Illicit drug use and acute kidney injury in patients admitted to hospital with rhabdomyolysis.

Abstract

Severe rhabdomyolysis is associated with acute kidney injury, but it is unclear if patients developing rhabdomyolysis after illicit drug use have a higher risk of acute kidney injury compared to other causes. To provide a descriptive analysis of patients admitted with rhabdomyolysis, with a focus on illicit drug use, and to determine if illicit drug use was an independent predictor for acute kidney injury or renal replacement therapy. We conducted a 5-year cohort study of patients admitted to Monash Health, a tertiary referral hospital network. We identified adult patients with muscle injury from ICD-10 AM codes, serum creatine kinase level greater than 1000 U/mL, and a clinical history consistent with rhabdomyolysis. We determined the prevalence and type of illicit drug involved and determined the association between illicit drug use and renal outcomes by logistic regression. Of 643 patients, illicit drug use was identified in 12%. Acute kidney injury developed in 51%, and 5% required renal replacement therapy. Compared to the rest of the cohort, patients who used illicit drugs were younger and had higher peak serum creatine kinase, and developed a higher severity of acute kidney injury. In multivariable analysis, the factors associated with acute kidney injury were illicit drug use, peak creatine kinase, cardiovascular disease, concurrent sepsis and a clinically-evident pressure injury. Chronic kidney disease and need for fasciotomy were additional risk factors for renal replacement therapy. Illicit drug use was associated with acute kidney injury and renal replacement therapy independent of creatine kinase levels.