Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis

Fernandez, William G.; Hung, Oliver L.; Bruno, G; Galea, Sandro; Chiang, William K.

doi:10.1016/j.ajem.2004.09.025

Cited by 93 publications

(68 citation statements)

References 36 publications

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“…Fernandez et al [13] found that the only variable that was predictive of both ARF and need for hemodialysis in separate multivariate regression models was initial serum creatinine. No patient developed ARF with initial creatinine less than 1.7 mg/dL [13]).…”

Section: Discussionmentioning

confidence: 99%

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Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients

Bhavsar

Rathod

et al. 2012

Indian J Surg

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Rhabdomyolysis due to trauma and burns is an important cause of acute renal failure (ARF) secondary to myoglobinuria. To prevent morbidity and mortality from ARF due to rhabdomyolysis, early detection of ARF by monitoring the biochemical parameters such as serum creatinine, serum creatine kinase (CK), and urinary myoglobin (UM) can be helpful. The aims of the study were (1) to detect ARF due to rhabdomyolysis using serum creatinine, serum CK, and UM in trauma and electrical burn patients (2) to compare utility of these parameters in early prediction of ARF in patients of rhabdomyolysis. A total of 50 patients with trauma and electrical burns were included in the study. Serum creatinine, serum CK, and UM measurements were done at the time of admission and after 48 h. Diagnosis of ARF was made in the patients by Rifle's criteria. The presence of significant elevation of creatinine, serum CK, and UM at the time of admission and after 48 h was compared in patients developing ARF by Fisher's exact test. Fifteen of the 50 patients developed ARF as per the defined criteria. Of these, 9 patients (60%) had raised level of serum creatinine above 1.4 mg% at admission and 14 patients (93.33%) had CK level >1250 U/L at admission, whereas UM was positive in 6 (40%) patients. Serum creatinine was significantly raised in all of the 15 ARF patients (100%) after 48 h of admission and serum CK was raised in 14 of the 15 ARF patients (93.33%). UM was negative in all the patients after 48 h of admission. Statistical analysis showed that rise in serum CK on admission was significantly increased in patients developing ARF as compared with serum creatinine and UM (P<0.0001). On admission, CK is a better predictor of ARF due to rhabdomyolysis than creatinine and UM. Initial creatinine is a better predictor of ARF due to rhabdomyolysis than UM. UM assay is not a good investigation for early prediction of ARF in rhabdomyolysis.

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Section: Discussionmentioning

confidence: 99%

“…No patient developed ARF with initial creatinine less than 1.7 mg/dL [13]). On the other hand, the present study showed that only 9 of the 15 (60%) patients who developed ARF had significantly raised initial creatinine.…”

Section: Discussionmentioning

confidence: 99%

Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients

Bhavsar

Rathod

et al. 2012

Indian J Surg

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“…Some observational studies lack the patient-level data needed to adequately adjust for comorbid illness, and utilize limited registry data to categorize AKI (15). Small sample sizes of studies with patientlevel data have had limited ability to detect novel mediators of mortality or the provision of dialysis after the occurrence of AKI (16,17). Finally, few studies have accurately established the date of the onset of AKI.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Death and Dialysis in Severe AKI

Wilson

Yang

Feldman

2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives AKI carries a substantial risk of mortality, even after adjustment for comorbidities. Effective risk stratification may lead to more effective therapeutic interventions for high-risk subgroups.Design, setting, participants, & measurements This study identified adults who suffered severe in-hospital AKI from January 1, 2004 to August 31, 2010 at three hospitals in the University of Pennsylvania Health System (UPHS). Patients were included if baseline creatinine was #1.4 mg/dl for men or #1.2 mg/dl for women, and serum creatinine doubled during the hospital admission. Cox proportional hazards models predicting death, dialysis, or a combined endpoint of death or dialysis were fit using data from patients admitted to the Hospital of the University of Pennsylvania (n=4263), and validated at the two other UPHS facilities (n=758, n=1098).Results In adjusted analyses, strong predictors of the combined endpoint included intensive care unit location (versus floor), medical service, liver disease, higher creatinine, greater rate of change in creatinine, and greater number of pressor medications. Higher absolute creatinine concentration was associated with greater use of dialysis, but lower overall mortality in adjusted analyses. Harrell's c-index (95% confidence interval) for the model predicting the combined endpoint was 0.85 (0.84-0.86) in the derivation cohort, and 0.83 (0.80-0.86) and 0.84 (0.82-0.86) in the validation cohorts.Conclusions A small group of easily measured clinical factors has good ability to predict mortality and dialysis in severe AKI.

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“…AKI is a serious and often life-threatening complication of rhabdomyolysis and requires immediate diagnosis and emergency treatment (9,33,34). AKI is believed to be due to decreased extracellular volume, which results in renal vasoconstriction.…”

Section: Discussionmentioning

confidence: 99%

“…Medical Science and Discovery, 2016; 3(1): [28][29][30][31][32][33][34] rhabdomyolysis-induced AKI is higher in patients with CK levels at admission more than 5000 IU/L (16).…”

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confidence: 99%

Admission Characteristics and Outcomes of ED Patients With Rhabdomyolysis

Golcuk

Ozsarac

et al. 2016

Med Sci and Discov

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Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis

Abstract: Acute renal failure and need for HD are common complications of rhabdomyolysis. Except for initial serum Cr and blood urea nitrogen, clinical and laboratory factors were not reliable predictors for the development of ARF or need for HD.

Cited by 93 publications

References 36 publications

Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients

Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients

Predictors of Death and Dialysis in Severe AKI

Admission Characteristics and Outcomes of ED Patients With Rhabdomyolysis

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