CytoSorb hemoadsorption in rhabdomyolysis-induced acute kidney injury: a case report from a tertiary hospital in Bangladesh

Authors

  • Mohammad J. Alam Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Showkat Azad Consultant, Department of Nephrology, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • M. Z. M. Hossain Department of Internal Medicine, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Faisal Ahmed Department of Paediatrics and Paediatric Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Nasreen Chowdhury Department of Biochemistry and Molecular Biology, Bangladesh Medical University (BMU), Dhaka, Bangladesh
  • Sarwar K. Russel Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Salman Rahman Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • M. Shahidul Islam Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Asif Saihum Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Masum Billah Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Shantanu Barua Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Muhammad I. Hossen Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Anisa Anan Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Showrov S. Emu Department of Accident and Emergency, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Raju Das Senior Medical Officer, Department of Accident & Emergency, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Adnan B. Saleh Department of Accident and Emergency, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Mohammed I. Shukkur Department of Cardiology, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Mohammad S. Bhuiyan Department of Cardiology, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Muhammad M. Rahman Department of Internal Medicine, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Diponkar Dutta Department of Cardiology, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Hussein M. Nizamuddin Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Tausiful Haque Department of Neurology, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Nargis I. Noor Department of General Surgery, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Avijith K. Nath Department of Nephrology, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Tasnia Zafar Department of Nephrology, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Sudip Rakshit Department of Anaesthesia, Analgesia and ICM, Bangladesh Medical University (BMU), Dhaka, Bangladesh
  • M. Imran S. Siam Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh
  • Jarin Tasnim Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253624

Keywords:

Rhabdomyolysis, CytoSorb, Acute kidney injury, Hemoadsorption, Creatine phosphokinase

Abstract

Rhabdomyolysis is a serious clinical condition involving the breakdown of skeletal muscle, leading to the release of intracellular components into circulation. Among its complications, acute kidney injury (AKI) is the most critical, occurring in up to 50% of cases. This report presents the case of a 42-year-old male with schizophrenia and hypertension who developed rhabdomyolysis-induced AKI following a fall. He exhibited markedly elevated creatine phosphokinase (CPK) levels (360,000 u/l) and deteriorating renal function. In addition to supportive management, CytoSorb hemoadsorption was initiated. Over three sessions, CPK levels dropped to 174 u/l, and serum creatinine declined from 3.53 mg/dl to 2.16 mg/dl. This case demonstrates that CytoSorb therapy can be effective even in limited-resource settings where myoglobin assays are unavailable, offering a promising strategy for early intervention in rhabdomyolysis-induced AKI. Our experience suggests early initiation of hemoadsorption could serve as an effective adjunct in managing challenging cases where conventional therapies alone may be insufficient.

Metrics

Metrics Loading ...

References

Cervellin G, Comelli I, Benatti M, Sanchis‑Gomar F, Bassi A, Lippi G. Non‑traumatic rhabdomyolysis: background, laboratory features, and acute clinical management. Clin Biochem. 2017;50(12):656-62. DOI: https://doi.org/10.1016/j.clinbiochem.2017.02.016

Neves Pinto G, Campelo Fraga Y, de Francesco Daher E, Bezerra da Silva Júnior G. Acute kidney injury due to rhabdomyolysis: a review of pathophysiology, causes, and cases reported in the literature, 2011–2021. Rev Colomb Nefrol. 2023;10(3):e619. DOI: https://doi.org/10.22265/acnef.10.3.619

Zager RA, Foerder CA. Effects of inorganic iron and myoglobin on in vitro proximal tubular lipid peroxidation and cytotoxicity. J Clin Invest. 1992;89(3):989-96. DOI: https://doi.org/10.1172/JCI115682

Lu Y, Neyra JA. How I treat rhabdomyolysis-induced AKI? Clin J Am Soc Nephrol. 2024;19(3):385-7. DOI: https://doi.org/10.2215/CJN.0000000000000372

Cabral BMI, Edding SN, Portocarrero JP, Lerma EV. Rhabdomyolysis. Dis Mon. 2020;66(8):101015. DOI: https://doi.org/10.1016/j.disamonth.2020.101015

Safari S, Yousefifard M, Hashemi B, Baratloo A, Forouzanfar MM, Rahmati F, et al. The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis. Clin Exp Nephrol. 2016;20(2):153-61. DOI: https://doi.org/10.1007/s10157-015-1204-1

Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. Eur J Intern Med. 2008;19(8):568-74. DOI: https://doi.org/10.1016/j.ejim.2007.06.037

Pieri M, Russo G, Francescon C, Fominskiy E, Nardelli P, Calabrò MG, et al. Dual concomitant CytoSorb hemoadsorption therapy in severe rhabdomyolysis: A novel approach to myoglobin clearance and organ preservation. Int J Artif Organs. 2025;48(6):429-33. DOI: https://doi.org/10.1177/03913988251339080

Albrecht F, Schunk S, Fuchs M, Volk T, Geisel J, Fliser D, et al. Rapid and effective elimination of myoglobin with CytoSorb in severe rhabdomyolysis. Blood Purif. 2024;53(2):88-95. DOI: https://doi.org/10.1159/000534479

Dilken O, Ince C, van der Hoven B, Thijsse S, Ormskerk P, de Geus HRH. Successful Reduction of Creatine Kinase and Myoglobin Levels in Severe Rhabdomyolysis Using Extracorporeal Blood Purification (CytoSorb®). Blood Purif. 2020;49(6):743-7. DOI: https://doi.org/10.1159/000505899

Heyne N, Guthoff M, Krieger J, Haap M, Häring HU. High cut-off renal replacement therapy for removal of myoglobin in severe rhabdomyolysis and acute kidney injury: a case series. Nephron Clin Pract. 2012;121(3-4):c159-64. DOI: https://doi.org/10.1159/000343564

de Fallois J, Scharm R, Lindner TH, Lindner TH, Scharf C, Petros S, et al. Kidney replacement and conservative therapies in rhabdomyolysis: a retrospective analysis. BMC Nephrol. 2024;25(1):96. DOI: https://doi.org/10.1186/s12882-024-03536-8

Graf H, Gräfe C, Bruegel M, Zoller M, Maciuga N, Frank S, et al. Myoglobin adsorption and saturation kinetics of the cytokine adsorber Cytosorb® in patients with severe rhabdomyolysis: a prospective trial. Ann Intensive Care. 2024;14(1):96. DOI: https://doi.org/10.1186/s13613-024-01334-x

Downloads

Published

2025-10-30

How to Cite

Alam, M. J., Azad, S., Hossain, M. Z. M., Ahmed, F., Chowdhury, N., Russel, S. K., Rahman, S., Islam, M. S., Saihum, A., Billah, M., Barua, S., Hossen, M. I., Anisa Anan, Emu, S. S., Das, R., Saleh, A. B., Shukkur, M. I., Bhuiyan, M. S., Rahman, M. M., Dutta, D., Hussein M. Nizamuddin, Haque, T., Noor, N. I., Nath, A. K., Zafar, T., Rakshit, S., Siam, M. I. S., & Tasnim, J. (2025). CytoSorb hemoadsorption in rhabdomyolysis-induced acute kidney injury: a case report from a tertiary hospital in Bangladesh. International Journal of Research in Medical Sciences, 13(11), 4933–4936. https://doi.org/10.18203/2320-6012.ijrms20253624

Issue

Section

Case Reports