Myoglobin Removal by High Cut-off CVVHD (HicoRhabdo)
A high cut-off dialyzer (septeX) is tested for the removal of myoglobin which is not efficiently removed by standard high flux dialysis membranes. Hypothesis: The high cut-off dialyzer (septeX) can remove 2-fold more efficiently myoglobin from the circulation of Rhabdomyolysis patients as by conventional treatment with standard high flux dialyzer.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Myoglobin Reduction by High Cut-off (HCO) Continuous Veno- Venous Hemodialysis (CVVHD) in Patients With Rhabdomyolysis and an Increased Risk for Acute Kidney Injury|
- Myoglobin plasma level [ Time Frame: 24h ] [ Designated as safety issue: No ]Two fold- increased reduction of myoglobin plasma level in favor of the HCO CVVHD group compared with standard therapy group (HF-CVVH and fluid therapy, respectively) after 48 hours treatment time.
- eGFR [ Time Frame: at 3 and 6 month after treatment ] [ Designated as safety issue: No ]Estimation of kidney function by estimated glomerular filtration rate (eGFR)
- Duration of hospital stay (days)and Duration of ICU stay (days) [ Time Frame: 6 month ] [ Designated as safety issue: No ]
- Duration of dialysis dependence (days) [ Time Frame: 6 month ] [ Designated as safety issue: No ]
- Diuresis / oliguria (<0.5 ml/kg/12h)/ anuria [ Time Frame: 6 month ] [ Designated as safety issue: No ]
- patient survival [ Time Frame: 6 month ] [ Designated as safety issue: Yes ]
|Study Start Date:||November 2011|
|Study Completion Date:||May 2014|
|Primary Completion Date:||April 2014 (Final data collection date for primary outcome measure)|
Experimental: HCO CVVHD
treatment of rhabdomyolysis pts with septeX dialyzer
continuous veno-venose hemodialysis (CVVHD) with dialysate flow rate (Qd)of 35ml/kg/h for 48h
Active Comparator: HF CVVH
treatment of rhabdomyolysis pts with standard high flux dialyzer
Device: HF CVVH
continuous veno-venose hemofiltration (CVVH) with 35ml/kg/h UF-rate for 48h
Excess myoglobin in the circulation is a causative pathogenetic factor of rhabdomyolysis associated with acute kidney injury (AKI). The rapid elimination of myoglobin by standard dialysis membranes is limited to its molecular weight of 17.8kDa, although some removal can be achieved when a convective therapy is applied.
Significant clearance for myoglobin has been reported for high flux membranes from < 8 mL/min (5) up to 22 mL/h (CVVH) (10) and for high cut-off (HCO) membranes a mean clearance rate of 36.2 mL/min in HD mode (7) and 39.2 mL/h in CVVH mode (5). The use of high cut-off (HCO) continuous veno- venous hemodialysis (CVVHD) may constitute a novel therapeutic strategy for effectively reduction of myoglobin in the patient's serum to ameliorate the course of AKI.
Previously, a case study of the removal of myoglobin by HCO-CVVH in one single patient with severe rhabdomyolysis was published.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01467180
|Klinik für Anästhesiologie, Intensivmedizin, Uni-Klinikum|
|Frankfurt, Hessen, Germany, 60590|