Background: No study has specifically investigated the duration of continuous renal replacement therapy (CRRT) in\npatients who experienced acute kidney injury during extracorporeal membrane oxygenation (ECMO) support.\nHowever, there are concerns that prolonged CRRT may be futile.\nMethods: We conducted a retrospective population-based cohort study using Taiwan National Health Insurance\nResearch Database data collected between January 1, 2007 and December 31, 2013. Patients who received ECMO\nand CRRT during the study period were included. We divided patients into three groups based on the duration of\nCRRT received: less than equal to 3 days, 4-6 days, and Greater than equal to 7 days. The outcomes were all-cause mortality, end-stage renal disease,\nventilator dependency, and readmission rate.\nResults: There were 247, 134 and 187 patients who survived the hospitalization in the CRRT for less than equal to3 days, 4-6 days\nand > 7 days respectively. Survival after discharge did not differ significantly between CRRT for 4-6 days vs. less than equal to 3 days\n(adjusted hazard ratio [aHR] 1.16, 95% confidence interval [CI] 0.85-1.57), between CRRT for > 7 days vs. less than equal to 3 days\n(aHR 1.001, 95% CI 0.73-1.38) and between CRRT for > 7 days vs. 4-6 days (aHR 0.87, 95% CI 0.62-1.22). The patients\nwho received CRRT for Greater than equal to7 days had a higher risk of ESRD than did those who received CRRT for less than equal to3 days (adjusted\nhazard ratio [aHR] 3.46, 95% confidence interval [CI] 1.47-8.14) and for 4-6 days (aHR 3.10, 95% CI 1.03-9.29). The\nincidence of ventilator dependence was higher in the patients with CRRT Greater than equal to7 days than in those with less than equal to3 days (aHR\n2.45, 95% CI 1.32-4.54). The CRRT Greater than equal to7 days group also exhibited a higher readmission rate than did the 4-6 days\nand less than equal to 3 days groups (aHR 1.43, 95% CI 1.04-1.96 and aHR 1.67, 95% CI 1.13-2.47, respectively).\nConclusions: Our study found similar long-term survival but increased ESRD and ventilator dependency among\nECMO patients who underwent CRRT for Greater than equal to7 days. These results offer reason to be concerned that this aggressive\nlife support may maintain patient survival but do so at the cost of long-term disabilities and a lower quality of life.
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