Critical care considerations in rhabdomyolysis-associated acute kidney injury and kidney replacement therapy

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Rhabdomyolysis is a frequently seen and potentially severe condition in intensive care, resulting from causes like trauma, infection, drug toxicity, or prolonged immobility. When muscle cells break down, substances such as myoglobin enter the bloodstream, increasing the risk of acute kidney injury (AKI), which greatly affects patient outcomes. Prompt diagnosis, effective fluid management, and supportive care are crucial for reducing kidney-related complications. In more critical situations, standard treatments may not be enough, and kidney replacement therapy (KRT) may be required. This review offers practical, evidence-based guidance on managing AKI associated with rhabdomyolysis, focusing on decision-making in critical care settings. Main topics include understanding disease mechanisms and assessing risk, strategies for fluid resuscitation, managing electrolytes and acid-base balance, and considering additional medications. It also discusses when and how to start KRT, comparing continuous and intermittent methods, and reviews practical aspects of removing myoglobin from circulation. The article highlights new developments, such as early detection biomarkers for AKI and advanced extracorporeal techniques. By combining scientific knowledge with hands-on clinical recommendations, this review helps healthcare professionals provide the best possible care for patients with rhabdomyolysis who develop AKI, including those needing KRT.