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Meta-Analysis
. 2014 Jun 15;2014(6):CD008566.
doi: 10.1002/14651858.CD008566.pub2.

Continuous renal replacement therapy (CRRT) for rhabdomyolysis

Xiaoxi Zeng  1 , Ling Zhang, Taixiang Wu, Ping Fu
Affiliations
Meta-Analysis

Continuous renal replacement therapy (CRRT) for rhabdomyolysis

Xiaoxi Zeng et al. Cochrane Database Syst Rev. .

Abstract

Background: Rhabdomyolysis is a condition that is characterised by the breakdown of skeletal muscle tissue and leakage of intracellular myocyte contents into circulating blood. Rhabdomyolysis can lead to acute kidney injury (AKI) and is a potentially life-threatening condition. Studies have indicated that continuous renal replacement therapy (CRRT) may provide benefits for people with rhabdomyolysis by removing potentially damaging myoglobin and stabilising haemodynamic and metabolic status.

Objectives: We aimed to: i) assess the efficacy of CRRT in removing myoglobin; ii) investigate the influence of CRRT on mortality and kidney-related outcomes; and iii) evaluate the safety of CRRT for the treatment of people with rhabdomyolysis.

Search methods: We searched the Cochrane Renal Group's Specialised Register to 6 January 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We also searched China National Knowledge Infrastructure (from 1 January 1979 to 16 April 2013) and the Chinese Clinical Trials Register (to 16 April 2013).

Selection criteria: All randomised controlled trials (RCTs) and quasi-RCTs that investigated clinical outcomes of CRRT for people with rhabdomyolysis were included.

Data collection and analysis: Two authors independently assessed studies for inclusion and extracted data. We derived risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI). Methodological risk of bias was assessed using the Cochrane risk of bias tool.

Main results: Of the three included studies (101 participants), one evaluated continuous arteriovenous haemodialysis and two investigated continuous venovenous haemofiltration; all included conventional therapy as control.We found significant decreases in myoglobin in patients among whom CRRT therapy was initiated on days four, eight, and 10 (day 4: MD -11.00 (μg/L), 95% CI -20.65 to -1.35; Day 8: MD -23.00 (μg/L), 95% CI -30.92 to -15.08; day 10: MD -341.87 (μg/L), 95% CI -626.15 to -57.59) compared with those who underwent conventional therapy.Although CRRT was associated with improved serum creatinine, blood urea nitrogen, and potassium levels; reduced duration of the oliguria phase; and was associated with reduced time in hospital, no significant differences were found in mortality rates compared with conventional therapy (RR 0.17, 95% CI 0.02 to 1.37). The included studies did not report on long-term outcomes or prevention of AKI.Overall, we found that study quality was suboptimal: blinding and randomisation allocation were not reported by any of the included studies, leading to the possibility of selection, performance and detection bias.

Authors' conclusions: Although CRRT may provide some benefits for people with rhabdomyolysis, the poor methodological quality of the included studies and lack of data relating to clinically important outcomes limited our findings about the effectiveness of CRRT for people with rhabdomyolysis.There was insufficient evidence to discern any likely benefits of CRRT over conventional therapy for people with rhabdomyolysis and prevention of rhabdomyolysis-induced AKI.

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Conflict of interest statement

  1. Ping Fu: none known

  2. Xiaoxi Zeng: none known

  3. Ling Zhang: none known

  4. Taixiang Wu: none known

Figures

1
1
Flow chart of study selection procedure
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study
1.1
1.1. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 1 All‐cause mortality.
1.2
1.2. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 2 Duration of hospitalisation.
1.3
1.3. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 3 Serum myoglobin.
1.4
1.4. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 4 Serum creatine kinase (day 10).
1.5
1.5. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 5 Duration of oliguria phase.
1.6
1.6. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 6 Serum creatinine.
1.7
1.7. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 7 Serum BUN.
1.8
1.8. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 8 Serum potassium.
1.9
1.9. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 9 Serum calcium.
1.10
1.10. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 10 Serum ALT (day 10).
1.11
1.11. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 11 Serum AST (day 10).
1.12
1.12. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 12 White blood cell count.
1.13
1.13. Analysis
Comparison 1 CRRT versus conventional therapy, Outcome 13 Adverse events.
See this image and copyright information in PMC

Update of

References

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References to other published versions of this review

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