Acute Poisoning with Rhabdomyolysis in the Intensive Care Unit: Risk Factors for Acute Kidney Injury and Renal Replacement Therapy Requirement

Pierre-François Rogliano,Bruno Mégarbane,Jean-Louis Laplanche,Isabelle Malissin,Dominique Vodovar,Nicolas Deye,Sebastian Voicu,Laurence Labat

doi:10.3390/toxics8040079

Abstract

Acute kidney injury (AKI) is the major complication of rhabdomyolysis. We aimed to identify the predictive factors for AKI and renal replacement therapy (RRT) requirement in poisoning-associated rhabdomyolysis. We conducted a cohort study including 273 successive poisoned patients (median age, 41 years) who developed rhabdomyolysis defined as creatine kinase (CK) >1000 IU/L. Factors associated with AKI and RRT requirement were identified using multivariate analyses. Poisonings mainly involved psychotropic drugs. AKI occurred in 88 patients (37%) including 43 patients (49%) who required RRT. Peak serum creatinine and CK were weakly correlated (R2 = 0.17, p < 0.001). Death (13%) was more frequent after AKI onset (32% vs. 2%, p < 0.001). On admission, lithium overdose (OR, 44.4 (5.3–371.5)), serum calcium ≤2.1 mmol/L (OR, 14.3 (2.04–112.4)), female gender (OR, 5.5 (1.8–16.9)), serum phosphate ≥1.5 mmol/L (OR, 2.0 (1.0–4.2)), lactate ≥ 3.3 mmol/L (OR, 1.2 (1.1–1.4)), serum creatinine ≥ 125 µmol/L (OR, 1.05 (1.03–1.06)) and age (OR, 1.04 (1.01–1.07)) independently predicted AKI onset. Calcium-channel blocker overdose (OR, 14.2 (3.8–53.6)), serum phosphate ≥ 2.3 mmol/L (OR, 1.6 (1.1–2.6)), Glasgow score ≤ 5 (OR, 1.12; (1.02–1.25)), prothrombin index ≤ 71% (OR, 1.03; (1.01–1.05)) and serum creatinine ≥ 125 µmol/L (OR, 1.01; (1.00–1.01)) independently predicted RRT requirement. We identified the predictive factors for AKI and RRT requirement on admission to improve management in poisoned patients presenting rhabdomyolysis.

Highlights

Rhabdomyolysis is commonly reported in the poisoned patient with variable consequences ranging from a simple increase in serum creatine kinase (CK) to life-threatening electrolyte disturbances and acute kidney injury (AKI) requiring renal replacement therapy (RRT) [1,2]
For rhabdomyolysis in poisonings admitted to the ICU
We found a weak correlation between peak CK and peak creatinine (Figure 2) as previously observed [3,16]

Summary

Introduction

Rhabdomyolysis is commonly reported in the poisoned patient with variable consequences ranging from a simple increase in serum creatine kinase (CK) to life-threatening electrolyte disturbances and acute kidney injury (AKI) requiring renal replacement therapy (RRT) [1,2]. A 13-50% risk of AKI [1,2,3,4] and up to 83% risk of mortality [5] have been reported. Mechanisms by which toxicants cause rhabdomyolysis are variable including prolonged unconsciousness and immobility, agitation, seizures, fall, withdrawal and hyperthermia [1,2]. Nutritional deficiencies, hypophosphatemia and hypokalemia may represent coexistent risk factors for the development of rhabdomyolysis [2]

Objectives

Methods

Results

Discussion

Conclusion