Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients

Abstract

Background: Rhabdomyolysis is a life-threatening disease that can lead to severe hyperkalemia, acute kidney injury (AKI) and hypovolemic shock. The predictive factors of AKI and acute to chronic kidney disease (CKD) transition remain poorly described. Methods: This multicenter retrospective study enrolled 387 patients with severe rhabdomyolysis (CPK > 5000 U/L). Primary end-point was the development of severe AKI, defined as stage 2 or 3 of KDIGO classification. Secondary endpoints included the incidence of AKI to CKD transition. Results: Among the 387 patients, 315 (81.4%) developed AKI, including 171 (44.1%) with stage 3 AKI and 103 (26.6%) requiring RRT. Stage 2-3 AKI was strongly correlated with serum phosphate, potassium and bicarbonate at admission, as well as myoglobin over 8000 U/L and the need for mechanical ventilation. 42 patients (10.8%) died before day 28. In the 80 patients with available eGFR values both before and 3 months after the rhabdomyolysis, the decrease in eGFR (greater than 20 mL/min/1.73 m 2 in 23 patients; 28.8%) was correlated to the severity of the AKI and serum myoglobin levels > 8000 U/L at admission. Conclusions: Severe rhabdomyolysis leads to AKI in most patients admitted to an ICU. Mechanical ventilation and severity of the rhabdomyolysis, including myoglobin level, are associated with the risk of stage 2-3 AKI. The long-term renal decline is correlated to serum myoglobin at admission.

The Association Between Illicit Drug Use and the Duration of Renal Replacement Therapy in Patients With Acute Kidney Injury From Severe Rhabdomyolysis

“…The majority of studies in patients with rhabdomyolysis focused on risk factors or prediction of AKI and RRT (3,10,11), but the RRT duration is not always reported. Even a Cochrane review on continuous RRT for rhabdomyolysis did not include RRT duration as an outcome of interest (12).…”

“…However, the French investigators showed that 30% had significant residual impairment. Progression to advanced CKD (eGFR < 30 ml/min/1.73 m 2 ) was also relatively common (11). A smaller study by Rodriguez et al reported that RRT was maintained for 8.3 (range, 2-21) days in 12 patients who needed RRT (of 73 patients with AKI), and no patient remained dialysis-dependent at discharge (3).…”

“…To our knowledge, this study has one of the largest cohorts of RRT-requiring rhabdomyolysis-associated AKI patients reported in the literature. Even a recent French multi-center study of eight ICUs could only include 103 patients with severe rhabdomyolysis and AKI needing RRT (11). Another strength is the use of survival analysis which accounted for the high mortality in this population.…”

Rhabdomyolysis following coronary angiography: an unexpected detection on 99mTc-methyl diphosphonate bone scintigraphy

“…It can cause severe morbidity and mortality from cardiac arrhythmia, hypovolemia, acute kidney injury, electrolyte imbalances and metabolic acidosis if left untreated [5]. A CPK cut-off value of 5000 U/L has been proposed to indicate the risk of developing AKI or death [6].…”

Contrast-Induced Rhabdomyolysis Occurring after ERCP in a Patient with Pancreatic Cancer: A Case Report

“…Renal replacement therapy was indicated as the renal function, metabolic acidosis and electrolyte derangements failed to improve with initial therapy. A review article by Chavez et al noted that, despite the improvements in myoglobin and electrolyte concentrations in patients treated with haemofiltration, the mortality rates of up to 59% with severe forms of rhabdomyolysis remained unchanged [ 1 , 2 ] . This was the case for our patient who developed an upper gastrointestinal bleed after haemofiltration, which was a likely combination of DIC and hepatic impairment that culminated in an unfavourable outcome.…”