The effectiveness of various approaches to the use of renal replacement therapy in the treatment of toxic rhabdomyolysis complicated by acute kidney injury

BACKGROUND. 60 % of cases of acute poisoning are complicated by the occurrence of rhabdomyolysis. The most common and dangerous complication of rhabdomyolysis is acute kidney injury (AKI), which increases mortality by up to 10 %. One of the most promising directions of pathogenetic therapy of rhabdomyolysis complicated by AKI is extracorporeal removal of myoglobin and other factors of endogenous intoxication from the systemic bloodstream. THE AIM: to improve the results of treatment of patients with toxic rhabdomyolysis complicated by acute kidney injury by applying the most effective tactics of renal replacement therapy. PATIENTS AND METHODS. The prospective study included 81 patients with toxic rhabdomyolysis complicated by AKI. In the first group, standard basic intensive therapy was performed; in the second group, hemodiafiltration was performed at an early stage of AKI, in the third group, early application of hemodiafiltration with selective hemosorption was performed. The analysis of laboratory parameters of rhabdomyolysis, renal damage, as well as the outcomes of treatment of patients in groups was carried out. RESULTS. Early use of renal replacement therapy (RRT) increased the severity of reduction of myoglobin concentrations in blood and KIM-1 in urine during the first week of treatment from 26.3 % to 73.4 % and from 76.1 % to 96.8 %, respectively. The inclusion of RRT with selective hemosorption in the intensive therapy at an early stage of AKI allowed to increase these indicators to 88.0 % and 99.0 %, respectively. The most effective method is the use of a combination of RRT with selective hemosorption, which allows to increase the rate of recovery of kidney function and reduce the duration of the necessary use of RRT from 15 to 6 days, as well as to reduce hospital mortality from 14.3 % to 6.9 %.

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