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Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC.

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Presentation on theme: "Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC."— Presentation transcript:

1 Renal dysfunction is common in neonates on Extra Corporeal Membrane Oxygenation Alexandra J.M. Zwiers Pediatric Nephrology & Intensive Care Erasmus MC - Sophia Childrens Hospital Rotterdam, The Netherlands

2 Erasmus MC – Sophia Childrens Hospital Extra Corporeal Membrane Oxygenation (ECMO) facility since 1993 All age groups of children & diagnoses Total number of ECMO runs > 460 Annual number of ECMO runs ± 35

3 Rationale I Decreased blood pressure Insufficient tissue perfusion Hypoxia/Ischemia Nephrotoxic drugs Incidence Acute Kidney Injury in critically ill infants ranges from 8% to 60%¹ ² ³ Incidence of renal dysfunction in ECMO patients..? ¹Andreoli et al. Pediatr Nephrol 2009 24:253-263 ²Askenazi DJ et al. Pediatr Nephrol. 2009 24;265-274 ³Akcan-Arikan A et al. Kidney Int. 2007 May;71(10):1028-35 Renal dysfunction

4 Rationale II Early detection of renal dysfunction has implications for the childs treatment in the short term 50% of the survivors of childhood Acute Kidney Injury on the ICU have signs of Chronic Kidney Disease 3 to 5 years after the initial event 4 4 Askenazi DJ et al. Kidney Int. 2006 Jan;69(1):184-9

5 Aim of the study To determine the incidence of renal dysfunction in neonates treated with ECMO using two methods: Maximal serum creatinine per patient during ECMO treatment Mean serum creatinine level per patient by means of a Z-score Compared with recently collected serum creatinine reference values in our hospital. 4 4 Boer et al. Pediatr Nephrol 2010, In press

6 Methods All patients treated with ECMO before routine use of CVVH Inclusion Criteria: Treated with ECMO in our center Age at start of ECMO max 30 days Exclusion Criteria: Died within one week after ECMO Pre-existent renal anomalies Statistics: Z-score, ANOVA Clinical data from our patient data management system (PDMS) over a 6- year period, from 1996 until 2002

7 Results l Patient characteristics (n=90) Female/Male (n)38/52 42% / 58% MedianRange Age (days)4.81.6 – 24.4 Weight (kg)3.42.2 – 4.8 ECMO duration (days)5.6 1.8 – 21.3 125 Neonates treated with ECMO of whom 90 survived (72%)

8 Results ll Primary Diagnosis Patient characteristics (n=90) Meconium Aspiration Syndrome*46 Congenital Diaphragmatic Hernia*15 Primary Persistent Pulmonary Hypertension12 Sepsis12 Pneumonia3 Other2 *Majority of the patients had severe Persistent Pulmonary Hypertension

9 Results llI - Maximal level of creatinine Forty patients (44%) showed at least one serum creatinine level (median value 62 [10 -166]) above P97.5 for age Median time of 43 hours [5 - 222 hours] after start of ECMO Compared with: Serum creatinine reference values 4 4 Boer et al. Pediatr Nephrol 2010, In press

10 Results IV - Individual Z-scores of Creatinine Z-scores are calculated, based on serum reference values 4 Z-score: Tells how the data- point compares to normal data 4 Boer et al. Pediatr Nephrol 2010, In press

11 Results V – ANOVA Serum Creatinine Mixed Model ANOVA with 95% Confidence Interval Z-score: Mean Z-values per ECMO day

12 Results VII - Serum creatinine 2 SD N=84N=80N=72N=68N=58N=37N=35N=3N=17N=14N=12N=8N=3N=27

13 Conclusion Renal dysfunction is common in neonates treated with ECMO!

14 Limitations Retrospective cohort study Renal dysfunction is diagnosed by measuring serum creatinine, which is not considered the golden standard

15 Discussion Awareness of renal dysfunction may result into rapid adjustment of dosage of drugs eliminated by the kidneys: Studying Chronic Kidney Disease in children with renal dysfunction during ECMO treatment is indicated To avoid accumulation To avoid nephrotoxic drugs

16 Acknowledgements S.N. de Wildt¹, MD PhD W.C.J. Hop², MSc PhD K. Cransberg¹, MD PhD D. Tibboel¹, MD PhD ¹Pediatric Nephrology & Intensive Care, ErasmusMC - Sophia Childrens Hospital ²Department of Biostatistics, ErasmusMC, Rotterdam, The Netherlands Funding: Sophia Foundation Scientific Research, Grant application number: 633

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18 Statistics lV Mean Z-scores of all patients who have been treated with ECMO Died during ECMO Survived ECMO


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