Open Access Research article

Effect of acute kidney injury requiring extended dialysis on 28 day and 1 year survival of patients undergoing interventional lung assist membrane ventilator treatment

Jan T Kielstein1*, Soeren Tolk1, Carsten Hafer1, Anna Heiden1, Olaf Wiesner2, Christian Kühn3, Johannes Hadem4, Marius M Hoeper2 and Stefan Fischer3

Author Affiliations

1 Department Nephrology and Hypertension, Medical School Hannover, Germany

2 Department of Pulmonary Medicine, Medical School Hannover, Germany

3 Department of Cardiothoracic Surgery, Medical School Hannover, Germany

4 Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Germany

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BMC Nephrology 2011, 12:15  doi:10.1186/1471-2369-12-15

Published: 13 April 2011

Abstract

Background

Extracorporeal lung assist devices are increasingly used in the intensive care unit setting to improve extracorporeal gas exchange mainly in patients with acute respiratory distress syndrome. ARDS is frequently accompanied by acute kidney injury; however it is so far unknown how the combination of these two conditions affects long term survival of critically ill patients.

Methods

In a retrospective analysis of a tertiary care hospital we evaluated all patients undergoing interventional lung assist (iLA) treatment between January 1st 2005 and December 31st 2009. Data from all 61 patients (31 F/30 M), median age 40 (28 to 52) years were obtained by chart review. Follow up data up to one year were obtained.

Results

Of the 61 patients undergoing iLA membrane ventilator treatment 21 patients had acute kidney injury network (AKIN) stage 3 and were treated by extended dialysis (ED). Twenty-eight day survival of all patients was 33%. While patients without ED showed a 28 day survival of 40%, the survival of patients with ED was only 19%. Patients on ED were not different in respect to age, weight, Horowitz index and underlying disease.

Conclusions

AKI requiring ED therapy in patients undergoing iLA treatment increases mortality in ICU patients. Patients in whom iLA was placed as a bridge to lung transplantation and that were successfully transplanted showed the best outcome. Future studies have to clarify whether it is possible to identify patients that truly benefit from the combination of these two extracorporeal treatment methods.