29, 55, 37
Haemolysis identifies real organ-specific harm beyond the neurological signal, and the renal endpoint is the better-powered one. Supports treating sub-threshold haemolysis as a finding rather than noise.
Children without elevated haemolysis markers
Strong AE, Zee J, Fulchiero R, Kilbaugh TJ, Connelly J, Makeneni S, Campos D, Laskin BL, Denburg MR. Kidney360 2023;4(11):1536-1544. DOI 10.34067/KID.0000000000000253
Elevated plasma free haemoglobin and elevated lactate dehydrogenase as time-varying exposures, with the pre-ECMO creatinine as baseline
Retrospective; paediatric, so extrapolation to adults is indirect
Free haemoglobin — described by the authors as the most specific of the haemolysis markers — carried an adjusted HR of 2.9 (1.4 to 5.6) for a composite of acute kidney injury or renal replacement therapy, rising to 6.6 (3.3 to 13.2) for stage 2 or worse injury. LDH gave 3.1 and 2.8 respectively.
501 children on ECMO