy or having a pacemaker or internal cardiac defibrillator ( ICD ) were associated with the need for RRT ( v 2 = 44 , P = 0.0003 ). The c-index statistic for this model was 0.81 . The anticoagulation therapy administered in these two groups was also analyzed . Patients in these two groups receiving unfractionated heparin were observed to have a higher incidence ( 44 %) in the need for RRT . Conclusion : The incidence of RRT was high in this patient population . The novel associations in patients requiring MCS who have received prior immunologic therapy or have pre-existing pacemaker / ICDs suggest that an increased systemic inflammatory state exists that escalates the need for RRT . Unfractionated heparin appears to provide minimal protection from the need for RRT in patients requiring MCS . These findings suggest that other options for systemic anticoagulation in patients requiring MCS should be considered . Further investigation into how these background inflammatory conditions contribute to the need for RRT in patients requiring MCS is warranted .
Key words : Extracorporeal membrane oxygenation ( ECMO ), Renal replacement therapy ( RRT ), Mechanical circulatory support ( MCS ), Anticoagulation , Inflammation .
Introduction
Cardiopulmonary shock contributes to the development of end-organ hypoperfusion [ 1 ]. Although the therapy for this type of shock includes the administration of intravenous vasoactive medications , percutaneous coronary artery interventions , and / or mechanical ventilation , patients who continue to deteriorate may require mechanical circulatory support ( MCS ) [ 2 ]. MCS
w Presented at the Annual Meeting of the American Society of
Extracorporeal Technology , New Orleans , Louisiana , March 2024 * Corresponding author : kelsey . gore @ ochsner . org swiftly augments tissue perfusion and assists to normalize the pathophysiology observed in these conditions [ 2 ].
Although the reperfusion of tissues with MCS is beneficial , this therapy risks development of reperfusion injury due to the prior hypoperfusion period as well as due to further development of reactive oxygen / nitrogen species , cytokines release , and hyperinflammatory responses exacerbating tissue injury [ 2 , 3 ]. Acute kidney injury frequently develops in patients requiring MCS [ 3 – 5 ]. However , the etiologies for the need of RRT during MCS are unclear [ 6 , 7 ]. The purpose of this investigation was to examine the association of patient comorbidities receiving MCS with the need for RRT .
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