PROPHYLAXIS OF ACUTE-RENAL-FAILURE IN PATIENTS WITH RHABDOMYOLYSIS

Patients that develop rhabdomyolysis of different causes are at high r isk of acute renal failure. Efforts to minimize this risk include volu me repletion, treatment with mannitol, and urinary alkalinization as s oon as possible after muscle injury. This is a retrospective analysis (from January 1, 1992, to December 31, 1995) of therapeutic response t o prophylactic treatment in patients with rhabdomyolysis admitted to a n intensive care unit (ICU). The diagnosis of rhabdomyolysis was based on creatinine kinase (CK) level (>500 Ul/L) and the criteria for prop hylaxis were: time elapsed between muscle injury to ICU admission < 48 h and serum creatinine < 3 mg/dL. Fifteen patients were treated with the association of saline, mannitol, and sodium bicarbonate (S+M+B gro up) and 9 patients received only saline (S group). Serum creatinine at admission was similar in both groups: 1.6 +/- 0.6 mg/dL in the S+M+B group and 1.5 +/- 0.6 mg/dL in the S group (p > 0.05). Maximum serum C K measured was 3351 +/- 1693 IU/L in the S+M+B group and 1747 +/- 2345 IU/L in the S group (p < 0.05). However the measurement of CK was ear lier in S+M+B patients (1.7 vs 2.7 days after rhabdomyolysis). APACHE II scores were 16.9 +/- 7.4 and 13.4 +/- 4.9 in the S+M+MB and S group s, respectively (p > 0.05). Despite the treatment protocol the serum l evels of creatinine had similar behavior and reached normal levels in all patients in 2 or 3 days. The saline infusion during the first 60 h on the ICU was 206 mL/h in the S group and 204 mL/h in S+M+B (p > 0.0 5). Mannitol dose was 56 g/day, and bicarbonate 225 mEq/day during 4.7 days. Our data show that progression to established renal failure can be totally avoided with prophylactic treatment, and that once appropr iate saline expansion is provided, the association of mannitol and bic arbonate seems to be unnecessary.