Acute kidney injury in ECMO patients

Table 1 Risk factors for acute kidney injury (AKI) during extracorporeal membrane oxygenation (ECMO)

Factors	Pathophysiological mechanisms
Patient-related variables	Hypoperfusion Loss of autoregulation Hypoxia Hypercapnia Nephrotoxins Systemic inflammation Cardiorenal syndrome Increased intrathoracic pressure Increased intra-abdominal pressure Neuro-hormonal effects
IMV-related factors	Biotrauma
ECMO-related factors	PEEP
Hemodynamic variables	Continuous flow (VA-ECMO) Ischemia–reperfusion injury
Hormonal variables	RAAS dysregulation ANP downregulation
Circuit-related factors	Blood shear stress Rhabdomyolysis Hemolysis and oxidative stress Embolism Aortic dissection
Systemic inflammation	Systemic inflammation Renal macro/microcirculatory dysfunction Bioincompatibility Blood/air/surface interaction Hypercoagulable state

IMV invasive mechanical ventilation, PEEP positive end-expiratory pressure, VA veno-arterial, RAAS renin–angiotensin–aldosterone system, ANP atrial natriuretic peptide

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