Wong FHA, See KC. Critical care considerations in rhabdomyolysis-associated acute kidney injury and kidney replacement therapy. World J Nephrol 2026; 15(2): 118309 [DOI: 10.5527/wjn.v15.i2.118309]
Corresponding Author of This Article
Faith Hui Ai Wong, Department of Medicine, National University Hospital, Level 10 NUHS Tower Block, 119228, Singapore. faithwonghuiai@u.nus.edu
Research Domain of This Article
Urology & Nephrology
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review-article
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Wong FHA, See KC. Critical care considerations in rhabdomyolysis-associated acute kidney injury and kidney replacement therapy. World J Nephrol 2026; 15(2): 118309 [DOI: 10.5527/wjn.v15.i2.118309]
World J Nephrol. Jun 25, 2026; 15(2): 118309 Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.118309
Critical care considerations in rhabdomyolysis-associated acute kidney injury and kidney replacement therapy
Kay Choong See, Faith Hui Ai Wong
Faith Hui Ai Wong, Department of Medicine, National University Hospital, 119228, Singapore
Kay Choong See, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, 119228, Singapore
Author contributions: Wong FHA conducted the literature review and wrote the manuscript; See KC conceptualised the review, critically revised the manuscript, and provided academic supervision. Both authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Faith Hui Ai Wong, Department of Medicine, National University Hospital, Level 10 NUHS Tower Block, 119228, Singapore. faithwonghuiai@u.nus.edu
Received: December 29, 2025 Revised: February 28, 2026 Accepted: March 23, 2026 Published online: June 25, 2026 Processing time: 168 Days and 18.8 Hours
Abstract
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.
Core Tip: Rhabdomyolysis-associated acute kidney injury (AKI) remains a serious concern in critical care, with management strategies often limited by a lack of clinical evidence. This review synthesises underlying pathophysiological mechanisms, current established and novel biomarkers, early AKI risk prediction scores and key management strategies, including fluid resuscitation and addressing debates regarding urine alkalisation and the role of kidney replacement therapy. By integrating a holistic understanding of pathophysiology with evidence-guided clinical practice, this article supports more informed and individualised care for critically ill patients with rhabdomyolysis-associated AKI, while highlighting possible future therapeutic directions.
