Effects of early continuous renal replacement therapy in critically ill patients requiring ECMO treatment: results of a randomised controlled trial
In brief
Early renal replacement therapy fails to cut 30-day mortality in ECMO
In a randomized trial of 91 adults on extracorporeal membrane oxygenation, 30-day death occurred in 43.5% of patients who received continuous renal replacement therapy within 24 hours versus 46.7% with usual-care timing-no meaningful survival benefit. The study stopped early and was underpowered, so modest advantages or harms cannot be ruled out.
- Journal
- Open heart (Q1)
- Published
- 9 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Xiaofang Wang, Ying Liu, Zhiyan Wang, Hong Wang, Chenglong Li, Jiakun Tian, et al.
- PMID
- 42425722
- DOI
- 10.1136/openhrt-2026-003963
Why clinicians should know about it
- Picked for Nephrology (top studies of the week, 11 October 2026): Early CRRT RCT, informs AKI management in ECMO
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 11 October 2026): Early CRRT vs usual care RCT in ECMO patients
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat patients with severe cardiac and pulmonary failure but the complications of acute kidney injury and fluid overload are common. We aimed to determine whether the early initiation of continuous renal replacement therapy (CRRT) can reduce 30-day mortality in patients with ECMO. METHODS: The Evaluation of early CRRT intervention in patients with ECMO study was an investigator-initiated, multicentre, randomised, open clinical trial of patients undergoing ECMO who were randomly assigned to early initiation of CRRT (within 24 hours after ECMO) or conventionally indicated initiation of CRRT. All participants received standard diagnostic and therapeutic procedures. The primary endpoint was the 30-day mortality. A sample size of 500 patients was estimated to provide 80% power and a two-sided α of 0.05 to detect a 20% relative reduction in 30-day mortality assuming a rate of 70% in the usual care group. The primary analysis was unadjusted. RESULTS: The study stopped early due to feasibility. Of the 131 patients assessed for eligibility, 40 were excluded based on the inclusion and exclusion criteria. Of the 91 randomised patients, 46 were assigned to the early CRRT group and 45 were assigned to the usual care group. In the intervention group, 35 patients (76.1%) received CRRT within 24 hours post-ECMO implementation vs 15 patients (33.3%) in the usual care group. In the intention-to-treat analysis, the primary outcome occurred in 20 patients (43.5%) in the early CRRT group and 21 patients (46.7%) in the usual care group (HR 0.93, 95% CI 0.50 to 1.72; p=0.75). There was no significant difference in serious adverse events between the two groups (11 (25.6%) vs 9 (21.4%); OR 1.26, 95% CI 0.46 to 3.45; p=0.65). CONCLUSIONS: Early implementation of CRRT in patients with ECMO showed no evidence of a difference in 30-day mortality compared with conventional initiation. However, the trial was substantially underpowered and clinically important benefits or harms cannot be excluded. TRIAL REGISTRATION NUMBER: NCT03549923.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.