Extracorporeal myoglobin elimination using the adsorber CytoSorb or the high-flux HF80 dialyzer for patients with severe rhabdomyolysis: a comparative study

Abstract

Background: Critically ill patients are frequently affected by severe rhabdomyolysis, consequently requiring renal replacement therapy (RRT). We asked whether CytoSorb is more potent than continuous veno-venous hemodiafiltration (CVVHDF) with the high-flux HF80 dialyzer in removing myoglobin and improving outcome for patients with rhabdomyolysis accompanied by acute kidney injury (AKI).

Methods: The historical HF80 cohort consisted of 97 patients who underwent CVVHDF with the HF80 dialyzer between 2010 and 2016. The CytoSorb cohort consisted of 102 patients who underwent treatment with CytoSorb in combination with CVVHDF with the standard high-flux F60S dialyzer between 2018 and 2023.

Results: Patients treated with the HF80 dialyzer achieved a median relative reduction of myoglobin of 39% after 24 h of treatment and of 69% after 3 days of treatment; this reduction was similar to the median relative myoglobin elimination achieved for the CytoSorb group (40% after 24 h and 60% after 3 days). The proportions of patients in whom return of diuresis occurred were comparable between the two extracorporeal treatments. The groups did not differ significantly in in-hospital mortality rates. The decrease in the Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scores at the end of therapy was more pronounced in the CytoSorb group (SOFA P < .0001; SAPS II P < .0001) than in the HF80 group (SOFA P = .004; SAPS II P = .03). The frequency of new-onset end-stage kidney disease among survivors was similar in both groups.

Conclusions: Our analysis showed that using CytoSorb resulted in myoglobin reduction rates and clinical outcomes similar to those achieved with CVVHDF with the high-flux HF80 dialyzer for patients with rhabdomyolysis and AKI.

Keywords: CytoSorb; acute kidney injury (AKI); continuous veno-venous hemodiafiltration (CVVHDF); high-flux HF80 dialyzer; rhabdomyolysis.

Figure 1:

Myoglobin clearance among 97 rhabdomyolysis patients treated with CVVHDF with the high-flux HF80 dialyzer or among 102 rhabdomyolysis patients treated with a combination of CytoSorb and CVVHDF with the conventional high-flux F60S dialyzer. (A) The course of absolute myoglobin concentrations during the treatment period with HF80 or CytoSorb. (B) Comparison of relative myoglobin change after 24 and 72 h of treatment [related to baseline (d0) levels] between patients treated with HF80 and those treated with CytoSorb. (C) Comparison between patients treated with HF80 and those treated with CytoSorb with regard to relative myoglobin change after 24 h and 72 h of treatment. **P = .01; ****P ≤ .0001. d, day.

Figure 2:

CK reduction among 97 rhabdomyolysis patients treated with CVVHDF with the high-flux HF80 dialyzer and among 102 rhabdomyolysis patients treated with a combination of CytoSorb and CVVHDF with the conventional high-flux F60S dialyzer. (A) The course of absolute CK concentrations during the treatment period with HF80 or CytoSorb. (B) Relative CK change after 24 h and 72 h of treatment in relation to baseline CK concentration. (C) Relative change in CK after 24 h and 72 h of treatment. **P = .01; ***P = .001. d, day; L, liter.

Figure 3:

Alterations in prognostic intensive care unit scores during extracorporeal treatment of rhabdomyolysis with CVVHDF with the high-flux HF80 dialyzer or with a combination of CytoSorb with CVVHDF with the conventional high-flux F60S dialyzer. (A) Comparison of pretreatment and post-treatment SOFA and SAPS II scores for 102 rhabdomyolysis patients treated with CytoSorb. (B) Comparison of pretreatment and post-treatment SOFA and SAPS II scores for 98 rhabdomyolysis patients treated with the HF80 dialyzer. (C) Relative reduction of SOFA and SAPS II scores for the CytoSorb and HF80 treatment groups of patients with rhabdomyolysis and AKI. *P = .05; **P = .01; ****P ≤ .0001. d, day; L, liter; SAPS II, Simplified Acute Physiology Score II; SOFA, Sequential Organ Failure Assessment.

Figure 4:

Effects on overall mortality of extracorporeal therapy for rhabdomyolysis patients with AKI treated with CVVHDF with the high-flux HF80 dialyzer or a combination of CytoSorb with CVVHDF with the conventional high-flux F60S dialyzer. (A) Short-term 7-day mortality rates for rhabdomyolysis patients treated with the HF80 dialyzer or with CytoSorb. (B) In-hospital mortality rates for rhabdomyolysis patients treated with HF80 dialyser or with CytoSorb.

Figure 5:

Effect of the change in CK values within the first 24 h after the initiation of extracorporeal therapy on myoglobin elimination, prognostic intensive care unit scores and overall mortality rates for 97 rhabdomyolysis patients treated with CVVHDF with the high-flux HF80 dialyzer or for 102 rhabdomyolysis patients treated with a combination of CytoSorb and CVVHDF with the conventional high-flux F60S dialyzer. (A) Relative myoglobin reduction according to CK change within the first 24 h after the initiation of extracorporeal therapy with CytoSorb or with HF80 dialyser. (B) Improvement in SOFA and SAPS II scores according to CK change within the first 24 h after the initiation of extracorporeal therapy for the CytoSorb and the HF80 group. Seven-day (C) and in-hospital mortality rates (D) according to CK change within the first 24 h after the initiation of extracorporeal therapy for rhabdomyolysis patients treated with either CytoSorb or HF80 dialyser. *P = .05; ***P = .001; ****P ≤ .0001. d, day.