Rhabdomyolysis‐associated acute kidney injury: clinical characteristics and intensive care unit transfer analysis

Abstract

Background: Rhabdomyolysis (RM) associated acute kidney injury (AKI) is the most common systemic complication of RM. The present study aimed to assess the clinical characteristics and risk factors for intensive care unit (ICU) transfer for patients with RM-associated AKI.Methods: We included all patients who were age ≥ 18 years old with a diagnosis of RM from September 2012 to October 2018 and divided them into RM-associated AKI group and RM without AKI group. The primary outcome was transferring to ICU treatment. Regression analysis was performed to identify factors associated with ICU treatment and recovery of renal function.Results: Among the 149 patients with RM, 68 (45.6%) developed AKI. The percentage of patients with AKI who transferred to ICU was higher than patients without AKI (33.8% versus 12.3%, P < 0.002). Additionally, patients with AKI had higher percentage of undergoing dialysis (19.1% versus 2.5%, P < 0.01), all-cause mortality (13.2% versus 1.2%, P < 0.01), cost of hospitalization [10.8 1,000 yuan, IQR (5.5, 3.5) versus 5.9 1,000 yuan, IQR 5.9 (3.6, 9.9), P = 0.03], as well as longer length of hospital stay [8.0 (5.0, 14.0)] versus [6.0 (4.0, 11.0)], P = 0.02). Moreover, most patients with AKI achieved complete recovery (77.9%) at discharge. After adjusting for potential risk factors, RM-associated AKI remained an independent risk factor for ICU transfer (OR = 3.0, 95% CI, 1.11-8.3, P = 0.03). However, ICU transfer was not associated with recovery of renal function (OR = 0.88, 95% CI, 0.22-3.57, P = 0.856). Conclusion: RM leaded to AKI in most patients. RM-associated AKI could cause worse clinical outcome and predict ICU transfer for patients with RM.

Predictive value of serum myoglobin and lactate dehydrogenase in rhabdomyolysis-induced acute kidney injury from severe heatstroke

“…Severe heatstroke patients often develop RM, possibly due to disrupted thermoregulatory center function and loss of water, electrolytes, and membrane channel integrity under prolonged high temperature and thermal radiation, affecting skeletal muscle energy metabolism [16]. Clinically, RM is frequently associated with AKI, attributed to reduced renal perfusion from effective circulatory volume depletion, potentially causing ischemic rhabdomyocyte necrosis and subsequent renal tubular obstruction [17,18]. Existing biomarkers for AKI in severe heatstroke with RM are often insufficient and can be influenced by various factors.…”

Iron as an emerging therapeutic target in critically ill patients

“…In cases of severe muscle injury (rhabdomyolysis), much myoglobin (and consequently iron) can be released into the bloodstream [ 54 ]. Rhabdomyolysis is an acute syndrome characterized by skeletal muscle injuries resulting from trauma, inflammation, or ischemia, which leads to the release of breakdown products, including myoglobin [ 55 ]. AKI often occurs as a complication of rhabdomyolysis due to myoglobin-induced renal toxicity [ 54 , 56 ].…”

Investigating raised creatine kinase

“…Myoglobinuria is frequently seen in rhabdomyolysis but is not often directly measured; an approximate surrogate is the use of 2+haematuria on dipstick urine testing without detectable red cells on urine microscopy 21. Patients with rhabdomyolysis and acute kidney injury have worse outcomes22 and require urgent assessment and consideration for admission, since dialysis may be required. If creatine kinase is >50×ULN and renal function is normal, then a referral to a metabolic/neurology clinic is appropriate to investigate a possible metabolic or genetic myopathy, such as muscular dystrophy syndromes.…”