Table 1 Summary of guidance based on the consensus statements

Q1

Myoglobin can directly contribute to the development of AKI in rhabdomyolysis

100

0

Strong consensus - A

Q2*

Myoglobin can indirectly contribute to the development of AKI in rhabdomyolysis

100

0

Strong consensus - A

Q3

Myoglobin may also contribute to other organ dysfunctions than AKI in rhabdomyolysis

80

20

Consensus - A

Q4

Severe rhabdomyolysis should be considered when:

a) CK > 5,000 U/l

50

50

No consensus

b) Myoglobin > 10,000 ng/ml

100

0

Strong consensus - A

c) In the case of both parameters (CK and myoglobin) are available, myoglobin should be interpreted with priority

89

11

Consensus - A

d) Criteria for RRT

50

50

No consensus

Q5

There is an association between high myoglobin/CK levels and the risk of the development of AKI

100

0

Strong consensus - A

Q6

Reducing the circulating level of myoglobin in severe rhabdomyolysis is beneficial in general

67

33

Majority - A

Q7

Reducing the circulating level of myoglobin in severe rhabdomyolysis might be beneficial for the kidneys

80

20

Consensus - A

Q8*

Reducing the circulating level of myoglobin in severe rhabdomyolysis is beneficial for the kidneys

80

20

Consensus - A

Q9*

Reducing the circulating level of myoglobin in severe rhabdomyolysis might be beneficial in general

93

7

Strong consensus - A

Q10*

Standard means of renal replacement therapy in the ICU do not significantly contribute to elimination of myoglobin.

87

13

Consensus - A

Q11*

HA can effectively remove circulating myoglobin

100

0

Strong consensus - A

Q12

HA can effectively remove circulating CK

72

28

Majority - A

Q13

HA can be considered as therapy for myoglobin removal in severe rhabdomyolysis

100

0

Strong consensus - A

Q14*

Therapy should ideally be started within 24 h after the onset of severe rhabdomyolysis

87

13

Consensus - A

Q15

Therapy should ideally be started within 24 h after the detection of severe rhabdomyolysis

67

33

Majority - A

Q16

Therapy should ideally be started within 12 h after the onset of severe rhabdomyolysis

67

13

Majority - A

Q17

Therapy should ideally be started within 12 h after the detection of severe rhabdomyolysis

67

13

Majority - A

Q18*

If the hospital is unable to measure myoglobin within a reasonably short timeframe, then treatment may be indicated based on the clinical picture and elevated CK levels.

93

7

Strong consensus - A

Q19

Consider CK > 5,000 U/l as criteria for diagnosis severe rhabdomyolysis in the absence of myoglobin.

56

44

Majority - A

Q20

HA can be used as a stand-alone hemoperfusion in a situation when CRRT is not required

67

33

Majority - A

Q21

HA can be used in combination with CRRT in patients who developed AKI and requiring CRRT

100

0

Strong consensus - A

Q22*

The HA cartridge should be changed after 8–12 h until achieving myoglobin values < 10,000 ng/ml, then at least every 24 h based on clinical response and values

87

13

Consensus - A

Q23

The optimal duration of hemoadsorption in severe rhabdomyolysis remains uncertain.

93

7

Strong consensus - A

Q24

The treatment with hemoadsorption in patients with AKI should be continued until CRRT is discontinued.

7

93

Strong consensus - DA

Q25*

In patients with AKI: The treatment should be continued until myoglobin values are < 5,000 ng/ml.

73

27

Majority - A

Q26

Do you consider defining absolute cut-off values for myoglobin and CK to start/stop therapy appropriate?

56

44

Majority - A

Q27

In patients without AKI: The treatment should be continued until sufficient myoglobin/CK reduction has been achieved and no AKI has developed.

a) Myoglobin < 10,000

44

56

Majority - DA

b) Myoglobin < 5,000

56

44

Majority - A

c) Myoglobin < 1,000*

27

73

Consensus - DA

d) CK: <10,000

44

56

Majority - DA

e) CK: <5,000*

40

60

Majority - DA

f) CK: <1,000*

13

87

Consensus - DA

Q28

Testing rebound after interruption of HA of myoglobin/CK levels to determine continuation or discontinuation HA

93

7

Strong consensus - A

Q29*

In case of continued rhabdomyolysis or redistribution of myoglobin from other tissues into the blood stream, hemoadsorption treatment should be continued or re-installed.

87

13

Consensus - A