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

Lim, Andy K.H.; Azraai, Meor; Pham, Jeanette H; Looi, Wenye F; Bennett, Caitriona

doi:10.3389/fmed.2020.588114

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…In our present cohort, the common causes were trauma, heat stroke, and vascular ischemia. Trauma and vascular ischemia had been widely reported as major causes of RM as well [21,22]. Compared with previous studies, a higher proportion of heat stroke was found in our cohort.…”

Section: Discussioncontrasting

confidence: 76%

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Earlier CRRT is Associated with Reduced Mortality in Rhabdomyolysis Patients

Bai

et al. 2022

Preprint

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Background: Continue renal replacement therapy (CRRT) is commonly employed for rhabdomyolysis (RM) patients. However, the optimal initiation timing of CRRT and prognostic factors were not well evaluated for patients with RM. We aimed to investigate the efficacy of CRRT timing on mortality and the risk factors of death in RM patients who accepted CRRT.Methods: RM patients who received CRRT between May 2010 and May 2021 in our center were retrospectively included. The primarily endpoint was 90-day mortality. Univariate and multivariate logistic analyses were performed to identify the risk factors of 90-day mortality.Results: A total of 134 patients were included in our present study. The 90-day mortality rate was 38.06%. Most of the patients (88.81%) reached peak creatine kinase (CK) within 72 hours after admission, and 58 (43.28%) patients received CRRT before the peak CK occurrence (earlier CRRT) and 76 (56.72%) of patients had CRRT after the peak CK occurrence (later CRRT). Multivariate logistic regression analysis showed that CRRT initiation after the peak CK occurrence (OR = 3.74, 95%CI 1.17-11.95, p = 0.026), the elevated serum cTnI (OR = 1.23, 95%CI 1.02-1.49, p = 0.032), and the need of mechanical ventilation support (OR = 7.18, 95%CI 1.67-30.83, p = 0.008) were independent risk factors of 90-day mortality. Similar results were obtained in a subgroup analysis of patients with acute kidney injury (AKI).Conclusions: Earlier CRRT initiation before the peak CK occurrence was associated with lower 90-day patient mortality.

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Section: Discussioncontrasting

confidence: 76%

“…Half of the patients need aggressive therapies such as mechanical ventilation (45.52%), vasoactive drugs (37.31%), and blood transfusion (60.3%). Most likely, the disease severity of the included patients mainly contributed to relatively high 90-day mortality rate (38.1%), which in the upper range of the previous reports (20.5%-40%) [8,22].…”

Section: Discussionmentioning

confidence: 78%

Earlier CRRT is Associated with Reduced Mortality in Rhabdomyolysis Patients

Bai

et al. 2022

Preprint

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“…RM may develop due to a wide range of traumatic and non-traumatic insults (metabolic, infectious, immune-mediated and toxic), including drugs [3] [6] [7]. RM may lead to severe renal damage, acute and chronic kidney injury requiring temporary or long-term renal-replacement therapy [6] [7] [8].…”

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis after the Intake of Illicit Drugs as a Cause of Acute Renal Failure

Nikolova¹,

Kotseva²,

Monov³

et al. 2022

OJNeph

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Background: Rhabdomyolysis (RM) is striate muscle-cell damage with the release of intracellular substances to the circulation-myoglobin, muscular enzymes, potassium, etc., with or without the development of acute renal injury. RM due to the intake of illicit and controlled substances, including cocaine, amphetamine and its derivates, cannabis, and alcohol abuse is a common cause of acute renal failure in adolescents and adults. Aim: to alert clinicians to the need of early diagnosis and treatment of RM due to the intake of controlled substances and energy drinks. Case Presentation: We describe a 20-year-old male patient with acute renal failure due to rhabdomyolysis after the intake of controlled substances, energy drinks, physical efforts and dehydration. The renal biopsy revealed acute tubular injury. After rehydration, alkalization, temporary dialysis treatment, intravenous corticosteroids and symptomatic treatment the patient restored renal function. Conclusion: RM can be a severe life-threatening complication of the intake of controlled substances combined with strenuous physical activity, energy drinks and dehydration. The described case represents a typical scenario of RM developing secondary to controlled substance abuse in combination with alcohol and strenuous physical activity. The prompt diagnosis and the timely initiation of supportive (rehydration and alkalization) and corticosteroid therapy and the early dialysis lead to fast resolution of renal failure. The clinicians should keep in mind illicit drugs, alcohol and energy drinks and physical efforts as possible triggers of RM and acute kidney injury, especially in young people.

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“…123 (2022) No. 4, p. 266-278 patients requiring RRT at 3 months (Lim et al, 2020). Chronic methamphetamine use can result in end-stage renal disease even without a sentinel event of rhabdomyolysis (Foley et al, 1984;Baradhi et al, 2019).…”

Section: )mentioning

confidence: 99%

Pervitin Intoxication with Two-peak Massive Myoglobinemia, Acute Kidney Injury and Marked Procalcitonin Increase Not Associated with Sepsis

2022

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Patients intoxicated with methamphetamine-like substances may present with myoglobinuria but rarely require admission. An 18-year-old female was admitted due to intoxication with pervitin, a methamphetamine derivative. She presented with an altered mental status, fever, and increased heart and respiratory rates. Biomarkers showed leukocytosis and markedly increased procalcitonin levels, suggestive of sepsis. However, blood cultures and infectious disease workup were unrevealing. Clinical course was heralded by rhabdomyolysis and myoglobinuria resulting in multi-organ failure including respiratory failure necessitating mechanical ventilation, hemodynamic compromise with need for inotropic support, and an acute renal failure requiring renal replacement therapy. Surprisingly, after a transient improvement, an unexpected second peak of myoglobin was observed on hospital day 5, controlled by intensifying the elimination methods, and administration of dantrolene. Acute kidney injury resolved by hospital day 15, and the patient could be discharged on day 22. While most patients with intoxications are discharged within 24 hours from emergency departments without being admitted, our case report highlights that the organ injury may evolve beyond the usual observation period, traditional renal-replacement therapies may not be sufficient to mitigate myoglobinemia with resulting acute kidney injury, and that procalcitonin may not be a reliable biomarker of infection in the setting of drug-induced rhabdomyolysis.

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

Cited by 8 publications

References 15 publications

Earlier CRRT is Associated with Reduced Mortality in Rhabdomyolysis Patients

Earlier CRRT is Associated with Reduced Mortality in Rhabdomyolysis Patients

Rhabdomyolysis after the Intake of Illicit Drugs as a Cause of Acute Renal Failure

Pervitin Intoxication with Two-peak Massive Myoglobinemia, Acute Kidney Injury and Marked Procalcitonin Increase Not Associated with Sepsis

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