Factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation: retrospective cohort.
Filipe Utuari de Andrade Coelho, Barbara Gadioli, Flavia Fernandes Manfredi de Freitas and 1 others
PMID 37071796WHAT IT FOUND
Most ECMO patients developed acute kidney injury: 98 of 122.
Higher nursing workload at ICU admission, vasopressin use, and lower admission kidney filtration were associated with AKI. These were associations, not proven causes.
Key findings
01Of 122 patients, 98 (80.3%) developed acute kidney injury, and none had acute renal function impairment at admission.
02In multivariable analysis, vasopressin use, ICU admission Nursing Activities Score, and admission glomerular filtration rate were associated with acute kidney injury.
03Fluid overload was 41.8% versus 12.5% in patients with and without acute kidney injury, and fluid balance was 3320.0 ml versus 861.6 ml.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study looked back at records from one hospital, so it cannot prove cause and effect. The group without AKI was small (24 patients), which can make the adjusted estimates unstable. Nursing Activities Score may reflect how sick the patient was or how much care was needed, not nursing quality. Fluid balance, vasopressin use, and GFR were measured in a complex ICU population, so they may be markers of severity rather than independent causes. The study did not test an intervention, so it cannot tell nurses whether any action changes AKI risk. Baseline serum creatinine was taken as the first value on hospital admission, which may not represent the patient's usual kidney function.
The easy way to misread this
Do not conclude that reducing nursing workload, stopping vasopressin, or changing staffing will prevent acute kidney injury. This was a retrospective single-centre cohort, and the factors were associations, not proven causes.