Some kinetic considerations in high cut-off hemodiafiltration for acute myoglobinuric renal failure.
The kinetics of myoglobin in severe rhabdomyolysis and dialysis-dependent myoglobinuric acute kidney injury (Mb-AKI) is still not well elucidated, and more detailed knowledge could improve the now empiric use of rapid extracorporeal myoglobin removal by high cut-off (HCO) hemodialysis treatments. Eighteen adult patients with severe dialysis-dependent Mb-AKI (median serum concentration of myoglobin 57.4 mg/L) participated in the prospective clinical study, assessing myoglobin kinetics during HCO hemodiafiltration (HCO HDF). High initial serum concentrations of myoglobin (median 57.4 mg/L), together with protracted myoglobin appearance in the blood, indicated a large accumulation of myoglobin in body fluids. Extra-renal endogenous metabolic myoglobin clearance was delayed, with a slow exponential fall in serum myoglobin (t½ 35 h). A mean myoglobin clearance of 90-94 mL/min, a reduction ratio of 80%, and a rapid exponential fall (t½ 1 h) in serum and dialysate myoglobin were achieved by HCO HDF. Half of the cumulative myoglobin removal was accomplished in 3-5 h, with an additional removal of 7% each hour thereafter. A 2.4-fold rebound in serum myoglobin followed the HCO procedures. Large amounts of myoglobin are released into the circulation, and its endogenous metabolic clearance in dialysis-dependent Mb-AKI is slow. Owing to its rapid and highly efficient myoglobin elimination, HCO HDF may represent a valuable tool in the initial management of severe Mb-AKI, with a potential for earlier application in the future.
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia. vladimir.premru@kclj.si
Vladimir
V
Premru
Janko
J
Kovač
Jadranka
J
Buturović-Ponikvar
Rafael
R
Ponikvar
D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood*; D009212:Myoglobinuria / Q000209:etiology; D011446:Prospective Studies; D012206:Rhabdomyolysis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D009211:Myoglobin
Acute renal failure; Hemodiafiltration; High cut-off; Kinetics; Myoglobin