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Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients

Authors
  • Candela, Nelly1
  • Silva, Stein2
  • Georges, Bernard2
  • Cartery, Claire3
  • Robert, Thomas4
  • Moussi-Frances, Julie4
  • Rondeau, Eric5
  • Rebibou, Jean-Michel6
  • Lavayssiere, Laurence1
  • Belliere, Julie1
  • Krummel, Thierry7
  • Lebas, Céline8
  • Cointault, Olivier1
  • Sallee, Marion4, 9
  • Faguer, Stanislas1, 10
  • 1 Centre Hospitalo-Universitaire de Toulouse, 1, Avenue Jean Poulhes, Toulouse, 31059, France , Toulouse (France)
  • 2 Centre Hospitalo-Universitaire de Toulouse, Toulouse, France , Toulouse (France)
  • 3 Centre Hospitalier de Valenciennes, Valenciennes, France , Valenciennes (France)
  • 4 Centre Hospitalo-Universitaire de Marseille, Marseille, France , Marseille (France)
  • 5 Assistance Publique des Hôpitaux de Paris, Paris, France , Paris (France)
  • 6 Centre Hospitalo-Universitaire de Dijon, Dijon, France , Dijon (France)
  • 7 Centre Hospitalo-Universitaire de Strasbourg, Strasbourg, France , Strasbourg (France)
  • 8 Centre Hospitalo-Universitaire de Lille, Lille, France , Lille (France)
  • 9 Université Aix-Marseille, C2VN, Marseille, France , Marseille (France)
  • 10 Institut National de la Science et de la Recherche Médicale, Unité 1048 (équipe 12–Fibrose rénale: détection et mécanismes de progression), Paris, France , Paris (France)
Type
Published Article
Journal
Annals of Intensive Care
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Mar 02, 2020
Volume
10
Issue
1
Identifiers
DOI: 10.1186/s13613-020-0645-1
Source
Springer Nature
Keywords
License
Green

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.

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