The Use of Selective Hemoperfusion in Treatment of Toxic Rhabdomyolysis Complicated by Acute Kidney Injury

The objective: to improve treatment results in patients with toxic rhabdomyolysis (RM) complicated by acute kidney injury (AKI) through using selective hemoperfusion (НР).

Subjects and Methods. The study included 45 patients aged 18 to 55 years diagnosed with toxic RM complicated by AKI. The patients were divided into two groups. Group 1 received standard conservative therapy. In Group 2, during the first day of treatment, HP was used to prevent AKI progression. Changes in clinical and laboratory parameters of RM and renal damage as well as treatment outcomes between the groups were analyzed and compared.

Results. Significantly better decrease in myoglobin blood level was revealed in Group 2 from day 1 to day 7 of treatment. In Groups 1 and 2, these parameters made 26.3% and 52.1%, respectively. The use of НР allowed reducing the urine concentration of KIM-1 by day 3 of treatment in Group 2 by 16.9%, in Group 1, the urine concentration of KIM-1 increased by 15.5%. The frequency of RRT initiation for urgent indications decreased from 75% to 52.9% when using HP, as a result, duration of inpatient treatment decreased from 19.5 (14; 22) to 16.5 (13; 19) days, as well as the period of ICU stay from 11 (9; 15) to 8 (6; 11) days.

Conclusions. The early use of НР as part of the complex intensive therapy of toxic RM complicated by the development of AKI is accompanied by an earlier and significant decrease in laboratory markers of RM and AKI compared to standard treatment, as well as shorter ICU and hospital stay

1. Zharskiy S.L., Slobodyanyuk O.N., Slobodyanyuk S.N. Exercise-related rhabdomyolysis in young adults. Klinicheskaya Meditsina, 2013, no. 3, pp. 62-65. (In Russ.)

2. Fedorova А.А., Kutepov D.E., Zubarev А.V. et al. Rhabdomyolysis: what is new in diagnosis and treatment? Kremlevskaya Meditsina. Klinicheskiy Vestnik, 2020, no. 2, pp. 102‒109. (In Russ.)

3. Khoroshilov S.E. Detoxication in critical conditions: an insight into the scientific problem in the XXI Century (review). Obschaya Reanimatologiya, 2017, vol. 5, no. 13, pp. 85-108. (In Russ.) doi:10.15360/1813-9779-2017-5-85-108.

4. Khoroshilov S.E. Pathogenesis, diagnosis and efferent treatment of rhabdomyolysis complicated by acute renal failure. Tverskoy Meditsinskiy Journal, 2017, no. 5, pp. 45‒51. (In Russ.)

5. Bagley W.H., Yang H., Shah K.H. Rhabdomyolysis. Intern. Emerg. Med., 2017, vol. 2, no. 3, pp. 210-218. doi: 10.1007/s11739-007-0060-8.

6. Bosch X., Poch E., Grau J.M. Rhabdomyolysis and acute kidney injury. N. Engl. J. Med., 2009, vol. 361, no. 1, pp. 62-72. doi: 10.1056/NEJMra0801327.

7. Chatzizisis Y.S. et al. The syndrome of rhabdomyolysis: complications and treatment. Eur. J. Intern. Med., 2008, vol. 19, no. 8, pp. 568-574. doi:10.1016/j. ejim. 200.06.037.

8. Cote D.R. et al. A “crush” course on rhabdomyolysis: risk stratification and clinical management update for the perioperative clinician. J. Anesth., 2020, vol. 34, no. 4, pp. 585-598. doi: 10.1007/s00540-020-02792-w.

9. Debelmas A., Benchetrit D., Galanaud D. et al. Case 251: nontraumatic drug-associated rhabdomyolysis of head and neck muscles. Radiology, 2018, vol. 286, no. 3, pp. 1088-1092. doi: 10.1148/radiol.2018152594.

10. Donati G., Cappuccilli M., Di Filippo F. et al. The Use of supra-hemodiafiltration in traumatic rhabdomyolysis and acute kidney injury: A case report. Case Rep. Nephrol. Dial., 2021, vol. 11, no. 1, pp. 26‒35. doi: 10.1159/000507424.

11. Kwiatkowska M., Chomicka I., Malyszko J. Rhabdomyolysis – induced acute kidney injury – an underestimated problem. Wiad. Lek., 2020, vol. 73, no. 11, pp. 2543-2548. doi: 10.36740/wlek202011137.

12. Lang C.N., Sommer M.J., Neukamm M.A. et al. Use of the CytoSorb adsorption device in MDMA intoxication: a first-in-man application and in vitro study. Intens. Care Med. Exp., 2020, vol. 8, no. 1, pp. 21. doi:10.1186/s40635-020-00313-3.

13. Masakane I., Sakurai K. Current approaches to middle molecule removal: room for innovation. Nephrol Dial Transplant, 2018. 33(suppl_3): iii12–iii21, doi: 10.1093/ndt/gfy224.

14. Oshima Y. Characteristics of drug-associated rhabdomyolysis: analysis of 8,610 cases reported to the U.S. Food and Drug Administration. Intern. Med., 2011, vol. 50, no. 8, pp. 845-853. doi:10.2169/internalmedicine.50.4484.

15. Padiyar S., Deokar A., Birajdar S. et al. Cytosorb for management of acute kidney injury due to rhabdomyolysis in a child. Indian. Pediatr., 2019, vol. 56, no. 11, pp. 974‒976. doi:10.1007/s13312-019-1661-9.

16. Panizo N., Rubio-Navarro A., Amaro-Villalobos J.M. et al. Molecular mechanisms and novel therapeutic approaches to rhabdomyolysis-induced acute kidney injury. Kidney Blood Press. Res., 2015, vol. 40, no. 5, pp. 520-532. doi:10.1159/000368528.

17. Petejova N., Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Crit. Care, 2014, vol. 18, no. 3, pp. 224. doi:10.1186/cc13897.

18. Ronco C. Extracorporeal therapies in acute rhabdomyolysis and myoglobin clearance. Crit. Care, 2005, vol. 9, no. 2, pp. 141-142. doi: 10.1186/cc3055.

19. Scharf C., Liebchen U., Paal M. et al. Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis. Crit. Care, vol. 25, no. 41 (2021). doi: 10.1186/s13054-021-03468-x.

20. Taxbro K., Kahlow H., Wulcan H., Fornarve A. Rhabdomyolysis and acute kidney injury in severe COVID-19 infection. BMJ Case Rep., 2020, vol. 13, no. 9, pp. 237616. doi:10.1136/bcr-2020-237616.