Acute Kidney Injury in Adult Patients Receiving Extracorporeal Membrane Oxygenation: A Systematic Review

Abstract

Introduction. Acute kidney injury (AKI) is a frequent and 
clinically important complication in adults receiving extracorporeal 
membrane oxygenation (ECMO), yet reported incidence and 
associated outcomes vary widely due to differences in populations, 
ECMO configuration, and AKI definitions. We systematically 
reviewed full-text studies reporting AKI and related outcomes in 
adult patients supported with veno-arterial (VA) and/or veno
venous (VV) ECMO.
Methods. A systematic search of PubMed identified 661 records; 
660 remained after deduplication. Full texts available for assessment 
were screened for eligibility (n = 126). We included original adult 
ECMO/ECLS studies reporting extractable AKI and/or renal 
replacement therapy (RRT/CRRT) outcomes.
Results. Forty-five studies were included in qualitative synthesis. 
AKI incidence was extractable in 29 studies and ranged from 
2.3% to 89.0% (median 50.5%). RRT/CRRT use was extractable 
in 29 studies and ranged from 1.8% to 91.0% (median 53.3%). 
Mortality was extractable in 37 studies (ICU, in-hospital, or 30
day) and ranged from 6.0% to 95.0% (median 53.3%). KDIGO 
was the most frequently referenced AKI definition (reported in 
26 studies), followed by RIFLE (19) and AKIN (11), with overlap 
across studies.
Conclusions. AKI and RRT/CRRT use are common in adults 
receiving ECMO, with substantial variability driven by clinical 
heterogeneity and inconsistent AKI definitions and outcome 
reporting. Standardized AKI definitions and harmonized 
reporting of renal and mortality outcomes are needed to improve 
comparability and guide future ECMO–kidney research.