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Vol. 27, Art. 24 (pp. 577-594)    |    2026       

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Enhancing the detoxification efficacy of renal replacement therapy in the treatment of the wounded and injured with severe myoglobin-induced acute kidney injury

Belskikh A.N., Marukhov A.V., Vetryakov O.V., Zakharov M.V., Chubchenko N.V.
Federal State Budgetary Military Educational Institution of Higher Education "S.M. Kirov Military Medical Academy" of the Ministry of Defense of the Russian Federation

Brief summary

Rhabdomyolysis is one of the most common causes of acute kidney injury (AKI) in the wounded and injured with combat surgical trauma. One effective approach to improving treatment outcomes in patients with severe rhabdomyolysis complicated by AKI is the use of renal replacement therapy (RRT), which enables the removal of a wide range of low- and medium-molecular-weight endogenous intoxication factors, including myoglobin, from the internal environment of the body. Standard mass-exchange devices have very limited capacity for myoglobin elimination from the systemic circulation, necessitating the search for ways to enhance their detoxification potential. Objective. To evaluate the detoxification efficacy of mass-exchange devices with enhanced adsorptive potential during renal replacement therapy in the wounded and injured with myoglobin-induced AKI. Materials and Methods. In a single-center prospective observational study, a comparative analysis of detoxification efficacy was performed between standard mass-exchange devices and hemofilters/dialyzers with enhanced adsorptive properties in the treatment of 43 patients with combat surgical trauma complicated by rhabdomyolysis and AKI. The patients were treated at the clinics of the S.M. Kirov Military Medical Academy between 2022 and 2025. The extracorporeal clearance of myoglobin and the degree of its blood concentration reduction during RRT sessions were assessed and compared between different mass-exchange devices. Results. Myoglobin clearance values in the group receiving standard mass-exchange devices (Group 1) during intermittent hemodialysis and hemodiafiltration were 22 (20; 26) and 43 (41.5; 46.5) mL/min, respectively, which were significantly lower compared to the group receiving dialyzers/hemofilters with enhanced adsorptive properties (Group 2): 42 (33.5; 46) and 57 (51; 67) mL/min, respectively. Significant differences were also found between the groups in the degree of myoglobin blood concentration reduction during a single RRT session. For hemodialysis and hemodiafiltration, these values were 34 (31; 37) % and 48 (46; 51.5) %, respectively, in Group 1, and 46.5 (41.25; 51) % and 69 (61; 72) %, respectively, in Group 2. Conclusion. The study results demonstrate significantly higher myoglobin clearance and serum myoglobin reduction rates when using dialyzers/hemofilters with adsorptive membranes. More effective myoglobin elimination from the blood by enhancing the detoxification potential of RRT creates prerequisites for reducing the pathogenetic impact of this endogenous intoxication factor, which may be accompanied by improved intensive care outcomes.


Key words

combat surgical trauma, rhabdomyolysis, hemodiafiltration, hemodialysis, myoglobin

Reference list

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