Nelly Candela1, Stein Silva2, Bernard Georges3, Claire Cartery4, Thomas Robert5, Julie Moussi-Frances5, Eric Rondeau6, Jean-Michel Rebibou7, Laurence Lavayssiere1, Julie Belliere1, Thierry Krummel8, Céline Lebas9, Olivier Cointault1, Marion Sallee5,10, Stanislas Faguer11,12. 1. Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Intensive Care Unit, Centre Hospitalo-Universitaire de Toulouse, 1, Avenue Jean Poulhes, 31059, Toulouse, France. 2. Réanimation-URM, Hôpital Purpan, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France. 3. Département d'Anesthésie et Réanimation-Unité de Réanimation Polyvalente, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France. 4. Service de Néphrologie, Centre Hospitalier de Valenciennes, Valenciennes, France. 5. Service de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Centre Hospitalo-Universitaire de Marseille, Marseille, France. 6. Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France. 7. Service de Néphrologie, Centre Hospitalo-Universitaire de Dijon, Dijon, France. 8. Service de Néphrologie, Centre Hospitalo-Universitaire de Strasbourg, Strasbourg, France. 9. Service de Néphrologie, Centre Hospitalo-Universitaire de Lille, Lille, France. 10. Institut National de la Science et de la Recherche Médicale, Institut National de la recherche Agronomique, Université Aix-Marseille, C2VN, Marseille, France. 11. Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Intensive Care Unit, Centre Hospitalo-Universitaire de Toulouse, 1, Avenue Jean Poulhes, 31059, Toulouse, France. stanislas.faguer@inserm.fr. 12. Institut National de la Science et de la Recherche Médicale, Unité 1048 (équipe 12-Fibrose rénale: détection et mécanismes de progression), Paris, France. stanislas.faguer@inserm.fr.
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 end-points 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 m2 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.
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 end-points 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 m2 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.