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Acta Anaesthesiol Scand. 2019 May;63(5):576-586. doi: 10.1111/aas.13308. Epub 2019 Jan 15.

Prevention of rhabdomyolysis-induced acute kidney injury - A DASAIM/DSIT clinical practice guideline.

Author information

1
Department of Intensive Care, Odense University Hospital, Odense, Denmark.
2
Department of Emergency Medicine, University Hospital Zealand, Køge, Denmark.
3
Department of Intensive Care Unit, Department for Anesthesiology, Regional Hospital Central Jutland, Viborg, Denmark.
4
Cardiothoracic Intensive Care Unit, Department for Anesthesiology, Aalborg University Hospital, Aalborg, Denmark.
5
Department of Anesthesiology, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark.
6
Department of Nephrology 2132, Copenhagen University Hospital, Rigshospitalet, Denmark.
7
Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Denmark.

Abstract

BACKGROUND:

Rhabdomyolysis-induced acute kidney injury (AKI) is a common and serious condition. We aimed to summarise the available evidence on this topic and provide recommendations according to current standards for trustworthy guidelines.

METHODS:

This guideline was developed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The following preventive interventions were assessed: (a) fluids, (b) diuretics, (c) alkalinisation, (d) antioxidants, and (e) renal replacement therapy. Exclusively patient-important outcomes were assessed.

RESULTS:

We suggest using early rather than late fluid resuscitation (weak recommendation, very low quality of evidence). We suggest using crystalloids rather than colloids (weak recommendation, low quality of evidence). We suggest against routine use of loop diuretics as compared to none (weak recommendation, very low quality of evidence). We suggest against use of mannitol as compared to none (weak recommendation, very low quality of evidence). We suggest against routine use of any diuretic as compared to none (weak recommendation, very low quality of evidence). We suggest against routine use of alkalinisation with sodium bicarbonate as compared to none (weak recommendation, low quality of evidence). We suggest against the routine use of any alkalinisation as compared to none (weak recommendation, low quality of evidence). We suggest against routine use of renal replacement therapy as compared to none (weak recommendation, low quality of evidence). For the remaining PICO questions, no recommendations were issued.

CONCLUSION:

The quantity and quality of evidence supporting preventive interventions for rhabdomyolysis-induced AKI is low/very low. We were able to issue eight weak recommendations and no strong recommendations.

PMID:
30644084
DOI:
10.1111/aas.13308

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