Rhabdomyolysis among Critically Ill Combat Casualties: Long-Term Outcomes

Abstract

Background: Although rhabdomyolysis has been associated with acute kidney injury and mortality in the short term, the long-term consequences of an episode of rhabdomyolysis remain unknown. We sought to identify the long-term outcomes of rhabdomyolysis, including mortality, renal function, and incidence of hypertension (HTN), among service members initially admitted to the intensive care unit after sustaining a combat injury in Iraq or Afghanistan between February 1, 2002 and February 1, 2011. Methods: Information on age, sex, injury severity score, mechanism of injury, serum creatinine, burn injury, presenting mean arterial pressure, and creatine kinase were retrospectively collected and analyzed for 2,208 patients. Standard descriptive tests were used to compare characteristics of patients with and without rhabdomyolysis. Competing risk Cox proportional hazards models were performed to assess the associated risk of rhabdomyolysis with both HTN and poor renal function. Results: While rhabdomyolysis was associated with HTN on univariate analysis (hazard ratio [HR] 1.30, 95% CI 1.03–1.64; p = 0.029), this difference did not persist on multivariable analysis (HR 1.27, 95% CI 0.99–1.62; p = 0.058). The median estimated glomerular filtration rate (eGFR) was 119 (interquartile range [IQR] 103–128) among those with rhabdomyolysis, compared with 108 (IQR 94–121) in the group without rhabdomyolysis (p < 0.001). Conclusion: After adjustment, patients with rhabdomyolysis were not at an increased risk of HTN compared to patients without rhabdomyolysis. eGFR was paradoxically higher in patients with rhabdomyolysis. There was no association found between rhabdomyolysis and mortality.

Cilastatin Ameliorates Rhabdomyolysis-induced AKI in Mice

“…These patients have elevated risk of developing CKD and hypertension, and in this context, AKI independently quadruples the risk of subsequent CKD 5 . However, a subsequent study by the same investigators in a similar population did not support a strong independent relationship between rhabdomyolysis alone and subsequent CKD 31 . We found progressive decline in GFR after rhabdomyolysis, accompanied by persistent proteinuria, both mediated by megalin.…”

“…5 However, a subsequent study by the same investigators in a similar population did not support a strong independent relationship between rhabdomyolysis alone and subsequent CKD. 31 We found progressive decline in GFR after rhabdomyolysis, accompanied by persistent proteinuria, both mediated by megalin. These findings further support rhabdomyolysis-induced AKI-CKD transition and www.jasn.org BASIC RESEARCH provide data that we hope may assist in future clinical studies.…”

Capillary rarefaction is more closely associated with CKD progression after cisplatin, rhabdomyolysis, and ischemia-reperfusion-induced AKI than renal fibrosis

“…These data are consistent with limited long-term outcome studies in mice and rats with Rb-AKI, showing that renal function is only mildly impaired 30Ϫ60 days after injury (4, 62). In addition, limited outcome data in combat casualties who developed dialysis-dependent AKI as a result of traumatic rhabdomyolysis indicate that creatinine-based GFR estimates return to baseline on long-term followup (8,20). However, proteinuria develops in~25% of patients on long-term followup (8), suggesting that there may be chronic tubular and/or glomerular injury in patients after severe traumatic Rb-AKI.…”

Paediatric rhabdomyolysis: A UK centre's 10‐year retrospective experience

“…In the adult literature, Faulk et al . explored the risk for development of hypertension and CKD in 675 critically injured combat patients who developed rhabdomyolysis, compared to a control group of injuries without rhabdomyolysis 24 . The authors report that over an average of 4‐year follow‐up, hypertension diagnosis was increased on univariate analysis, but not multivariate.…”