Abstract
BackgroundRhabdomyolysis 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.MethodsThis 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 end-points included the incidence of AKI to CKD transition.ResultsAmong 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 m2 in 23 patients; 28.8%) was correlated to the severity of the AKI and serum myoglobin levels > 8000 U/L at admission.ConclusionsSevere 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.
Highlights
Rhabdomyolysis is a life-threatening disease that can lead to severe hyperkalemia, acute kidney injury (AKI) and hypovolemic shock
Beside the severity of the acute condition that led to rhabdomyolysis, life-threatening complications related to the massive muscle cells necrosis include severe hyperkalemia and hypocalcemia, acute kidney injury and hypovolemic shock [4]
Chronic kidney disease was staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification [17] and chronic kidney disease (CKD) progression was estimated by measuring the decrease of estimated glomerular filtration rate (eGFR) at month 3
Summary
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. Beside the severity of the acute condition that led to rhabdomyolysis, life-threatening complications related to the massive muscle cells necrosis include severe hyperkalemia and hypocalcemia, acute kidney injury and hypovolemic shock [4]. Acute kidney injury (AKI) occurs in 19–58% of patients with rhabdomyolysis, depending on the diagnostic. Whether cell lysis-related hyperphosphoremia and subsequent calcium–phosphorus deposition in the kidney may promote AKI is currently unknown. Renal recovery is observed in most survivors but data on the risk of AKI to chronic kidney disease (CKD) transition in this specific setting are scarce [4, 11]
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