Abstract: FR-PO069
Myoglobin Clearance in Acute Rhabdomyolysis: Theralite and Theranova
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Godi, Ilaria, University of Padova, IRRIV, San Bortolo Hospital, Vicenza, Italy
- Brendolan, Alessandra, St Bortolo Hospital, Vicenza, Italy
- Lorenzin, Anna, IRRIV, Vicenza, Italy
- Ronco, Claudio, University of Padova, IRRIV, San Bortolo Hospital, Vicenza, Italy
Background
Rhabdomyolysis is a cause of acute kidney injury (AKI) in a large number of cases where traumatic or non-traumatic causes induce muscle cell disruption. Although the rationale for a quick and effective removal of myoglobin in acute rhabdomyolysis would be strong and logical, the practical results obtained with extracorporeal therapies are modest.
Theralite2100 and Theranova400 (Baxter) are new generation membranes designed to increase the removal of larger middle molecules like myoglobin. While Theralite takes advantage of the membrane high cut-off (HCO), the high retention onset (HRO) and internal filtration are the peculiarities of Theranova.
We report a critically ill patient case to describe and compare two novel strategies for extracorporeal elimination of myoglobin in rhabdomyolysis-associated AKI with Theranova and Theralite continuous venovenous hemodialysis (CVVHD).
Methods
The treatment included 22 hours of HRO-CVVHD (Qb 200 ml/min, Qd 4000 ml/h, Quf 150 ml/h), followed by 6 hours of HCO-CVVHD (Qb200 ml/min, Qd 4000 ml/h, Quf 0 ml/h). Samples were collected from arterial, venous, and effluent lines in two timepoints: t1 (30 minutes after starting each session) and t2 (before changing hemodialyzer). Plasmatic clearance for myoglobin (Km) was calculated at t1 and t2 to evaluate the efficiency in myoglobin removal. The intensity (Km x hours of treatment) was estimated using the mean value of calculated Km.
Results
During CVVHD the Kmin t1 and t2 were 37.99 and 16.88 ml/min and 66.05 and 46.68 ml/min, using HRO and HCO respectively (Fig 1).
The blood volume cleared of myoglobin after the entire treatment was 36.22l and 20.29l for twenty-two hours of HRO-CRRT and six hours of HCO-CRRT, respectively (Fig 2).
Conclusion
Theralite-CVVHD guaranteed quick and efficient removal of myoglobin. Theranova-CVVHD might be considered as efficient for longer treatment and even more when an adjunctive convective mechanism is desirable, customizing the prescription on the basis of the patient clinical status.