Dual concomitant CytoSorb hemoadsorption therapy in severe rhabdomyolysis: A novel approach to myoglobin clearance and organ preservation

Abstract

Severe rhabdomyolysis, characterized by extensive muscle breakdown and release of myoglobin and creatine kinase (CK), is a life-threatening condition often complicated by acute kidney injury (AKI) and multi-organ failure (MOF). Even when conventional treatments such as fluid resuscitation and renal replacement therapy (RRT) are timely applied, severe cases remain challenging to manage. Among therapies available in this setting, hemadsorption with CytoSorb has the potential not only to treat rhabdomyolysis through removal of circulating molecules but also to limit or even prevent rhabdomyolysis-related renal failure and MOF. In this case series we present a preliminary experience with a novel use CytoSorb hemoadsorption therapy, which encompassed the use of two CytoSorb cartridges running in parallel, to enhance myoglobin and cytokine clearance. Clinical data from the three patients with severe rhabdomyolysis treated with dual concomitant CytoSorb treatments highlighted marked improvements in CK, renal, hepatic, and inflammatory markers, with possible remarkable impact in containing rhabdomyolysis-related organ failure and death. Further investigation is warranted to establish the opportunity of tailored protocols for critically ill patients.

Keywords: CytoSorb; Rhabdomyolysis; acute kidney injury; hemoadsorption.

Figure 1.

Temporal trend of laboratory parameters in Case 1. This figure illustrates the evolution of various laboratory biomarkers over 6 days of monitoring. The Y-axis represents laboratory values plotted on a logarithmic scale to better visualize differences in magnitude. The X-axis indicates the days of observation (Day 1 to Day 6). CPK: Creatine Phosphokinase; LDH: Lactate Dehydrogenase; AST: Aspartate Aminotransferase; ALT: Alanine Aminotransferase; PCR: C-reactive protein; Urea; Creatinine; Troponin; Total Bilirubin. A decline in CPK and LDH levels is observed over time, while other biomarkers exhibit variable trends.

Figure 2.

Temporal trend of laboratory parameters in Case 2. This figure illustrates the evolution of various laboratory biomarkers over 6 days of monitoring. The Y-axis represents laboratory values plotted on a logarithmic scale to better visualize differences in magnitude. The X-axis indicates the days of observation (Day 1 to Day 12). CPK: Creatine Phosphokinase; LDH: Lactate Dehydrogenase; AST: Aspartate Aminotransferase; ALT: Alanine Aminotransferase; PCR: C-reactive protein; Urea; Creatinine; Troponin; Total Bilirubin. A decline in CPK and LDH levels is observed over time, while other biomarkers exhibit variable trends.

Figure 3.

Temporal trend of laboratory parameters in Case 3. This figure illustrates the evolution of various laboratory biomarkers over 6 days of monitoring. The Y-axis represents laboratory values plotted on a logarithmic scale to better visualize differences in magnitude. The X-axis indicates the days of observation (Day 1 to Day 18). CPK: Creatine Phosphokinase; LDH: Lactate Dehydrogenase; AST: Aspartate Aminotransferase; ALT: Alanine Aminotransferase; PCR: C-reactive protein; Urea; Creatinine; Troponin; Total Bilirubin. A decline in CPK and LDH levels is observed over time, while other biomarkers exhibit variable trends.