Effectiveness of Medium Cut off Dializer Membrane (Theranova) for Rhabdomyolysis in ICU for Recovery of Renal Functions – Retrospective Case Series

INTRODUCTION: Rhabdomyolysis is not very uncommon in icu settings. Poly Trauma, crush injuries, seizures, vascular insufficiencies, sepsis, shock can lead to muscle damage and myoglobin release. Rhabdomyolysis contribute to AKI in 10 to 40%of cases with subsequent high morbidity and mortality(1). Early clearance of myoglobin (17Kd) by medium cut off (MCO) membrane ‘Theranova’ have potential to minimize renal injury and enhances renal recovery(2). OBJECTIVES: To study effectiveness of medium cut off (MCO) dialyzer membrane (THERANOVA) in patients with AKI with high creatinine phosphokinase levels (CPK) and follow them up for recovery of renal functions. MATERIALS AND METHODS: Retrospective single center study analyzed patients with rhabdomyolysis with acute kidney injury (AKI) with raised CPK levels more than 1000 μg/L from July 2024 to November 2024(3). A medium cut off dialyzer ‘Theranova’ was used in present study till CPK level decreased below 1000 μg/L(4). Primary mechanism of muscle injury e.g. shock, sepsis etc. was treated simultaneously to prevent further damage to muscles. Patients were followed up for CPK levels, improvement in urine output and creatinine level till it decreased below 1.5 mg/dL. RESULTS: Total 8 patients with rhabdomyolysis and AKI are included in present study. 6 out of 8 were in oliguria and shock with one or multiple vasopressors/inotropic supports. 2 cases with pancreatitis, 2 with urosepsis, 1 with acute gastroenteritis, 2 with post viral illness with shock and 1 patient with psoas abscess had elevated CPK levels with range of 2000 to 10000 μg/L. 1 to 3 cycles of MCO membrane dialysis were used in all cases till CPK level decreased less than 1000 μg/L. 2 patients with severe shock underwent CRRT (continuous renal replacement therapy) for 72 hrs. before Theranova dialysis. In 4 oliguric cases urine output increased more than 500 ml within 1 to 10 days of admission except 1case who became non oliguric after 25 days of admission. All the patients are off dialysis since discharge except 2 who died during ICU stay. 1 case had creatinine level fall less than 1.5 mg/dL within 14 days of admission, that of in 3 cases within 25 days and 2 case had creatinine level decreased less than 1.5 mg/dL in 40 days of admission. DISCUSSIONS/CONCLUSIONS: Rhabdomyolysis is known risk factor to develop AKI and residual renal damage. Present study showed MCO Theranova filter is effective for renal recovery when patients with rhabdomyolysis and CPK levels developed AKI(5,6,7) Randomized control trials are needed for definitive evidence as compared to other extracorporeal therapies(8).