Supplementary Material for: Rapid and effective elimination of myoglobin with CytoSorb® hemoadsorber in patients with severe rhabdomyolysis

Introduction: Rhabdomyolysis is characterized by destruction of muscle fibres by various causes, diagnosed by increased creatin kinase concentrations in the blood. Myoglobin released into the blood may cause acute kidney injury. In this randomized controlled study, we hypothesized that myoglobin elimination would be faster when a hemoadsorber is added to a continuous venovenous hemodialysis.
Methods: Four patients in the control group received CVVHD with a high cut-off hemofilter using high blood and dialysate flows for 48 hours. Four patients in the CytoSorb group received the same treatment, but in addition, the hemoadsorber CytoSorb® was inserted in front of the hemofilter and replaced once after 24 hours. Blood samples were drawn simultaneously before (pre) and after (post) the hemofilter or else the hemoadsorber, after 5 and 30 min, as well as after 2, 4, 8 and 24 hours. All measurements were repeated the next day after the hemoadsorber had been renewed in the CytoSorb group. Primary outcome was the area under the curve of the relative myoglobin concentrations as percent of baseline (AUC). To evaluate the efficacy of myoglobin removal, relative reductions in myoglobin concentrations during one passage through of each device at each time point were calculated.
Results: Patients in the CytoSorb group had a significantly lower AUC during the first 24 hours (42±10% versus 63±6%, P = 0.029) as well as during the observation period of 48 hours (26±7% versus 51±12%, P = 0.029). The relative reductions for myoglobin were considerably higher in the CytoSorb compared to the control group during the first 8 hours.
Conclusion: Myoglobin concentrations declined considerably faster when CytoSorb was added to a CVVHD. When compared to a high cut-off hemofilter, efficacy of CytoSorb in myoglobin elimination was much better. Because of saturation after 8 to 12 hours an exchange may be necessary.