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The following is a summary of “Kidney replacement and conservative therapies in rhabdomyolysis: a retrospective analysis,” published in the March 2024 issue of Nephrology by Fallois et al.

Limited clinical data exists on the effectiveness of kidney replacement therapy (KRT) in critical care patients with rhabdomyolysis-induced acute kidney injury (AKI), highlighting the importance of prompt myoglobin elimination to preserve kidney function and enhance repair.

Researchers conducted a retrospective study to delineate variances in myoglobin clearance and clinical outcomes between conservative therapy and various KRT modalities.

They conducted a study involving 328 critical care patients diagnosed with rhabdomyolysis (myoglobin levels >1000 µg/l). The study calculated and compared the median reduction rate of myoglobin after initiating different KRT modalities. Multivariate logistic regression models were employed to identify potential confounders affecting hospital mortality. Additionally, the lifespan of various extracorporeal circuits was analyzed using Kaplan-Meier curves.

The results revealed that out of 328 patients included in the study, 171 necessitated KRT. Upon admission, the health condition of this group was notably more critical compared to patients undergoing conservative therapy. The reduction rate of myoglobin did not exhibit any significant difference between the groups, as the KRT group showed a 49% reduction (30.8% to 72.2%). In contrast, the conservative treatment (CT) group exhibited a reduction of 61% (38.5% to 73.5%) (P=0.082). Analysis of various extracorporeal procedures regarding mortality did not reveal any significant disparities. However, hospital mortality was substantially higher among patients receiving KRT, with a rate of 55.6%, compared to 18.5% among those receiving CT (P<0.001). In a multivariate logistic regression model, the need for KRT (OR: 2.163; CI: 1.061–4.407; P=0.034) and the SOFA Score (OR: 1.111; CI: 1.004–1.228; P=0.041) were identified as independent predictive factors for hospital mortality. Upon comparison of specific KRT methods using multivariate regression, no treatment modality demonstrated a clear benefit. It was observed that the lifespan of the extracorporeal circuit was shorter with continuous venovenous hemofiltration (CVVH) compared to other modalities (log-Rank P=0.017).

Investigators concluded that Rhabdomyolysis with AKI needing KRT has a high mortality, and while all KRTs remove myoglobin, CVVH may shorten filter life.

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03536-8