CytoSorb’s important role in severe rhabdomyolysis requiring continuous veno-venous haemodialysis

Early Stoppage Due to significant Outcome Difference

The appearance of myoglobin in blood is a consequence of rhabdomyolysis (RML). When the renal mechanism for excretion of the myoglobin protein is overwhelmed, extensive tubular damage arises, which can lead to acute kidney injury (AKI)1. This study investigated whether CytoSorb haemoadsorption technology would improve myoglobin elimination when added to continuous veno-venous haemodialysis (CVVHD). Adult patients requiring CVVHD for severe rhabdomyolysis were included in this study. In the treatment group, in addition to the usual CVVHD high cut-off filter (EMIC-2) a CytoSorb cartridge was installed before the haemofilter and replaced once after 24 hours. This study was randomised, controlled and recruitment could be stopped after 8 patients (4 in each group) because a significant difference in the primary outcome was already evident.

Primary Outcome: Lower Myoglobin Levels with CytoSorb

Concerning the primary outcome the CytoSorb group had a significantly lower AUC of the myoglobin concentration as a percent of baseline during the first 24 hours compared with the control group as well as during the whole observation period of 48 hours. The relative reduction of myoglobin was considerably higher in the CytoSorb compared to the control group during the first 8 hours of therapy. The authors noted that the decline in relative reduction in myoglobin over time in the treatment group suggests a saturation effect. They therefore recommend that the CytoSorb cartridge be replaced after 8–12 hours if further myoglobin reduction is indicated.

Technical Flexibility of CytoSorb: A Seamless Combination

Rapid elimination of myoglobin seems crucial to decrease the incidence and severity of AKI and so to help avoid developing long-term renal damage.1,2 This study showed a notable difference in myoglobin clearance when using CytoSorb plus the usual haemofilter, compared with a haemofilter alone. As also noted by the authors CytoSorb provides technical flexibility as it can be added to a dialysis machine but can also be used stand-alone with its own external, pump-driven blood circuit available from the manufacturer. So CytoSorb and hemofilter can present a seamless combination and when used in the right patient, at the right time and in the right dose it might indeed provide outcome benefits in patients with severe rhabdomyolysis as suggested in another interesting recent publication (Gräfe et al., Ren Fail 2023; 45(2):2259231), which will also be discussed soon in this blog.