https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Regensburg Klinik und Poliklinik für Innere Med. II, Kardiologie Regensburg, Deutschland; 2Universitätsklinikum Regensburg Herz-, Thorax- und herznahe Gefäßchirurgie Regensburg, Deutschland; 3Universitätsklinikum Regensburg Regensburg, Deutschland
Background:
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) supports circulation in severe cardiogenic shock. Patients with V-A ECMO are very likely to suffer from secondary organ failure such as acute kidney injury (AKI). NT-proBNP is an established marker whose association with AKI has already been shown in patients with congestive heart failure
Aim:
The goal of the current study was to evaluate whether NT-proBNP correlates with an increased rate of acute kidney injury and with the necessity for renal replacement therapy (RRT) in patients with VA-ECMO.
Methods:
Prospective observational study in the university hospital Regensburg. Patients supported with V-A ECMO were recruited from 30.08.2022 to 11.09.2024. The serum-level of NT-proBNP was measured at the start of ECMO therapy. AKI was defined according to KDIGO criteria.
Results:
101 patients were included in the analysis (mean 57 years old, 71% male). Duration of V-A ECMO support was in median 5 days. 76 patients developed acute kidney injury. The 27 patients with the necessity for RRT showed significantly higher levels of NT-proBNP compared to patients with AKI and without RRT (p < 0.05). Both groups showed significantly higher levels of NT-proBNP compared to patients without AKI (12100 ng/l vs. 2850 ng/l vs 280 ng/l, each p = 0.001). Binary logarithmic regression analysis revealed the logarithm of NT-proBNP as the only independent and significant predictor for the occurrence of AKI (HR 3.24; 1.63-6.44; p < 0.001). Age, sex, the duration of ECMO therapy or the preexisting degree chronic kidney disease were no significant predictors. Regarding the occurrence of AKI with the necessity for RRT, the logarithm of NT-proBNP was also shown as an independent and statistically significant predictor (HR 2.59; 1.26-5.30; p=0.009) alongside the duration of ECMO therapy (HR 1.14; 1.04-1.24; p=0.005) in contrast to the degree of chronic kidney disease (p=n.s.).
Conclusion:
Patients with AKI and with AKI with the necessity for RRT during V-A ECMO showed significantly higher levels of NT-proBNP at the beginning of ECMO-therapy. This correlation might be an indication of a worsening in venous congestion causing a decrease in renal blood circulation. This finding could lead to nephroprotective strategies especially for this group. Further studies are required to confirm these findings.