title: The effect of combining intermittent hemodiafiltration with forced alkaline diuresis on plasma myoglobin in rhabdomyolysis.
abstract: BACKGROUND
  Our aim was to examine the effect of combining intermittent hemodiafiltration (HDF) with forced alkaline diuresis on plasma myoglobin in rhabdomyolysis.
  
  
  METHODS
  This was a prospective, randomized, controlled, cross-over study. Sixteen rhabdomyolysis patients with plasma myoglobin concentrations above 10,000 microg/l were randomized. Forced alkaline diuresis was started immediately after allocation and continued throughout the study. HDF, which lasted for 4 h, was started in group A immediately after allocation and in group B 4 h later. The primary analysis was intention-to-treat by repeated measures analysis of variance and Mann-Whitney U-test.
  
  
  RESULTS
  The percentage elimination of myoglobin from the circulation during HDF differed significantly from that during alkaline diuresis (28.1% vs. 14.2%, respectively; P < 0.01). The mean decrease in plasma myoglobin concentration during HDF [9731 microg/l; 95% confidence interval (CI), 3672-5345 microg/l] and forced alkaline diuresis (3646 microg/l; 95% CI, 1260-6032 microg/l) did not show a statistically significant difference (P= NS). The mean total amount of myoglobin found in the ultrafiltrate was 58.4 mg.
  
  
  CONCLUSIONS
  The percentage myoglobin decrease during combined HDF and forced alkaline diuresis was higher than that during forced alkaline diuresis alone. Renal replacement therapy with filtration techniques may be considered for the clearance of myoglobin from plasma when urine alkalinization is not successful.
authors: Division of Nephrology, Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland.
authors: S
authors: S
authors: Peltonen
authors: A
authors: A
authors: Ahlström
authors: V
authors: V
authors: Kylävainio
authors: E
authors: E
authors: Honkanen
authors: V
authors: V
authors: Pettilä
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D018592:Cross-Over Studies; D004231:Diuresis; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D017583:Hemodiafiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood*; D011446:Prospective Studies; D012206:Rhabdomyolysis / Q000097:blood / Q000628:therapy*; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use
chemical_list: D009211:Myoglobin; D012965:Sodium Chloride; D017693:Sodium Bicarbonate