Successful Treatment of Rhabdomyolysis-Associated Acute Kidney Injury with Haemoadsorption and Continuous Renal Replacement Therapy

We report two children with rhabdomyolysis-associated acute kidney injury who were successfully treated with a haemoadsorption column CytoSorb® in addition to continuous renal replacement therapy (CRRT). A 14-year-old girl with multiorgan failure requiring extracorporeal membrane oxygenation developed rhabdomyolysis due to reperfusion injury. Her creatine kinase (CK) and lactate levels continued to escalate despite high-dose CRRT. A haemoadsorption column was therefore added post-CRRT filter, which brought down the CK level from 264,500 IU/L to 97,436 IU/L after 8 hours of therapy. Another 4-year-old boy with epilepsy and cerebral palsy who was admitted for gastroenteritis with dehydration developed acute kidney injury and rhabdomyolysis with a peak CK level of 946,060 IU/L. He was initially treated with CRRT for 40 hours, which reduced his CK level to 147,580 IU/L. Two sessions of haemoadsorption were then performed in addition to the CRRT, which further lowered his CK level to 32,306 IU/L in 48 hours. Both patients demonstrated enhanced reduction of CK levels when the haemoadsorption column was used in addition to the CRRT, and no specific complication related to the haemoadsorption therapy was reported. Our cases showed that haemoadsorption can be considered as an adjunctive therapy for children with severe rhabdomyolysis-associated acute kidney injury.