Hemoadsorption therapy for myoglobin removal in rhabdomyolysis: consensus of the hemoadsorption in rhabdomyolysis task force.

Humans Rhabdomyolysis / therapy Myoglobin / blood Hemadsorption Delphi Technique Consensus
Acute kidney injury Blood purification CytoSorb Hemoadsorption Renal replacement therapy Rhabdomyolysis

Journal

BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793

Informations de publication

Date de publication:
31 Jul 2024
Historique:
received: 14 12 2023
accepted: 18 07 2024
medline: 1 8 2024
pubmed: 1 8 2024
entrez: 31 7 2024
Statut: epublish

Résumé

Rhabdomyolysis describes a syndrome characterized by muscle necrosis and the subsequent release of creatine kinase and myoglobin into the circulation. Myoglobin elimination with extracorporeal hemoadsorption has been shown to effectively remove myoglobin from the circulation. Our aim was to provide best practice consensus statements developed by the Hemoadsorption in Rhabdomyolysis Task Force (HRTF) regarding the use of hemadsorption for myoglobin elimination. A systematic literature search was performed until 11th of January 2023, after which the Rhabdomyolysis RTF was assembled comprising international experts from 6 European countries. Online conferences were held between 18th April - 4th September 2023, during which 37 consensus questions were formulated and using the Delphi process, HRTF members voted online on an anonymised platform. In cases of 75 to 90% agreement a second round of voting was performed. Using the Delphi process on the 37 questions, strong consensus (> 90% agreement) was achieved in 12, consensus (75 to 90% agreement) in 10, majority (50 to 74%) agreement in 13 and no consensus (< 50% agreement) in 2 cases. The HRTF formulated the following recommendations: (1) Myoglobin contributes to the development of acute kidney injury; (2) Patients with myoglobin levels of > 10,000 ng/ml should be considered for extracorporeal myoglobin removal by hemoadsorption; (3) Hemoadsorption should ideally be started within 24 h of admission; (4) If myoglobin cannot be measured then hemoadsorption may be indicated based on clinical picture and creatinine kinase levels; (5) Cartridges should be replaced every 8-12 h until myoglobin levels < 10,000 ng/ml; (6) In patients with acute kidney injury, hemoadsorption can be discontinued before dialysis is terminated and should be maintained until the myoglobin concentration values are consistently < 5000 ng/ml. The current consensus of the HRTF support that adjuvant hemoadsorption therapy in severe rhabdomyolysis is both feasible and safe and may be an effective method to reduce elevated circulating levels of myoglobin.

Sections du résumé

BACKGROUND BACKGROUND
Rhabdomyolysis describes a syndrome characterized by muscle necrosis and the subsequent release of creatine kinase and myoglobin into the circulation. Myoglobin elimination with extracorporeal hemoadsorption has been shown to effectively remove myoglobin from the circulation. Our aim was to provide best practice consensus statements developed by the Hemoadsorption in Rhabdomyolysis Task Force (HRTF) regarding the use of hemadsorption for myoglobin elimination.
METHODS METHODS
A systematic literature search was performed until 11th of January 2023, after which the Rhabdomyolysis RTF was assembled comprising international experts from 6 European countries. Online conferences were held between 18th April - 4th September 2023, during which 37 consensus questions were formulated and using the Delphi process, HRTF members voted online on an anonymised platform. In cases of 75 to 90% agreement a second round of voting was performed.
RESULTS RESULTS
Using the Delphi process on the 37 questions, strong consensus (> 90% agreement) was achieved in 12, consensus (75 to 90% agreement) in 10, majority (50 to 74%) agreement in 13 and no consensus (< 50% agreement) in 2 cases. The HRTF formulated the following recommendations: (1) Myoglobin contributes to the development of acute kidney injury; (2) Patients with myoglobin levels of > 10,000 ng/ml should be considered for extracorporeal myoglobin removal by hemoadsorption; (3) Hemoadsorption should ideally be started within 24 h of admission; (4) If myoglobin cannot be measured then hemoadsorption may be indicated based on clinical picture and creatinine kinase levels; (5) Cartridges should be replaced every 8-12 h until myoglobin levels < 10,000 ng/ml; (6) In patients with acute kidney injury, hemoadsorption can be discontinued before dialysis is terminated and should be maintained until the myoglobin concentration values are consistently < 5000 ng/ml.
CONCLUSIONS CONCLUSIONS
The current consensus of the HRTF support that adjuvant hemoadsorption therapy in severe rhabdomyolysis is both feasible and safe and may be an effective method to reduce elevated circulating levels of myoglobin.

Identifiants

DOI: 10.1186/s12882-024-03679-8 PMID: 39085790
pubmed: 39085790
doi: 10.1186/s12882-024-03679-8
pii: 10.1186/s12882-024-03679-8
doi:

Substances chimiques

Myoglobin 0

Types de publication

Journal Article Consensus Development Conference

Langues

eng

Sous-ensembles de citation

IM

Pagination

247

Informations de copyright

© 2024. The Author(s).

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Auteurs

Lui Forni (L)

Critical Care Unit, Royal Surrey Hospital, Guildford, Surrey, UK. luiforni@nhs.net.
School of Medicine, University of Surrey, Kate Granger Building, Guildford, UK. luiforni@nhs.net.

Filippo Aucella (F)

"Casa Sollievo della Sofferenza" Foundation, Scientific Institut for Research and Health Care, Viale Cappuccini, 1, San Giovanni Rotondo (FG), 71013, Italy.

Gabriella Bottari (G)

Pediatric Intensive Care Unit, Bambino Gesu Children's Hospital, IRCCS, Rome, 00165, Italy.

Stefan Büttner (S)

Cardiology, Pulmonology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg- Alzenau, Academic Teaching Hospital of Julius-Maximilians-University Würzburg, Aschaffenburg, Germany.

Vincenzo Cantaluppi (V)

Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy.
"Maggiore della Carità" University Hospital, via Gen. P. Solaroli 17, Novara, 28100, Italy.

Dietmar Fries (D)

Department for Anaesthesia and Critical Care Medicine, Medical University, Christoph-Probst- Platz 1, Innrain 52 A, Fritz-Pregl-Straße 3, Innsbruck, 6020, Austria.

Jan Kielstein (J)

Medical Clinic V, Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Naumburgstraße 15, D-38124, Braunschweig, Germany.

Detlef Kindgen-Milles (D)

Department of Anesthesiology, University Hospital Duesseldorf, Heinrich-Heine University, Moorenstr.5, D-40225, Duesseldorf, Germany.

Claus Krenn (C)

Clinic for Anaesthesia, General Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Wahringer Gurtel 18-20, Vienna, 1090, Austria.

Andreas Kribben (A)

Universitätsklinikum Essen (AöR) Nephrology Clinic, Medizinisches Zentrum, 2.104 Hufelandstraße 55, D-45147, Essen, Germany.

Andreas Meiser (A)

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University Hospital, D-66424, Homburg, Germany.

Steffen Mitzner (S)

Fraunhofer IZI Rostock, Schillingallee 68, 18057, Rostock, Germany.

Marlies Ostermann (M)

Department of Critical Care, King's College London, Guy's & St. Thomas' Hospital, London, SE1 9RT, UK.

Vedran Premuzic (V)

Department for Nephrology, Hypertension, Dialysis and Transplantation, School of Medicine, UHC Zagreb Croatia, University of Zagreb, Šalata ul. 2, Zagreb, 10000, Croatia.

Caroline Rolfes (C)

Department for Anesthesiology, Intensive Care Medicine, Pain Therapy and Emergency Medicine, GNH Klinikum Kassel, Mönchebergstraße 41-43, D-34125, Kassel, Germany.

Christina Scharf (C)

Department of Anesthesiology, LMU University Hospital, LMU Munich, Geschwister-Scholl- Platz 1, D-80539, München, Germany.

Stefan Schunk (S)

Department of Internal Medicine 4, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Str. 100, D-66421, Homburg/Saar, Germany.

Zsolt Molnar (Z)

Department of Anesthesiology and Intensive Therapy, Semmelweis University, Üllői út 78, Budapest, H-1082, Hungary.
Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Collegium Maius, Fredry 10, Poznan, 61-701, Poland.
CytoSorbents Europe, Müggelseedamm 131, D-12587, Berlin, Germany.

Alexander Zarbock (A)

Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149, Münster, Germany.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Hemoadsorption therapy for myoglobin removal...
questionsmedicales.fr › Maladies ostéomusculaires › Rhabdomyolyse › Hemoadsorption therapy for myoglobin removal...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Hémoprotéines › Globines › Myoglobine › Hemoadsorption therapy for myoglobin removal...
questionsmedicales.fr › Phénomènes microbiologiques › Hémadsorption › Hemoadsorption therapy for myoglobin removal...
questionsmedicales.fr › Sciences de l'information › Analyse des systèmes › Méthode Delphi › Hemoadsorption therapy for myoglobin removal...
questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Pensée (activité mentale) › Prise de décision › Consensus › Hemoadsorption therapy for myoglobin removal...