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. 2023;45(2):2259231.
doi: 10.1080/0886022X.2023.2259231. Epub 2023 Sep 20.

The effect of cytosorb® application on kidney recovery in critically ill patients with severe rhabdomyolysis: a propensity score matching analysis

Caroline Gräfe  1 , Uwe Liebchen  1 , Antonia Greimel  1 , Nils Maciuga  1 , Mathias Bruegel  2 , Michael Irlbeck  1 , Lorenz Weidhase  3 , Michael Zoller  1 , Michael Paal  2 , Christina Scharf  1
Affiliations

The effect of cytosorb® application on kidney recovery in critically ill patients with severe rhabdomyolysis: a propensity score matching analysis

Caroline Gräfe et al. Ren Fail. 2023.

Abstract

Severe rhabdomyolysis frequently results in acute kidney injury (AKI) due to myoglobin accumulation with the need of kidney replacement therapy (KRT). The present study investigated whether the application of Cytosorb® (CS) led to an increased rate of kidney recovery in patients with KRT due to severe rhabdomyolysis. Adult patients with a myoglobin-concentration >10,000 ng/ml and KRT were included from 2014 to 2021. Exclusion criteria were chronic kidney disease and CS-treatment before study inclusion. Groups 1 and 2 were defined as KRT with and without CS, respectively. The primary outcome parameter was independence from KRT after 30 days. Propensity score (PS) matching was performed (predictors: myoglobin, SAPS-II, and age), and the chi2-test was used. 35 pairings could be matched (mean age: 57 vs. 56 years; mean myoglobin: 27,218 vs. 26,872 ng/ml; mean SAPS-II: 77 vs. 76). The probability of kidney recovery was significantly (p = .04) higher in group 1 (31.4 vs. 11.4%, mean difference: 20.0%, odds ratio (OR): 3.6). Considering patients who survived 30 days, kidney recovery was also significantly (p = .03) higher in patients treated with CS (61.1 vs. 23.5%, mean difference: 37.6%, OR: 5.1). In conclusion, the use of CS might positively affect renal recovery in patients with severe rhabdomyolysis. A prospective randomized controlled trial is needed to confirm this hypothesis.

Keywords: Rhabdomyolysis; blood purification; cytosorb®; kidney recovery; kidney replacement therapy; myoglobin.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Selection of the study population. ICU: intensive care unit; CKD: chronic kidney disease; ®KRT: (continuous) kidney replacement therapy
Figure 2.
Figure 2.
Myoglobin serum concentration (ng/ml) on days 0, 1, and 2 in patients treated with cytosorb® (group 1) and those without cytosorb® application (group 2). Group 1 included patients treated with Cytosorb® and group 2 without Cytosorb® application. The boxes of the boxplots represent the interquartile-range (IQR) and the line the median. Whiskers were limited to 1.5 times the IQR. The cross represents the mean. Blue boxplots represent day 0 (d0), orange ones day 1 (d1), and grey ones day 2 (d2).
Figure 3.
Figure 3.
The proportion of patients (%) with kidney recovery, ongoing KRT or death on day 30. KRT: kidney replacement therapy; CS: Cytosorb®, kidney recovery was defined as independence of KRT on day 30, which then lasts for at least seven days. Kidney recovery was significantly more often observed in patients treated with dialysis + CS compared to dialysis alone.
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