Epidemiology, Risk Factors, and Outcomes of AKI and CRRT in Patients on ECMO: Workgroup Statements from the Joint ADQI and ELSO Consensus Conference on ECMO, AKI, Fluid Management, and CRRT
12 affiliations
- 1Division of Nephrology and Hypertension, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- 2Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- 3Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
- 4Department of Critical Care, King’s College London, Guy’s & St. Thomas’ Hospital, London, UK
- 5Department of Medicine, University of California, San Diego, San Diego, CA, USA
- 6Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
- 7Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
- 8Cardiothoracic Intensive Care Unit, National University Hospital, Singapore, Singapore
- 9Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- 10Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- 11Department of Surgery, Division of Cardiac Surgery, Faculty of Medicine and Dentistry, University of Alberta, Mazankowski Alberta Heart Institute, Alberta Health Services, Edmonton, AB, Canada
- 12Department of Pediatrics, Sidra Medicine, Doha, Qatar
Abstract
Background: Extracorporeal life support (ECLS), most commonly delivered as extracorporeal membrane oxygenation (ECMO), is a lifesaving therapy for refractory cardiac and respiratory failure. Acute kidney injury (AKI) is among the most frequent complications associated with ECMO, occurring in 40–80% of patients, with approximately 40–50% receiving continuous renal replacement therapy (CRRT). AKI in this setting is multifactorial, reflecting pre-ECMO shock or hemodynamic instability, systemic inflammation, hemolysis, venous congestion, nonpulsatile flow, nephrotoxic exposure, and fluid overload. Both AKI and CRRT among patients receiving ECMO are independently associated with increased mortality, prolonged duration of support, and long-term risk of chronic kidney disease (CKD).
Summary: This review was developed in pursuit of the 36th Acute Disease Quality Initiative (ADQI XXXVI) consensus conference, during which international experts in nephrology, critical care, cardiology, perfusion, and extracorporeal support convened to evaluate current evidence and generate consensus statements regarding the epidemiology, prevention, and management of AKI in patients receiving ECLS. The conference emphasized harmonization of definitions, identification of modifiable risk factors, optimization of CRRT strategies, and prioritization of future research directions. We highlight key epidemiologic patterns, mechanistic drivers, CRRT utilization, short- and long-term outcomes, and research priorities.
Key Messages: Particular attention is given to the need for standardized definitions, prospective multicenter trials, biomarker validation, and integration of nephrology expertise into ECMO programs to improve kidney-related outcomes in this high-risk population.
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BibTeX
@article{kashani2026epidemiology,
title = {{Epidemiology, Risk Factors, and Outcomes of AKI and CRRT in Patients on ECMO: Workgroup Statements from the Joint ADQI and ELSO Consensus Conference on ECMO, AKI, Fluid Management, and CRRT}},
author = {Kianoush Kashani and David T. Selewski and Katja M. Gist and Marlies Ostermann and Ravindra L. Mehta and Claudio Ronco and Sean M. Bagshaw and Graeme MacLaren and David J. Askenazi and Natalie E. Rintoul and Gurmeet Singh and Ahmad Kaddourah and on behalf of ADQI XXXVI authors},
journal = {Blood Purification},
year = {2026},
month = sep,
doi = {10.1159/bpu/abpag013},
url = {https://doi.org/10.1159/bpu/abpag013},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Epidemiology, Risk Factors, and Outcomes of AKI and CRRT in Patients on ECMO: Workgroup Statements from the Joint ADQI and ELSO Consensus Conference on ECMO, AKI, Fluid Management, and CRRT
AU - Kianoush Kashani
AU - David T. Selewski
AU - Katja M. Gist
AU - Marlies Ostermann
AU - Ravindra L. Mehta
AU - Claudio Ronco
AU - Sean M. Bagshaw
AU - Graeme MacLaren
AU - David J. Askenazi
AU - Natalie E. Rintoul
AU - Gurmeet Singh
AU - Ahmad Kaddourah
AU - on behalf of ADQI XXXVI authors
PY - 2026
DA - 2026/09/10
JO - Blood Purification
DO - 10.1159/bpu/abpag013
UR - https://doi.org/10.1159/bpu/abpag013
AB - Background: Extracorporeal life support (ECLS), most commonly delivered as extracorporeal membrane oxygenation (ECMO), is a lifesaving therapy for refractory cardiac and respiratory failure. Acute kidney injury (AKI) is among the most frequent complications associated with ECMO, occurring in 40–80% of patients, with approximately 40–50% receiving continuous renal replacement therapy (CRRT). AKI in this setting is multifactorial, reflecting pre-ECMO shock or hemodynamic instability, systemic inflammation, hemolysis, venous congestion, nonpulsatile flow, nephrotoxic exposure, and fluid overload. Both AKI and CRRT among patients receiving ECMO are independently associated with increased mortality, prolonged duration of support, and long-term risk of chronic kidney disease (CKD). Summary: This review was developed in pursuit of the 36th Acute Disease Quality Initiative (ADQI XXXVI) consensus conference, during which international experts in nephrology, critical care, cardiology, perfusion, and extracorporeal support convened to evaluate current evidence and generate consensus statements regarding the epidemiology, prevention, and management of AKI in patients receiving ECLS. The conference emphasized harmonization of definitions, identification of modifiable risk factors, optimization of CRRT strategies, and prioritization of future research directions. We highlight key epidemiologic patterns, mechanistic drivers, CRRT utilization, short- and long-term outcomes, and research priorities. Key Messages: Particular attention is given to the need for standardized definitions, prospective multicenter trials, biomarker validation, and integration of nephrology expertise into ECMO programs to improve kidney-related outcomes in this high-risk population.
SN - 0253-5068
SN - 1421-9735
ER -