Relation between Serum Creatine Phosphokinase Levels and Acute Kidney Injury among ST-Segment Elevation Myocardial Infarction Patients

Abstract

Background: Among patients with rhabdomyolysis, the leakage of intracellular skeletal muscle content such as creatine phosphokinase (CPK) into the bloodstream has been associated with an increased risk of acute kidney injury (AKI). We evaluated the possible relationship between serum CPK levels and AKI occurrence among patients with myocyte injury secondary to ST-elevation myocardial infarction (STEMI). Methods: We retrospectively included 2794 patients with STEMI. Patients were stratified according to peak serum CPK levels into mild (<1000 U/L, n = 1603), moderate (1000–5000 U/L, n = 1111), and severe (>5000 U/L, n = 80) categories. The occurrence of AKI was defined by the KDIGO criteria as an increase in serum creatinine (sCR) ≥0.3 mg/dL within 48 h following PCI. The predictive value of CPK for the risk of AKI occurrence was assessed using multivariate logistic regression models. Results: The overall occurrence of AKI was 10.4%. Incidence of AKI showed a gradual increase between patients with mild, moderate, and severe serum CPK level elevations (7.8% vs. 11% vs. 26% respectively; p < 0.001). In multivariate logistic regression models, both moderate or higher (OR 1.6, 95% CI 1.1–2.2; p = 0.01) and severe (OR 2.8 95% CI 1.4–5.6; p = 0.004) serum CPK level elevations were independently associated with AKI. Conclusions: Among STEMI patients, elevated CPK levels were associated with AKI. This association is presumably independent; however, it remains unclear whether it is due to direct toxic (myoglobin-related) or hemodynamic effects (poor left ventricular function). Further studies are required to reveal the underlying mechanism.

Administration of a single dose of lithium ameliorates rhabdomyolysis-associated acute kidney injury in rats

“…Moreover, myoglobin is reabsorbed by the proximal tubule cells and promotes oxidative stress, resulting in cortical acute tubular necrosis which is the hallmark of renal pathology in this model [ 11 ]. Thus, since higher CPK levels were associated with acute renal failure and the need for renal replacement therapy in patients [ 51 ], our findings suggest that therapeutic targeting of GSK3β with lithium treatment initially ameliorated rhabdomyolysis-induced AKI probably due to a decrease in CPK plasma levels.…”

Improvement of microvascular complications in STZ-diabetic rats treated with Pterocarpus erinaceus Poir. extract

“…Hepatic steatosis also increases oxidative stress through significant lipid metabolism [ 45 ]. Serum total CPK and proteinuria are predictive markers of heart and kidney damage [ 37 , 46 ]. Significantly elevated serum levels of CPK and LDL-cholesterol, as well as the presence of albuminuria, are often associated with cardiovascular events and nephrotic syndrome [ 46 , 47 ].…”

“…Serum total CPK and proteinuria are predictive markers of heart and kidney damage [ 37 , 46 ]. Significantly elevated serum levels of CPK and LDL-cholesterol, as well as the presence of albuminuria, are often associated with cardiovascular events and nephrotic syndrome [ 46 , 47 ]. Administration of P. erinaceus extract and glibenclamide for three weeks caused a significant decrease (p < 0.001) in transaminases (ALT, AST), triglycerides, LDL-cholesterol and CKP in diabetic rats.…”

Predictors and Prognostic Impact of Early Acute Kidney Injury in Cardiogenic Shock: Results from a Monocentric, Prospective Registry

“…Furthermore, rhabdomyolysis may further contribute to the occurrence of AKI. Zahler et al [41] recently demonstrated that increased levels of creatine phosphokinase were associated with the occurrence of AKI in 2,794 patients with STEMI. In line with this, hemolysis was shown to further contribute to AKI [42].…”