Observational studyPediatric nephrology (Berlin, Germany)2020
Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy: a multicenter retrospective cohort study.
Observational study in Pediatric nephrology (Berlin, Germany), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 1 synthesis or guideline pooled it, 83 citations in OpenAlex.
- Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy: a systematic review of the past decade (2014-2023).BMC anesthesiology · 2025Pooled it
- Fluid accumulation and outcomes in children receiving continuous kidney replacement therapy: an appraisal of the WE-ROCK registry.Pediatric nephrology (Berlin, Germany) · 2026Article
- Extracorporeal membrane oxygenation, acute kidney injury, fluid balance, and continuous renal replacement therapy: Acute Disease Quality Initiative (ADQI) and Extracorporeal Life Support Organization (ELSO) joint consensus conference.Intensive care medicine · 2026Article
- Beyond prescriptions: why fluid bias, survivorship, and modality shifts undermine neonatal CKRT nutrition guidelines.Pediatric nephrology (Berlin, Germany) · 2026Article
- Clinical Profile and Survival Outcomes of Children with Acute Kidney Injury Requiring Renal Replacement Therapy: A Retrospective Study from a Tertiary Pediatric Intensive Care Unit.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026Article
- Korean Society of Nephrology 2025 Evidence-Based Clinical Practice Guideline for Continuous Kidney Replacement Therapy.Electrolyte & blood pressure : E & BP · 2026Review
- Korean Society of Nephrology 2025 evidence-based clinical practice guideline for continuous kidney replacement therapy.Kidney research and clinical practice · 2026Article
- Bridging evidence and practice: implementation science and bundled care strategies for fluid management in critically ill neonates.Frontiers in medicine · 2026Article
- Comparison of the approaches to combine Renal Replacement Therapy with Extracorporeal Membrane Oxygenation - a Scoping Review.Annals of intensive care · 2026Review
- Kidney replacement therapy during extracorporeal membrane oxygenation: pathophysiology, technical considerations, and outcomes.Renal failure · 2025Review
- Enhancing outcomes in pediatric populations with continuous renal replacement therapy: Current multidisciplinary strategies and innovations.Journal of intensive medicine · 2025Review
- Concurrent use of continuous kidney replacement therapy during extracorporeal membrane oxygenation: what pediatric nephrologists need to know-PCRRT-ICONIC practice points.Pediatric nephrology (Berlin, Germany) · 2025Review
- Research progress on the pathogenesis of AKI complicated by ECMO.Clinical and experimental nephrology · 2025Review
- Acute kidney injury and cardiogenic shock severity for mortality risk stratification in patients supported with VA ECMO.ESC heart failure · 2024Article
- Nutritional Intake in Venovenous ECMO Patients: A Single-Center Study in a North American PICU.Nutrients · 2024Article
- An update on the role of fluid overload in the prediction of outcome in acute kidney injury.Pediatric nephrology (Berlin, Germany) · 2024Review
- Quantifying potential fluid transfused through pressure monitoring and circuit flushes in pediatric ECMO patients.The journal of extra-corporeal technology · 2024Article
- Uplift modeling to predict individual treatment effects of renal replacement therapy in sepsis-associated acute kidney injury patients.Scientific reports · 2024Article
- Impact of the first 24 h of continuous kidney replacement therapy on hemodynamics, ventilation, and analgo-sedation in critically ill children.Pediatric nephrology (Berlin, Germany) · 2024Article
- Fluid assessment, fluid balance, and fluid overload in sick children: a report from the Pediatric Acute Disease Quality Initiative (ADQI) conference.Pediatric nephrology (Berlin, Germany) · 2024Article
Corrections and comments
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Authors and funding
15 authors at 9 institutions in 2 countries.
Funding
Abstract
objectiveThe aim of this study was to characterize continuous renal replacement therapy (CRRT) utilization on extracorporeal membrane oxygenation (ECMO) and to determine the association of both fluid overload (FO) at CRRT initiation and fluid removal during CRRT with mortality in a large multicenter cohort.
methodsRetrospective chart review of all children < 18 years of age concurrently treated with ECMO and CRRT from January 1, 2007, to December 31, 2011, at six tertiary care children's hospital. Children treated with hemodialysis or peritoneal dialysis were excluded from the FO analysis. MEASUREMENTS AND MAIN
resultsA total of 756 of the 1009 children supported with ECMO during the study period had complete FO data. Of these, 357 (47.2%) received either CRRT or were treated with an in-line filter and thus entered into the final analysis. Survival to ECMO decannulation was 66.4% and survival to hospital discharge was 44.3%. CRRT initiation occurred at median of 1 day (IQR 0, 2) after ECMO initiation. Median FO at CRRT initiation was 20.1% (IQR 5, 40) and was significantly lower in ECMO survivors vs. non-survivors (15.3% vs. 30.5% p = 0.005) and in hospital survivors vs. non-survivors (13.5% vs. 25.9%, p = 0.004). Median FO at CRRT discontinuation was significantly lower in ECMO survivors (23% vs. 37.6% p = 0.002) and hospital survivors vs. non-survivors (22.6% vs. 36.1%, p = 0.002). In ECMO survivors, after adjusting for pH at CRRT initiation, non-renal complications, ECMO mode, support type, center, patient age and AKI, FO at CRRT initiation (p = 0.01), and FO at CRRT discontinuation (p = 0.0002) were independently associated with duration of ECMO. In a similar multivariable analysis, FO at CRRT initiation (adjusted adds ratio [aOR] 1.09, 95% CI 1.00-1.18, p = 0.045) and at CRRT discontinuation (aOR 1.11, 95% CI 1.03-1.19, p = 0.01) were independently associated with hospital mortality.
conclusionsIn a multicenter pediatric ECMO cohort, this study demonstrates that severe FO was very common at CRRT initiation. We found an independent association between the degree of FO at CRRT initiation with adverse outcomes including mortality and increased duration of ECMO support. The results suggest that intervening prior to the development of significant FO may be a clinical therapeutic target and warrants further evaluation.
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