LAUSR

Introduction Acute kidney injury is common in patients with cardiogenic shock supported with extracorporeal membrane oxygenation (ECMO), and it is associated with mortality. Hypothesis We hypothesized that mortality is not different between patients who require early (within 48 hours) vs late (≥48 hours of ECMO) initiation of continuous renal replacement therapy (CRRT). Methods We retrospectively reviewed all patients with cardiogenic shock who underwent veno-arterial ECMO at University Hospitals, between 2015 and 2018. Patients who required CRRT during ECMO support were divided into early vs late CRRT initiation. Inpatient mortality, one-year mortality and length of stay were compared between the two patient groups. Results Out of 127 patients supported with ECMO, 56 (44%) required CRRT (40 early and 16 late CRRT). Among patients requiring CRRT, mean age was 57±14 years, 74% were male, median SAVE score was -9 [-14, -5], and median lactate was 7.6 [4.2, 12.4] mmol/L. There were no statistically-significant differences in baseline characteristics (demographics, comorbidities, laboratory values, or hemodynamic measurements) between early and late CRRT (P>0.05 for all comparisons). There were no statistically-significant differences between early and late CRRT with respect to inpatient mortality (62% vs 64%, P>0.99), 1-year mortality (78% vs 67%, P=0.71) or length of stay (median 20 vs 16 days, P=0.61). There was no association between time of CRRT and risk of inpatient mortality (OR 1.00, 95% CI: 0.88-1.15, P=0.95), or one-year mortality (HR 0.96, 9% CI: 0.89-1.05, P=0.39). Conclusions Mortality is high among patients who require CRRT during ECMO support. There was no difference between early (