Objective To investigate the therapeutic dose of continuous hemofiltration in relation to the prognosis of critical rhabdomyolysis (RM). Methods A total of 47 RM patients were randomized into 2 groups: group A (n=26) treated with continuous venovenous hemofiltration (CVVH), and group B (n=21) treated with high volume hemofiltration (HVHF). Serum myoglobin (Mb), biochemistry parameters, tumor necrosis factor-α (TNF-α) and IL-6, and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were measured after the treatment for 24 hours. Changes of serum TNF-α after the treatment for 24, 48, 72, 96 and 120 hours were analyzed in association with the prognosis in the 2 groups. Results (a) After the presence of RM for 24～48h, the incidence of critical signs such as hypotension, acute kidney injury (AKI), hyperkalemia and acute respiratory distress syndrome (ARDS) were similar between the 2 groups (P＞0.05). (b) After treatment, APACHEⅡ score improved remarkably in the 2 groups (P＜0.05). Twenty-nine patients (61.70%) progressed into diuresis stage after treatment for 9.3±3.7 days. Eighteen patients (38.29%) showed delayed recovery of renal function, of which the incidence was 50% and 23.81% in group A and B (P＜0.05), respectively. (c) In the patients with delayed recovery of renal function, 12 patients (66.66%) passed through the oliguria stage after 24.2±4.2 days, while the remaining 6 patients (33.33%) died of acute hepatic failure, disseminated intravascular coagulation (DIC), severe craniocerebral injury or superinfection. (d) In patients showing recovery of renal function after the treatment for 24-48 hours, serum TNF-α was significantly lower than that before treatment (P＜0.05). In the dead patient, however, serum TNF-α decreased insignificantly or even increased. The decrease of serum TNF-α occurred earlier for 24 hours in group B than in group A. After the treatment for 120 hours, the clearance of TNF-α was higher in group B than in group A, and the mortality rate was lower in group B than in group A (P＜0.05). Conclusions Delayed recovery of renal function was closely related to the death of the patients. Due to the higher volume exchange of fluid, HVHF can efficiently displace fluid with blood, fluid in lymph system, tissue and intracellular compartments, decrease the concentration of inflammatory mediators in histiocytes, and protect the function of endothelial cells and epithelial cells. HVHF is useful to prevent DIC and multiple organ dysfunction syndrome (MODS), and thus provides the opportunity to reconstruct renal function in critical RM patients.