Association of chronic kidney disease with in-hospital mortality of cardiogenic shock patients undergoing veno-arterial extracorporeal membrane oxygenation

Abstract

BACKGROUND

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) improves survival in patients with cardiogenic shock (CS), but data on chronic kidney disease (CKD) as a predictor of mortality in these patients is limited.

AIM

To assess the association between CKD and in-hospital mortality in CS patients undergoing VA-ECMO through a systematic review and meta-analysis.

METHODS

We reviewed studies up to February 2024 that evaluated CKD’s impact on in-hospital mortality in CS patients treated with extracorporeal membrane oxygenation. Databases included PubMed, Google Scholar, EMBASE, and Scopus. A random-effects model was used to calculate the pooled unadjusted odds ratio, I² statistics to determine heterogeneity, and leave-one-out sensitivity analysis to assess robustness, with P < 0.05 considered statistically significant.

RESULTS

Thirteen studies, involving 12185 CS patients treated with VA-ECMO (mean age 63, 68% males), were included. CKD was significantly associated with an increased in-hospital mortality (odds ratio = 1.89, 95% confidence interval: 1.4-2.55, P < 0.01). Leave-one-out analysis confirms robustness of the association between CKD and increased in-hospital mortality post-extracorporeal membrane oxygenation (I² = 75%). Despite substantial heterogeneity, the association remains significant, indicating that CKD is a critical risk factor in these patients.

CONCLUSION

CKD is strongly associated with an increased in-hospital mortality in CS patients treated with VA-ECMO. Despite study heterogeneity, this association remains robust, highlighting CKD as a critical prognostic factor.

Keywords: Cardiogenic shock; Veno-arterial extracorporeal membrane oxygenation; Chronic kidney disease; Renal dysfunction; In-hospital mortality; Outcomes

Core Tip: The impact of chronic kidney disease on in-hospital mortality of patients receiving veno-arterial extracorporeal membrane oxygenation for cardiogenic shock is assessed through our study. It emphasizes how chronic kidney disease, which is frequently present in critically ill patients as a pre-existing comorbidity, may be a significant prognostic factor influencing clinical outcomes. The study offers new insights by examining this relationship across diverse populations and clinical settings. The study provides new insights into patient selection, risk assessment, and future directions for veno-arterial extracorporeal membrane oxygenation care in this patient population.