Intermittent hemodiafiltration rapidly decreases serum myoglobin levels in rhabdomyolysis

Introduction

Myoglobin is a pigment protein (MW 17800 D), which forms hematin if tubular pH is low and may cause acute renal failure (ARF). Aggressive fluid therapy, alkalinization of the urine, loop diuretics and mannitol are used in prevention of ARF with varying success. CAVH decreases serum myoglobin levels [1], but is not routinely used. Regardless of the therapy of rhabdomyolysis, the mortality of associated ARF remains high, approximately 30% [2]. The aim of this study was to examine the effect of intermittent 4-h hemodiafiltration (HDF) on serum myoglobin levels.

Methods

HDF was done using predilution technique with AK 100 Ultra equipment, Polyflux 17 hemodiafilter and BiCart 205 acid sodium bicarbonate concentrate (Gambro, Sweden)

Ultrafiltration rate was 167 ml/min, dialysis fluid rate was 333 ml/min and blood pump rate was 250 ml/min. The filtrated fluid was substituted by on-line system of the equipment.

Results

See table.

Discussion

Hemodiafiltration with predilution technique effectively and rapidly decreases serum myoglobin levels. In rhabdomyolysis associated with severe trauma, metabolic disturbance or intoxication HDF might prove to be effective in prevention or treatment of ARF.

Table