The use of combined extracorporeal detoxification in the treatment of toxic rhabdomyolysis complicated by acute kidney injury: single-center prospective randomized trial

INTRODUCTION. Rhabdomyolysis (RM) occurs in 40–60 % of patients with acute poisoning and is accompanied by acute kidney injury (AKI). The most effective method of treatment is the use of extracorporeal detoxification. The most promising is the combined methods of detoxification. OBJECTIVES. Improve outcomes in patients with toxic RM complicated by AKI through early use of selective hemosorption and hemodiafiltration. MATERIALS AND METHODS. The study included 57 patients with toxic genesis RM complicated by AKI. The first group received standard intensive therapy. For the treatment of the second group at the early stage of AKI, hemodiafiltration and selective hemoperfusion were used. We performed a comparative analysis of the dynamics of the main clinical and laboratory parameters, as well as treatment outcomes between groups. RESULTS. The use of selective hemoperfusion and hemodiafiltration at the early stage of AKI allowed to increase the decrease in the level of myoglobin in the blood from 26.3 to 88.0 % and KIM-1 in the urine from 76.1 to 99.0 % during the first week of treatment in the ICU (intensive care unit). Combined detoxification reduced the duration of RRT use from 15 to 6 days, which led to a significant decrease in the level of hospital mortality from 14.3 to 6.9 %, the duration of inpatient treatment from 19.5 to 11 days and the period of stay in the ICU from 11 to 4 days. CONCLUSIONS. Early use of combined extracorporeal detoxification leads to a significant decrease in the level of endogenous intoxication factors, which ultimately made it possible to reduce the duration of treatment in the ICU, hospital and reduce the level of hospital mortality.