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

Abstract

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 %.