Acute kidney injury is a common complication in patients on extracorporeal membrane oxygenation (ECMO) and is often associated with a very poor outcome. Precipitating factors include heart failure, hypotension, fluid overload, possible nephrotoxic medicine use, complications of ECMO insertion, and an acute inflammation-like reaction triggered by ECMO. The mortality rate increases with the severity of acute kidney injury, and the prognosis becomes worse if dialysis is needed. the treatment is to correct the cause of acute kidney injury, solve complications, control fluid status, and arrange dialysis if necessary.