Acute Kidney Injury in Hospitalized Patients With Exertional Rhabdomyolysis.

JAMA Netw Open

Department of Nephrology, The Permanente Medical Group, Santa Rosa, California.

Published: August 2024

AI Article Synopsis

  • A study was conducted to explore the connection between serum creatine kinase (CK) levels and the development of acute kidney injury (AKI) in hospitalized patients with exertional rhabdomyolysis (ERM).
  • Data from 200 patients, identified through a review of medical records from 2009 to 2019, showed that 8.5% developed AKI, with no cases of chronic kidney disease (CKD) or fatalities reported.
  • The findings indicated that there was no link between CK levels and AKI risk, but certain cofactors were identified that could heighten the likelihood of kidney injury in these patients.

Article Abstract

Importance: An association between serum creatine kinase (CK) levels and the risk of kidney failure in patients with exertional rhabdomyolysis (ERM) has been suggested. However, the actual incidence of AKI in hospitalized patients with ERM along with the contributing cofactors that may increase the risk of AKI have rarely been investigated.

Objectives: To examine the incidence of kidney injury in hospitalized patients with ERM and to identify additional cofactors that might contribute to the development of kidney injury in patients with ERM.

Design, Setting, And Participants: This retrospective cohort study was conducted in a diverse community population of patients 18 years or older with ERM who were hospitalized across Kaiser Permanente Northern California between January 1, 2009, and December 31, 2019. Patients were initially identified through electronic screening for all-cause rhabdomyolysis admissions, followed by manual medical record reviews to verify their eligibility for the study. The diagnosis of AKI and chronic kidney disease (CKD) was determined using KDIGO (Kidney Disease Improving Global Outcomes) criteria and confirmed by medical record review. Data analysis was performed from October 1, 2023, to January 31, 2024.

Exposures: History of strenuous physical exercise before hospitalization for ERM.

Main Outcome And Measures: Development of AKI, CKD, and compartment syndrome and number of deaths.

Results: Among 3790 patients hospitalized for rhabdomyolysis between 2009 and 2019 in Kaiser Permanente Northern California, 200 (mean [SD] age, 30.5 [8.5] years; 145 [72.5%] male) were confirmed to have ERM via medical record review. Seventeen patients (8.5%) developed AKI, none developed CKD, 1 (0.5%) developed compartment syndrome, and there were no fatalities. There was no association between serum CK levels and the risk of AKI. However, the risk of AKI was significantly higher in patients with ERM who used nonsteroidal anti-inflammatory drugs (NSAIDs) before admission (11 of 17 with AKI [64.7%] vs 40 of 183 without AKI [21.9%], P < .001) or experienced dehydration (9 of 183 without AKI [52.9%] vs 9 of 17 with AKI [4.9%], P < .001). This analysis suggests that eliminating preadmission NSAID use and dehydration could reduce the risk of potential AKI in patients with ERM by 92.6% (95% CI, 85.7%-96.1%) in this population.

Conclusions And Relevance: The findings of this cohort study of hospitalized patients with ERM suggest that serum CK elevation alone is insufficient as an indicator of AKI in patients with ERM. Concurrent risk factors, such as NSAID use or dehydration, may be associated with AKI development in patients with ERM.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11322840PMC
http://dx.doi.org/10.1001/jamanetworkopen.2024.27464DOI Listing

Publication Analysis

Top Keywords

kidney injury
12
hospitalized patients
12
patients erm
12
risk aki
12
medical record
12
patients
10
aki
9
injury hospitalized
8
patients exertional
8
exertional rhabdomyolysis
8

Similar Publications

The causal relationship of cigarette smoking to metabolic disease risk and the possible mediating role of gut microbiota.

Ecotoxicol Environ Saf

December 2024

The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China; State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing 100853,  China. Electronic address:

Background: Cigarette smoking is a leading cause of preventable death worldwide, with its associated diseases and conditions. Emerging evidence suggests that cigarette smoking contributes to a range of pathological metabolic injuries, including diabetes and nonalcoholic fatty liver disease (NAFLD). The impact of gut microbiota on metabolic health and diseases has been observed, but the causality remains uncertain.

View Article and Find Full Text PDF

Background: Optimizing outcomes of hospitalized patients anchors on standardizing processes in medical management, interventions to reduce the risk of decompensation, and prompt intervention when a patient decompensates.

Methods: A quality improvement initiative (optimized sepsis and respiratory compromise management, reducing health care-associated infection and medication risk, swift management of the deteriorating patient, feedback on performance, and accountability) was implemented in a multistate health system. The primary outcome was risk-adjusted in-hospital mortality.

View Article and Find Full Text PDF

Acute heat stress upregulates Akr1b3 through Nrf-2 to increase endogenous fructose leading to kidney injury.

J Biol Chem

December 2024

State Key Laboratory of Swine and Poultry Breeding Industry, Sichuan Agricultural University, Chengdu, 611130, China; Livestock and Poultry Multi-omics Key Laboratory of Ministry of Agriculture and Rural Affairs, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, 611130, China; Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan, China. Electronic address:

In recent years, the prevalence of extremely high-temperature climates, has led to an increase in cases of acute heat stress, which has been identified as a contributing factor to various kidney diseases. Fructose, the end product of the polyol pathway, has been linked to kidney conditions such as kidney stones, chronic kidney disease and acute kidney injury. However, the relationship between acute heat stress and kidney injury caused by endogenous fructose remains unclear.

View Article and Find Full Text PDF

Background And Aim: Comparative studies of Ceftazidime/avibactam(CAZ/AVI) versus polymyxin B (PMB) for carbapenem-resistant organisms (CRO) infections are limited. We aims to compare the efficacy and safety of CAZ/AVI and PMB in treating CRO infections.

Methods: This single-center, propensity score-matched (PSM) retrospective cohort study involved adult patients with CRO infections.

View Article and Find Full Text PDF

Objective: To assess urological complications in patients undergoing total pelvic exenteration (TPE) for locally advanced (LARC) and recurrent rectal cancer (RRC) as publications in this area are limited. Secondary objectives were to assess whether LARC vs RRC or radiation status affected urological outcomes.

Methods: Single-centre, retrospective study of TPE patients between January 2017 and December 2022.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!