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CytoSorb® is CE-mark approved in the E.U. In the U.S., CytoSorb® and DrugSorb-ATR® are investigational devices not yet FDA authorized/approved/cleared.
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Kidney

Managing myoglobin levels to support the kidneys

Rhabdomyolysis leads to the release of myoglobin into the bloodstream. Elevated circulating myoglobin levels may accumulate in the kidneys and are associated with the development of acute kidney injury (AKI). CytoSorb® may be used to manage conditions where myoglobin levels are high such as Rhabdomyolysis and/or AKI to support kidney health and is approved, according to its intended use and applicable regulatory approvals, for the extracorporeal removal of myoglobin from blood.

CytoSorb® in severe Rhabdomyolysis

 

In cases of severe rhabdomyolysis, large amounts of myoglobin are released into the bloodstream and can contribute to the development of acute kidney injury (AKI).

 

CytoSorb® Therapy is an extracorporeal hemoadsorption technology designed to remove selected middle-molecular-weight and hydrophobic substances such as myoglobin and cytokines from whole blood.

 

It can be applied alongside conventional renal-replacement therapies as part of a multimodal treatment approach aimed at supporting blood purification and reducing the burden of circulating inflammatory and myoglobin, thereby targeting preservation and recovery of renal function.

CytoSorb® is designed to support extracorporeal management in patients with severe rhabdomyolysis

Manage rhabdomyolysis

CytoSorb has been shown to effectively and safely remove elevated levels of myoglobin, while additionally addressing concomitant hyperinflammation, helping in the management of rhabdomyolysis.

Rhabdomyolysis can cause serious damage:

Rapid breakdown of the skeletal muscles
Myoglobin released into the bloodstream
Myoglobin accumulates in renal tubules
Excessive myoglobin levels may result in:
  • Oxidative stress
  • Inflammatory response
  • Endothelial dysfunction
  • Renal vasoconstriction
  • Apoptosis
  • Cellular and granular casts
As a consequences this may result in AKI - Akute Kidney injury
  • Rapid breakdown of the skeletal muscles
  • Myoglobin released into the bloodstream
  • Myoglobin accumulates in renal tubules
  • Excessive myoglobin levels may result in:
    • Oxidative stress
    • Inflammatory response
    • Endothelial dysfunction
    • Renal vasoconstriction
    • Apoptosis
    • Cellular and granular casts
  • As a consequences this may result in AKI - Akute Kidney injury

CytoSorb® Therapy adsorbs elevated levels of myoglobin, supporting blood purification in patients with rhabdomyolysis and kidney stress.

Effective myoglobin removal
Superior performance vs standalone HCO-filter
Supporting control of concomitant hyperinflammatory

Rhabdomyolysis

General Treatment Goals

CytoSorb Therapy is intended to reduce excessive levels of myoglobin and cytokines. This treatment approach might support preserving or restoring kidney function by reducing tissue risk factors such as tubular cast formation as well as local and systemic inflammation processes.

  		•
    Patient Selection
    Timing
    Dosing

    Highly Recommended

    Acute severe rhabdomyolysis with CK > 5,000 U/l and

    • Myoglobin > 30,000 μg/l OR
    • Myoglobin > 10,000 μg/l plus new impairment of kidney function
    • Start within 12-24 hrs. after onset
    • Exchange: Adsorber changes after 6 hrs. if ongoing reduction is needed
    • Duration: Continuation until myoglobin levels consistently well < 5000 μg/l

    Recommended

    Acute severe rhabdomyolysis with CK > 5,000 U/l and

    • Myoglobin > 10,000 μg/l
    • Intensified fluid therapy NOT possible
    • Start within 24-36 hrs.
    • Exchange: Change after 8 hrs. if ongoing reduction is needed
    • Duration: Continuation until myoglobin
      levels consistently well < 5000 μg/l

    Highly Recommended

    Acute severe rhabdomyolysis with CK > 5,000 U/l and

    • Myoglobin > 30,000 μg/l OR
    • Myoglobin > 10,000 μg/l plus new impairment of kidney function
    • Start within 12-24 hrs. after onset
    • Exchange: Adsorber changes after 6 hrs. if ongoing reduction is needed
    • Duration: Continuation until myoglobin levels consistently well < 5000 μg/l

    Recommended

    Acute severe rhabdomyolysis with CK > 5,000 U/l and

    • Myoglobin > 10,000 μg/l
    • Intensified fluid therapy NOT possible
    • Start within 24-36 hrs.
    • Exchange: Change after 8 hrs. if ongoing reduction is needed
    • Duration: Continuation until myoglobin
      levels consistently well < 5000 μg/l

  • Principles

    • Start early enough to catch bulk of myoglobin before tubuli are severely damaged
    • Exchange frequently to allow maximum removal effect

  • Therapy Goals

    • Prevention of rhabdomyolysis-induced AKI or
    • Support renal recovery in rhabdomyolysis-induced AKI

Additional Information

Download file
Flowchart Evolution of evidence Recommended literature
  • Albrecht et al., Blood Purif 2024; 53(2):88-95
  • Grafe et al., Ren Fail 2023; 45(2):2259231
  • Scharf et al., Crit Care 2021; 25(1):41
  • Chavez et al., Crit Care 2016; 20(1):135
  • Boutaud et al., Proc Natl Acad Sci USA 2010; 107(6):2699-704
  • Bosch et al., N Engl J Med 2009; 361(1):62-72
  • Khan et al., Neth J Med 2009; 67(9):272-283
  • Chatzizisis et al., Eur J Intern Med 2008; 19(8):568-574
  • Jansen et al., Crit Care 2023; 27(1):117
  • Weidhase et al., BMC Nephrology (2025) 26:23
  • Graf et al., Annals of Intensive Care 2024; 14(1):96
  • Forni et al., BMC Nephrology 2024; 25(1):247

CytoSorb 300 IFU 03/2023 – Indications:
CytoSorb is indicated for use in conditions where elevated levels of cytokines and/or bilirubin and/or myoglobin exist. CytoSorb is indicated for use intraoperatively during cardio-pulmonary bypass surgery for the removal of P2Y12-Inhibitor Ticagrelor and/or Factor Xa-Inhibitor Rivaroxaban. Results from current studies suggest that CytoSorb may be administered for up to 7 consecutive days. Maximum Treatment Time per Device: 24 Hour.

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