Kidney REPLACEment therapies in patients with acute kidney injury and RHABDOmyolysis (ReplaceRhabdo): a pilot trial
Abstract Background Rhabdomyolysis is frequently associated with acute kidney injury (AKI). Due to the nephrotoxic properties of myoglobin, its rapid removal is relevant. If kidney replacement therapy (KRT) is necessary for AKI, a procedure with effective myoglobin elimination should be preferred. T...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12882-025-03945-3 |
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| author | Lorenz Weidhase Antonia Borrmann Anja Willenberg Meinhard Mende Christina Scharf-Janßen Sirak Petros Jonathan de Fallois |
| author_facet | Lorenz Weidhase Antonia Borrmann Anja Willenberg Meinhard Mende Christina Scharf-Janßen Sirak Petros Jonathan de Fallois |
| author_sort | Lorenz Weidhase |
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| description | Abstract Background Rhabdomyolysis is frequently associated with acute kidney injury (AKI). Due to the nephrotoxic properties of myoglobin, its rapid removal is relevant. If kidney replacement therapy (KRT) is necessary for AKI, a procedure with effective myoglobin elimination should be preferred. This pilot trial was designed to compare different KRT modes that enable myoglobin elimination. Methods In this prospective randomized single-center study, 15 patients with rhabdomyolysis and severe AKI requiring KRT were randomized 1:1:1 into three groups: continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) using a high cut-off dialyzer (CVVHD-HCO), or CVVHD using a high-flux dialyzer in combination with the adsorber CytoSorb (CVVHD-CS). Concentrations of serum myoglobin, urea, creatinine, β2-microglobulin, interleukin-6, and albumin were measured before and after the dialyzer 1, 6, 12, and 24 h after initiating KRT. Results There was no significant difference in the median myoglobin clearance between the KRT modes during the 24-h study period. Nevertheless, the CVVHD-CS group showed a significantly higher myoglobin elimination compared to the other modes in the first hours of treatment. However, as a greater decline in clearance performance was observed over time, no better performance was detected over the whole study period. Simulation of different device combinations showed the highest myoglobin clearance for CVVHD-HCO combined with CS with a 12-hourly adsorber exchange interval. Conclusions All tested modes showed an effective myoglobin elimination capacity. The time-dependent elimination performance could be further increased by combining KRT with more frequent adsorber exchange. Trial registration German Clinical Trials Registry ( DRKS00023998 ); date of registration 03/03/2021. |
| format | Article |
| id | doaj-art-53566888a24b407ca259a058fa87e699 |
| institution | Kabale University |
| issn | 1471-2369 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Nephrology |
| spelling | doaj-art-53566888a24b407ca259a058fa87e6992025-01-19T12:13:35ZengBMCBMC Nephrology1471-23692025-01-0126111410.1186/s12882-025-03945-3Kidney REPLACEment therapies in patients with acute kidney injury and RHABDOmyolysis (ReplaceRhabdo): a pilot trialLorenz Weidhase0Antonia Borrmann1Anja Willenberg2Meinhard Mende3Christina Scharf-Janßen4Sirak Petros5Jonathan de Fallois6Medical Intensive Care Unit, University Hospital LeipzigMedical Intensive Care Unit, University Hospital LeipzigInstitute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital LeipzigInstitute for Medical Informatics, Statistics Und Epidemiology, University LeipzigDepartment of Anesthesiology, University Hospital, LMU MunichMedical Intensive Care Unit, University Hospital LeipzigMedical Department III, Division of Nephrology, University Hospital LeipzigAbstract Background Rhabdomyolysis is frequently associated with acute kidney injury (AKI). Due to the nephrotoxic properties of myoglobin, its rapid removal is relevant. If kidney replacement therapy (KRT) is necessary for AKI, a procedure with effective myoglobin elimination should be preferred. This pilot trial was designed to compare different KRT modes that enable myoglobin elimination. Methods In this prospective randomized single-center study, 15 patients with rhabdomyolysis and severe AKI requiring KRT were randomized 1:1:1 into three groups: continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) using a high cut-off dialyzer (CVVHD-HCO), or CVVHD using a high-flux dialyzer in combination with the adsorber CytoSorb (CVVHD-CS). Concentrations of serum myoglobin, urea, creatinine, β2-microglobulin, interleukin-6, and albumin were measured before and after the dialyzer 1, 6, 12, and 24 h after initiating KRT. Results There was no significant difference in the median myoglobin clearance between the KRT modes during the 24-h study period. Nevertheless, the CVVHD-CS group showed a significantly higher myoglobin elimination compared to the other modes in the first hours of treatment. However, as a greater decline in clearance performance was observed over time, no better performance was detected over the whole study period. Simulation of different device combinations showed the highest myoglobin clearance for CVVHD-HCO combined with CS with a 12-hourly adsorber exchange interval. Conclusions All tested modes showed an effective myoglobin elimination capacity. The time-dependent elimination performance could be further increased by combining KRT with more frequent adsorber exchange. Trial registration German Clinical Trials Registry ( DRKS00023998 ); date of registration 03/03/2021.https://doi.org/10.1186/s12882-025-03945-3Myoglobin clearanceRhabdomyolysisAcute kidney injury (AKI)High cut-off dialyzerAdsorberCytoSorb |
| spellingShingle | Lorenz Weidhase Antonia Borrmann Anja Willenberg Meinhard Mende Christina Scharf-Janßen Sirak Petros Jonathan de Fallois Kidney REPLACEment therapies in patients with acute kidney injury and RHABDOmyolysis (ReplaceRhabdo): a pilot trial BMC Nephrology Myoglobin clearance Rhabdomyolysis Acute kidney injury (AKI) High cut-off dialyzer Adsorber CytoSorb |
| title | Kidney REPLACEment therapies in patients with acute kidney injury and RHABDOmyolysis (ReplaceRhabdo): a pilot trial |
| title_full | Kidney REPLACEment therapies in patients with acute kidney injury and RHABDOmyolysis (ReplaceRhabdo): a pilot trial |
| title_fullStr | Kidney REPLACEment therapies in patients with acute kidney injury and RHABDOmyolysis (ReplaceRhabdo): a pilot trial |
| title_full_unstemmed | Kidney REPLACEment therapies in patients with acute kidney injury and RHABDOmyolysis (ReplaceRhabdo): a pilot trial |
| title_short | Kidney REPLACEment therapies in patients with acute kidney injury and RHABDOmyolysis (ReplaceRhabdo): a pilot trial |
| title_sort | kidney replacement therapies in patients with acute kidney injury and rhabdomyolysis replacerhabdo a pilot trial |
| topic | Myoglobin clearance Rhabdomyolysis Acute kidney injury (AKI) High cut-off dialyzer Adsorber CytoSorb |
| url | https://doi.org/10.1186/s12882-025-03945-3 |
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