• Extracorporeal membrane oxygenation
• acute kidney injury
• kidney replacement therapy
• pathophysiology

• Humans
• Extracorporeal Membrane Oxygenation/methods
• Extracorporeal Membrane Oxygenation/adverse effects
• Acute Kidney Injury/therapy
• Acute Kidney Injury/physiopathology
• Acute Kidney Injury/etiology
• Renal Replacement Therapy/methods
• COVID-19/epidemiology
• COVID-19/therapy
• SARS-CoV-2
• Treatment Outcome

• acute kidney injury
• acute respiratory distress syndrome
• critical care
• extracorporeal membrane oxygenation
• renal replacement therapy

• Humans
• Male
• Female
• Renal Replacement Therapy/statistics & numerical data
• Renal Replacement Therapy/methods
• Renal Replacement Therapy/mortality
• Case-Control Studies
• Retrospective Studies
• Extracorporeal Membrane Oxygenation/adverse effects
• Extracorporeal Membrane Oxygenation/methods
• Middle Aged
• Acute Kidney Injury/therapy
• Acute Kidney Injury/etiology
• Acute Kidney Injury/mortality
• Risk Factors
• Intensive Care Units/statistics & numerical data
• Respiratory Distress Syndrome/therapy
• Respiratory Distress Syndrome/complications
• Respiratory Distress Syndrome/mortality
• Adult
• Aged
• Logistic Models

• Extracorporeal membrane oxygenation
• inflammation
• kidney injury
• methane
• oxidative stress
• renal artery flow

• Animals
• Extracorporeal Membrane Oxygenation/adverse effects
• Extracorporeal Membrane Oxygenation/methods
• Acute Kidney Injury/etiology
• Acute Kidney Injury/drug therapy
• Acute Kidney Injury/prevention & control
• Swine
• Disease Models, Animal
• Methane/administration & dosage
• Methane/therapeutic use
• Swine, Miniature
• Female
• Interleukin-1beta/blood
• Interleukin-8/blood

• cytokine storm
• immune dysfunction
• immune modulation
• immune paralysis
• multiple-organ dysfunction syndrome
• pediatric septic shock

• Global transplantation
• National transplant organizations
• Organ donation
• Organ transplantation
• Transplant systems

• Humans
• Intensive Care Units, Pediatric
• Child
• Consensus
• Europe
• Delphi Technique
• Hemofiltration/methods
• Hemofiltration/standards

• Antibiotics
• EBPTs
• Inflammatory mediators
• Inotropes
• Microcirculation
• Mortality
• Organ cross talking
• Phenotypes
• Propensity score
• Sepsis

• Humans
• Sepsis/therapy

• Acute renal injury
• continuous renal replacement therapy
• extracorporeal membrane oxygenation
• mortality
• non-surgical patient
• risk factors

• Humans
• Retrospective Studies
• Male
• Female
• Extracorporeal Membrane Oxygenation/mortality
• Hospital Mortality
• Middle Aged
• Risk Factors
• Continuous Renal Replacement Therapy
• Nomograms
• Adult
• Aged
• ROC Curve
• Prognosis
• Acute Kidney Injury/therapy
• Acute Kidney Injury/mortality
• Logistic Models
• Age Factors

• acute kidney injury
• haemodialysis
• inflammation
• plasma exchange
• sepsis

• Humans
• Consensus
• Acute Disease
• Hemoperfusion/methods

• Baxter
• Jafron Biomedical
• BBraun Avitum
• CytoSorbents
• ExThera Medical
• Nipro Corporation
• SeaStar Medical
• Spectral
• Sphongo Tec
• Toray Medical Co

• Humans
• COVID-19/mortality
• COVID-19/complications
• COVID-19/therapy
• Male
• Female
• Acute Kidney Injury/mortality
• Acute Kidney Injury/therapy
• Acute Kidney Injury/etiology
• Middle Aged
• Aged
• Retrospective Studies
• Hospital Mortality
• Renal Replacement Therapy
• SARS-CoV-2/isolation & purification
• Creatinine/blood
• Time Factors
• Intensive Care Units
• Adult

• Fundação de Amparo à Pesquisa do Estado de São Paulo
• Brazilian Conselho Nacional de Desenvolvimento Científico e Tecnológico (National Council for Scientific and Technological Development

• Multiple organ dysfunction syndrome (MODS)
• Organ crosstalk
• Organ failure
• Sepsis

• Blood purification
• Extracorporeal organ support
• Heart-lung support
• Kidney-liver replacement therapy
• Multiple organ support therapy
• Native–artificial organ crosstalk

• Acute kidney injury
• ECMO
• Extracorporeal membrane oxygenation
• Renal replacement therapy

• Adult
• Humans
• Retrospective Studies
• Extracorporeal Membrane Oxygenation
• Acute Kidney Injury/therapy
• Outcome Assessment, Health Care
• Hospitals

• Bleeding
• Heparin
• Impella
• Major adverse cardiac and cerebrovascular events (MACCE)
• Percutaneous mechanical circulatory support

• Humans
• Heparin
• Anticoagulants
• Shock, Cardiogenic/diagnosis
• Cohort Studies
• Partial Thromboplastin Time
• Hemorrhage/chemically induced
• Hemorrhage/diagnosis
• Thromboembolism/chemically induced
• Retrospective Studies

• AKI
• ARDS
• ECMO
• KRT
• fluid overload
• kidney function

• Adult
• Humans
• Retrospective Studies
• Extracorporeal Membrane Oxygenation/adverse effects
• Creatinine
• Natriuresis
• Respiratory Distress Syndrome/etiology
• Kidney

• Acute kidney injury
• Continuous renal replacement therapy
• Extra corporeal membrane oxygenation

• Acute respiratory failure
• Gas exchange
• Lung protective ventilation
• V-V ECMO

• COVID-19
• acute kidney injury
• chronic kidney disease
• screening
• treatment

• Extracorporeal membrane oxygenation
• Mortality
• Renal complications
• Risk factors

• No. 2022YFC2504400 National Major Science and Technology Projects of China
• 82072155 National Natural Science Foundation of China
• 81971885 National Natural Science Foundation of China

• acute kidney injury
• cardiogenic shock
• veno-arterial extracorporeal life support

• extracorporeal blood purification therapy
• extracorporeal organ support
• multi-organ dysfunction
• renal replacement therapy
• sepsis

• Adsorption
• Cytokines
• Endotoxin
• Extracorporeal therapies
• Sepsis
• Septic shock
• Viral infection

• Humans
• Endotoxins
• Hemoperfusion/methods
• Polymyxin B/therapeutic use
• Sepsis/therapy
• Shock, Septic/therapy
• Extracorporeal Membrane Oxygenation

• Adult
• Humans
• Cardiopulmonary Resuscitation
• Retrospective Studies
• Heart Arrest/therapy
• Extracorporeal Membrane Oxygenation
• Nervous System Diseases/etiology

Coronavirus disease 2019 (COVID-19) is a highly infectious disease which emerged into a global pandemic. Although it primarily causes respiratory symptoms for affected patients, COVID-19 was shown to have multi-organ manifestations. Elevated liver enzymes appear to be commonly observed during the course of COVID-19, and there have been numerous reports of liver injury secondary to COVID-19 infection. It has been established that patients with pre-existing chronic liver disease (CLD) are more likely to have poorer outcomes following COVID-19 infection compared to those without CLD. Co-morbidities such as diabetes, hypertension, obesity, cardiovascular and chronic kidney disease frequently co-exist in individuals living with CLD, and a substantial population may also live with some degree of frailty. The mechanisms of how COVID-19 induces liver injury have been postulated. Hepatorenal syndrome (HRS) is the occurrence of kidney dysfunction in patients with severe CLD/fulminant liver failure in the absence of another identifiable cause, and is usually a marker of severe decompensated liver disease. Select reports of HRS following acute COVID-19 infection have been presented, although the risk factors and pathophysiological mechanisms leading to HRS in COVID-19 infection or following COVID-19 treatment remain largely unestablished due to the relative lack and novelty of published data. Evidence discussing the management of HRS in high-dependency care and intensive care contexts is only emerging. In this article, we provide an overview on the speculative pathophysiological mechanisms of COVID-19 induced HRS and propose strategies for clinical diagnosis and management to optimize outcomes in this scenario.

• COVID-19
• Hepatorenal syndrome
• Pathophysiology
• Clinical assessment
• Management
• Prognosis

• Humans
• Hepatorenal Syndrome/epidemiology
• Hepatorenal Syndrome/etiology
• Hepatorenal Syndrome/therapy
• COVID-19/complications
• Pandemics
• Liver Diseases/epidemiology
• Liver Diseases/therapy
• Liver Diseases/complications
• COVID-19 Drug Treatment

• acute kidney injury
• chronic kidney disease
• critical care nephrology
• extracorporeal blood purification
• patient safety
• risk management

Acute kidney injury (AKI) linked to coronavirus disease 2019 (COVID-19) has been identified in the course of the disease. AKI can be mild or severe and that is dependent on the presence of comorbidities and the severity of COVID-19. Among patients who had been hospitalized with COVID-19, some were admitted to intensive care unit. The etiology of AKI associated with COVID-19 is multifactorial. Prevention of severe AKI is the prime task in patients with COVID-19 that necessitates a battery of measurements and precautions in management. Patients with AKI who have needed dialysis are in an increased risk to develop chronic kidney disease (CKD) or a progression of their existing CKD. Kidney transplantation patients with COVID-19 are in need of special management to adjust the doses of immunosuppression drugs and corticosteroids to guard against graft rejection but not to suppress the immune system to place the patient at risk of developing a COVID-19 infection. Immunosuppression drugs and corticosteroids for patients who have had a kidney transplant has to be adjusted based on laboratory results and is individualized aiming at the protection of the transplanted from rejection.

• Acute kidney injury
• COVID-19
• SARS-CoV-2
• Kidney transplantation
• Dialysis
• Immunosuppressant
• Intensive care unit
• Mortality
• Cytokine storm

Veno-venous extracorporeal membrane oxygenation (vv-ECMO) can save lives in severe respiratory distress, but this innovative approach has serious side-effects and is accompanied by higher rates of iatrogenic morbidity. Our aims were, first, to establish a large animal model of vv-ECMO to study the pathomechanism of complications within a clinically relevant time frame and, second, to investigate renal reactions to increase the likelihood of identifying novel targets and to improve clinical outcomes of vv-ECMO-induced acute kidney injury (AKI).

Anesthetized Vietnamese miniature pigs were used. After cannulation of the right jugular and femoral veins, vv-ECMO was started and maintained for 24 hrs. In Group 1 (n = 6) ECMO was followed by a further 6-hr post-ECMO period, while (n = 6) cannulation was performed without ECMO in the control group, with observation maintained for 30 h. Systemic hemodynamics, blood gas values and hour diuresis were monitored. Renal artery flow (RAF) was measured in the post-ECMO period with an ultrasonic flowmeter. At the end of the experiments, renal tissue samples were taken for histology to measure myeloperoxidase (MPO) and xanthine oxidoreductase (XOR) activity and to examine mitochondrial function with high-resolution respirometry (HRR, Oroboros, Austria). Plasma and urine samples were collected every 6 hrs to determine neutrophil gelatinase-associated lipocalin (NGAL) concentrations.

During the post-ECMO period, RAF dropped (96.3 ± 21 vs. 223.6 ± 32 ml/min) and, similarly, hour diuresis was significantly lower as compared to the control group (3.25 ± 0.4 ml/h/kg vs. 4.83 ± 0.6 ml/h/kg). Renal histology demonstrated significant structural damage characteristic of ischemic injury in the tubular system. In the vv-ECMO group NGAL levels, rose significantly in both urine (4.24 ± 0.25 vs. 2.57 ± 0.26 ng/ml) and plasma samples (4.67 ± 0.1 vs. 3.22 ± 0.2 ng/ml), while tissue XOR (5.88 ± 0.8 vs. 2.57 ± 0.2 pmol/min/mg protein) and MPO (11.93 ± 2.5 vs. 4.34 ± 0.6 mU/mg protein) activity was elevated. HRR showed renal mitochondrial dysfunction, including a significant drop in complex-I-dependent oxidative capacity (174.93 ± 12.7 vs. 249 ± 30.07 pmol/s/ml).

Significantly decreased renal function with signs of structural damage and impaired mitochondrial function developed in the vv-ECMO group. The vv-ECMO-induced acute renal impairment in this 30-hr research protocol provides a good basis to study the pathomechanism, biomarker combinations or possible therapeutic possibilities for AKI.

• extracorporeal membrane oxygenation
• inflammation
• ischemia
• kidney injury
• mitochondrial function
• renal artery flow

End stage renal disease (ESRD) is a contraindication to isolated heart transplantation (HT). However, heart candidates with cardiogenic shock may experience acute kidney injury and require renal replacement therapy (RRT) and isolated HT as a life-saving operation. The outcomes, including survival and renal function, are rarely reported. We enrolled 569 patients undergoing isolated HT from 1989 to 2018. Among them, 66 patients required RRT before HT (34 transient and 32 persistent). The survival was worse in patients with RRT than those without (65.2% vs 84.7%; 27.3% vs 51.1% at 1- and 10-year, p < 0.001 and p = 0.012, respectively). Multivariate Cox analysis identified pre-transplant hyperbilirubinemia (Hazard ratio (HR) 2.534, 95% confidence interval (CI) 1.098–5.853, p = 0.029), post-transplant RRT (HR 5.551, 95%CI 1.280–24.068, p = 0.022) and post-transplant early bloodstream infection (HR 3.014, 95%CI 1.270–7.152, p = 0.012) as independent risk factors of 1-year mortality. The majority of operative survivors (98%) displayed renal recovery after HT. Although patients with persistent or transient RRT before HT had a similar long-term survival, patients with persistent RRT developed a high incidence (49.2%) of dialysis-dependent ESRD at 10 years. In transplant candidates with pretransplant RRT, hyperbilirubinemia should be carefully re-evaluated for the eligibility of HT whereas prevention and management of bloodstream infection after HT improve survival.

• acute kidney injury
• heart transplant
• long term survival
• renal failure
• renal replacement therapy

Multi‐organ failure characterized by acute kidney injury, liver dysfunction, and respiratory failure is a complex condition associated with high mortality, for which multiple individual support devices may be simultaneously required. This review aims to appraise the current evidence for the ADVanced Organ Support (ADVOS) system, a novel device integrating liver, lung, and kidney support with blood detoxification.

We performed a literature review of the PubMed database to identify human and animal studies evaluating the ADVOS system.

In porcine models of acute liver injury and small clinical studies in humans, ADVOS significantly enhanced the elimination of water‐soluble and protein‐bound toxins and metabolites, including creatinine, ammonia, blood urea nitrogen, and lactate. Cardiovascular parameters (mean arterial pressure, cerebral perfusion pressure, and cardiac index) and renal function were improved. ADVOS clears carbon dioxide (CO₂) effectively with rapid correction of pH abnormalities, achieving normalization of CO₂, and bicarbonate levels. In patients with COVID‐19 infection, ADVOS enables rapid correction of acid–base disturbance and respiratory acidosis. ADVOS therapy reduces mortality in multi‐organ failure and has been shown to be safe with minimal adverse events.

From the small observational studies analyzed, ADVOS demonstrates excellent detoxification of water‐soluble and protein‐bound substances. In particular, ADVOS permits the correction of metabolic and respiratory acidosis through the fluid‐based direct removal of acid and CO₂. ADVOS is associated with significant improvements in hemodynamic and biochemical parameters, a trend toward improved survival in multi‐organ failure, and is well‐tolerated. Larger randomized trials are now necessary to further validate these encouraging results.

• ADVanced Organ Support
• albumin dialysis
• extracorporeal organ support
• multiple organ failure
• multiple organ support

• AKI
• CAVH
• CRRT
• CRRT machine
• CRRT membranes
• CVVH
• CVVHD
• acute dialysis
• precision CRRT
• ultrafiltration

• CPB
• ECC
• ECMO
• Lung transplantation

• acute kidney injury
• covid 19
• creatinine
• hemodialysis
• intensive care unit

Refractory cardiogenic shock (CS) often requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to sustain end-organ perfusion. Current animal models result in heterogenous cardiac injury and frequent episodes of refractory ventricular fibrillation. Thus, we aimed to develop an innovative, clinically relevant, and titratable model of severe cardiopulmonary failure. Six sheep (60 ± 6 kg) were anaesthetized and mechanically ventilated. VA-ECMO was commenced and CS was induced through intramyocardial injections of ethanol. Then, hypoxemic/hypercapnic pulmonary failure was achieved, through substantial decrease in ventilatory support. Echocardiography was used to compute left ventricular fractional area change (LVFAC) and cardiac Troponin I (cTnI) was quantified. After 5 h, the animals were euthanised and the heart was retrieved for histological evaluations. Ethanol (58 ± 23 mL) successfully induced CS in all animals. cTnI levels increased near 5000-fold. CS was confirmed by a drop in systolic blood pressure to 67 ± 14 mmHg, while lactate increased to 4.7 ± 0.9 mmol/L and LVFAC decreased to 16 ± 7%. Myocardial samples corroborated extensive cellular necrosis and inflammatory infiltrates. In conclusion, we present an innovative ovine model of severe cardiopulmonary failure in animals on VA-ECMO. This model could be essential to further characterize CS and develop future treatments.

To provide multivariable prognostic models for severe complications prediction after heart valve surgery, including low cardiac output syndrome (LCOS), acute kidney injury requiring hemodialysis (AKI-rH) and multiple organ dysfunction syndrome (MODS).

We developed multivariate logistic regression models to predict severe complications after heart valve surgery using 930 patients collected retrospectively from the first affiliated hospital of Sun Yat-Sen University from January 2014 to December 2015. The validation was conducted using a retrospective dataset of 713 patients from the same hospital from January 2016 to March 2017. We considered two kinds of prognostic models: the PRF models which were built by using the preoperative risk factors only, and the PIRF models which were built by using both of the preoperative and intraoperative risk factors. The least absolute shrinkage selector operator was used for developing the models. We assessed and compared the discriminative abilities for both of the PRF and PIRF models via the receiver operating characteristic (ROC) curve.

Compared with the PRF models, the PIRF modes selected additional intraoperative factors, such as auxiliary cardiopulmonary bypass time and combined tricuspid valve replacement. Area under the ROC curves (AUCs) of PRF models for predicting LCOS, AKI-rH and MODS are 0.565 (0.466, 0.664), 0.688 (0.62, 0.757) and 0.657 (0.563, 0.751), respectively. As a comparison, the AUCs of the PIRF models for predicting LOCS, AKI-rH and MODS are 0.821 (0.747, 0.896), 0.78 (0.717, 0.843) and 0.774 (0.7, 0.847), respectively.

Adding the intraoperative factors can increase the predictive power of the prognostic models for severe complications prediction after heart valve surgery.

• Acute kidney injury
• Heart valve surgery
• Low cardiac output syndrome
• Multiple organ dysfunction syndrome
• Multivariable prognostic model

• Acute Kidney Injury/etiology
• Critical Care/methods
• Extracorporeal Membrane Oxygenation/adverse effects
• Extracorporeal Membrane Oxygenation/methods
• Humans
• Risk Factors

• AKI
• VA ECMO
• VV ECMO
• mortality
• risk

Disturbed oxygenation is foremost the leading clinical presentation in COVID‐19 patients. However, a small proportion also develop carbon dioxide removal problems. The Advanced Organ Support (ADVOS) therapy (ADVITOS GmbH, Munich, Germany) uses a less invasive approach by combining extracorporeal CO₂‐removal and multiple organ support for the liver and the kidneys in a single hemodialysis device. The aim of our study is to evaluate the ADVOS system as treatment option in‐COVID‐19 patients with multi‐organ failure and carbon dioxide removal problems. COVID‐19 patients suffering from severe respiratory insufficiency, receiving at least two treatments with the ADVOS multi system (ADVITOS GmbH, Munich, Germany), were eligible for study inclusion. Briefly, these included patients with acute kidney injury (AKI) according to KDIGO guidelines, and moderate or severe ARDS according to the Berlin definition, who were on invasive mechanical ventilation for more than 72 hours. In total, nine COVID‐19 patients (137 ADVOS treatment sessions with a median of 10 treatments per patient) with moderate to severe ARDS and carbon dioxide removal problems were analyzed. During the ADVOS treatments, a rapid correction of acid‐base balance and a continuous CO₂ removal could be observed. We observed a median continuous CO₂ removal of 49.2 mL/min (IQR: 26.9‐72.3 mL/min) with some treatments achieving up to 160 mL/min. The CO₂ removal significantly correlated with blood flow (Pearson 0.421; P < .001), PaCO₂ (0.341, P < .001) and HCO3‐ levels (0.568, P < .001) at the start of the treatment. The continuous treatment led to a significant reduction in PaCO₂ from baseline to the last ADVOS treatment. In conclusion, it was feasible to remove CO₂ using the ADVOS system in our cohort of COVID‐19 patients with acute respiratory distress syndrome and multiorgan failure. This efficient removal of CO₂ was achieved at blood flows up to 300 mL/min using a conventional hemodialysis catheter and without a membrane lung or a gas phase.

• ADVOS
• ARDS
• COVID-19
• Extracorporeal CO2 removal (ECCO2R)
• Multiple organ support

Acute kidney injury (AKI) is a commonly recognized complication after lung transplantation (LT) and is related to increased mortality and morbidity. With the improvement of survival after LT and the increasing number of lung transplant recipients, the detrimental impact of current management on renal function has become increasingly apparent. Multifarious risk factors in the perioperative setting contribute to the development of AKI, including the preoperative status and complications of the recipient, complex perioperative problems especially hemodynamic fluctuation, and exposure to nephrotoxic agents, mainly calcineurin inhibitors (CNIs) and antimicrobial drugs. Identification and minimization of the effects of these risk factors can relieve AKI severity and incidence in high-risk patients. Close monitoring of urine output and serum creatinine (sCr) levels and of specific biomarkers may promote early recognition of AKI and rapid nephrology intervention to improve outcomes. This review summarizes advances in the epidemiology, diagnostic criteria, biological markers of AKI, and further recommends appropriate treatment strategies for the long-term management of AKI related manifestations in lung transplant recipients. Future work will need to focus on developing more accurate measures of renal function and identifying patients before the occurrence of early renal damage. Combining renal protection strategies with the use of new biomarkers to develop early kidney risk identification and protection protocols is a promising idea that requires further investigation.

• Acute kidney injury (AKI)
• impact and management
• incidence
• lung transplantation (LT)
• risk factors