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Meng Y, Zhou MX, Wu CB, Wang DH, Zhao JR, Shi DY. Continuous venovenous hemodiafiltration versus standard medical therapy for the prevention of rhabdomyolysis-induced acute kidney injury: a retrospective cohort study. BMC Nephrol 2023; 24:215. [PMID: 37468857 DOI: 10.1186/s12882-023-03242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
AIM To determine whether continuous venovenous hemodiafiltration (CVVHDF) plus standard medical therapy (SMT) vs. SMT alone prevents rhabdomyolysis (RM)-induced acute kidney injury (AKI) and analyze the related health economics. METHODS This retrospective cohort study involved 9 RM patients without AKI, coronary heart disease, or chronic kidney disease treated with CVVHDF plus SMT (CVVHDF + SMT group). Nine matched RM patients without AKI treated with SMT only served as controls (SMT group). Baseline characteristics, biochemical indexes, renal survival data, and health economic data were compared between groups. In the CVVHDF + SMT group, biochemical data were compared at different time points. RESULTS At 2 and 7 days after admission, serum biochemical indices (e.g., myoglobin, creatine kinase, creatinine, and blood urea nitrogen) did not differ between the groups. Total (P = 0.011) and daily hospitalization costs (P = 0.002) were higher in the CVVHDF + SMT group than in the SMT group. After 53 months of follow-up, no patient developed increased serum creatinine, except for 1 CVVHDF + SMT-group patient who died of acute myocardial infarction. In the CVVHDF + SMT group, myoglobin levels significantly differed before and after the first CVVHDF treatment (P = 0.008), and serum myoglobin, serum creatinine, and blood urea nitrogen decreased significantly at different time points after CVVHDF. CONCLUSIONS Although CVVHDF facilitated myoglobin elimination, its addition to SMT did not improve biochemical indices like serum myoglobin, serum creatine kinase, creatinine, blood urea nitrogen, and lactate dehydrogenase or the long-term renal prognosis. Despite similar hospitalization durations, both total and daily hospitalization costs were higher in the CVVHDF + SMT group.
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Affiliation(s)
- Yan Meng
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, PR China
| | - Ming-Xue Zhou
- Department of Nephrology, Chifeng Municipal Hospital, Chifeng, China
| | - Chun-Bo Wu
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, PR China
| | - De-Hua Wang
- Department of Interventional Medicine, the Fifth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Jian-Rong Zhao
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, PR China.
| | - Dong-Yin Shi
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, PR China.
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Kodadek L, Carmichael SP, Seshadri A, Pathak A, Hoth J, Appelbaum R, Michetti CP, Gonzalez RP. Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document. Trauma Surg Acute Care Open 2022; 7:e000836. [PMID: 35136842 PMCID: PMC8804685 DOI: 10.1136/tsaco-2021-000836] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/16/2021] [Indexed: 12/14/2022] Open
Abstract
Rhabdomyolysis is a clinical condition characterized by destruction of skeletal muscle with release of intracellular contents into the bloodstream. Intracellular contents released include electrolytes, enzymes, and myoglobin, resulting in systemic complications. Muscle necrosis is the common factor for traumatic and non-traumatic rhabdomyolysis. The systemic impact of rhabdomyolysis ranges from asymptomatic elevations in bloodstream muscle enzymes to life-threatening acute kidney injury and electrolyte abnormalities. The purpose of this clinical consensus statement is to review the present-day diagnosis, management, and prognosis of patients who develop rhabdomyolysis.
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Affiliation(s)
- Lisa Kodadek
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samuel P Carmichael
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anupamaa Seshadri
- Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Pathak
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jason Hoth
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Rachel Appelbaum
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Richard P Gonzalez
- Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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Michelsen J, Cordtz J, Liboriussen L, Behzadi MT, Ibsen M, Damholt MB, Møller MH, Wiis J. Prevention of rhabdomyolysis-induced acute kidney injury - A DASAIM/DSIT clinical practice guideline. Acta Anaesthesiol Scand 2019; 63:576-586. [PMID: 30644084 DOI: 10.1111/aas.13308] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/28/2018] [Accepted: 12/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rhabdomyolysis-induced acute kidney injury (AKI) is a common and serious condition. We aimed to summarise the available evidence on this topic and provide recommendations according to current standards for trustworthy guidelines. METHODS This guideline was developed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The following preventive interventions were assessed: (a) fluids, (b) diuretics, (c) alkalinisation, (d) antioxidants, and (e) renal replacement therapy. Exclusively patient-important outcomes were assessed. RESULTS We suggest using early rather than late fluid resuscitation (weak recommendation, very low quality of evidence). We suggest using crystalloids rather than colloids (weak recommendation, low quality of evidence). We suggest against routine use of loop diuretics as compared to none (weak recommendation, very low quality of evidence). We suggest against use of mannitol as compared to none (weak recommendation, very low quality of evidence). We suggest against routine use of any diuretic as compared to none (weak recommendation, very low quality of evidence). We suggest against routine use of alkalinisation with sodium bicarbonate as compared to none (weak recommendation, low quality of evidence). We suggest against the routine use of any alkalinisation as compared to none (weak recommendation, low quality of evidence). We suggest against routine use of renal replacement therapy as compared to none (weak recommendation, low quality of evidence). For the remaining PICO questions, no recommendations were issued. CONCLUSION The quantity and quality of evidence supporting preventive interventions for rhabdomyolysis-induced AKI is low/very low. We were able to issue eight weak recommendations and no strong recommendations.
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Affiliation(s)
- Jens Michelsen
- Department of Intensive CareOdense University Hospital Odense Denmark
| | - Joakim Cordtz
- Department of Emergency MedicineUniversity Hospital Zealand Køge Denmark
| | - Lisbeth Liboriussen
- Department of Intensive Care Unit, Department for AnesthesiologyRegional Hospital Central Jutland Viborg Denmark
| | - Meike T. Behzadi
- Cardiothoracic Intensive Care Unit, Department for AnesthesiologyAalborg University Hospital Aalborg Denmark
| | - Michael Ibsen
- Department of AnesthesiologyNordsjællands Hospital, University of Copenhagen Hillerød Denmark
| | - Mette B. Damholt
- Department of Nephrology 2132Copenhagen University Hospital Rigshospitalet Denmark
| | - Morten H. Møller
- Department of Intensive Care 4131Copenhagen University Hospital Rigshospitalet Denmark
| | - Jørgen Wiis
- Department of Intensive Care 4131Copenhagen University Hospital Rigshospitalet Denmark
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Storrar N, Miller-Hodges E, Neary J, Hughes J, Priddee N. Microangiopathy and acute kidney injury in paroxysmal cold hemoglobinuria: A challenge for management. Am J Hematol 2018; 93:718-721. [PMID: 29341234 DOI: 10.1002/ajh.25038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Neill Storrar
- Department of Haematology, Royal Infirmary of Edinburgh, United Kingdom
| | - Eve Miller-Hodges
- Department of Renal Medicine, Royal Infirmary of Edinburgh, United Kingdom
| | - John Neary
- Department of Renal Medicine, Royal Infirmary of Edinburgh, United Kingdom
| | - Jeremy Hughes
- Department of Renal Medicine, Royal Infirmary of Edinburgh, United Kingdom
| | - Nicole Priddee
- Department of Haematology, Royal Infirmary of Edinburgh, United Kingdom
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Liu ZZ, Mathia S, Pahlitzsch T, Wennysia IC, Persson PB, Lai EY, Högner A, Xu MZ, Schubert R, Rosenberger C, Patzak A. Myoglobin facilitates angiotensin II-induced constriction of renal afferent arterioles. Am J Physiol Renal Physiol 2017; 312:F908-F916. [DOI: 10.1152/ajprenal.00394.2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/22/2016] [Accepted: 12/30/2016] [Indexed: 01/04/2023] Open
Abstract
Vasoconstriction plays an important role in the development of acute kidney injury in rhabdomyolysis. We hypothesized that myoglobin enhances the angiotensin II (ANG II) response in afferent arterioles by increasing superoxide and reducing nitric oxide (NO) bioavailability. Afferent arterioles of C57Bl6 mice were isolated perfused, and vasoreactivity was analyzed using video microscopy. NO bioavailability, superoxide concentration in the vessel wall, and changes in cytosolic calcium were measured using fluorescence techniques. Myoglobin treatment (10−5 M) did not change the basal arteriolar diameter during a 20-min period compared with control conditions. NG-nitro-l-arginine methyl ester (l-NAME, 10−4 M) and l-NAME + myoglobin reduced diameters to 94.7 and 97.9% of the initial diameter, respectively. Myoglobin or l-NAME enhanced the ANG II-induced constriction of arterioles compared with control (36.6 and 34.2%, respectively, vs. 65.9%). Norepinephrine responses were not influenced by myoglobin. Combined application of myoglobin and l-NAME further facilitated the ANG II response (7.0%). Myoglobin or l-NAME decreased the NO-related fluorescence in arterioles similarly. Myoglobin enhanced the superoxide-related fluorescence, and tempol prevented this enhancement. Tempol also partly prevented the myoglobin effect on the ANG II response. Myoglobin increased the fura 2 fluorescence ratio (cytosolic calcium) during ANG II application (10−12 to 10−6 M). The results suggest that the enhanced afferent arteriolar reactivity to ANG II is mainly due to a myoglobin-induced increase in superoxide and associated reduction in the NO bioavailability. Signaling pathways for the augmented ANG II response include enhanced cytosolic calcium transients. In conclusion, myoglobin may contribute to the afferent arteriolar vasoconstriction in this rhabdomyolysis model.
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Affiliation(s)
- Z. Z. Liu
- Institute of Vegetative Physiology, Berlin, Germany
| | - S. Mathia
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - E. Y. Lai
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, China; and
| | - A. Högner
- Institute of Vegetative Physiology, Berlin, Germany
| | - M. Z. Xu
- Institute of Vegetative Physiology, Berlin, Germany
| | - R. Schubert
- Medical Faculty Mannheim, Research Division Cardiovascular Physiology, Centre for Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany
| | - C. Rosenberger
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A. Patzak
- Institute of Vegetative Physiology, Berlin, Germany
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Abstract
BACKGROUND Rhabdomyolysis is a condition that is characterised by the breakdown of skeletal muscle tissue and leakage of intracellular myocyte contents into circulating blood. Rhabdomyolysis can lead to acute kidney injury (AKI) and is a potentially life-threatening condition. Studies have indicated that continuous renal replacement therapy (CRRT) may provide benefits for people with rhabdomyolysis by removing potentially damaging myoglobin and stabilising haemodynamic and metabolic status. OBJECTIVES We aimed to: i) assess the efficacy of CRRT in removing myoglobin; ii) investigate the influence of CRRT on mortality and kidney-related outcomes; and iii) evaluate the safety of CRRT for the treatment of people with rhabdomyolysis. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register to 6 January 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We also searched China National Knowledge Infrastructure (from 1 January 1979 to 16 April 2013) and the Chinese Clinical Trials Register (to 16 April 2013). SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs that investigated clinical outcomes of CRRT for people with rhabdomyolysis were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion and extracted data. We derived risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI). Methodological risk of bias was assessed using the Cochrane risk of bias tool. MAIN RESULTS Of the three included studies (101 participants), one evaluated continuous arteriovenous haemodialysis and two investigated continuous venovenous haemofiltration; all included conventional therapy as control.We found significant decreases in myoglobin in patients among whom CRRT therapy was initiated on days four, eight, and 10 (day 4: MD -11.00 (μg/L), 95% CI -20.65 to -1.35; Day 8: MD -23.00 (μg/L), 95% CI -30.92 to -15.08; day 10: MD -341.87 (μg/L), 95% CI -626.15 to -57.59) compared with those who underwent conventional therapy.Although CRRT was associated with improved serum creatinine, blood urea nitrogen, and potassium levels; reduced duration of the oliguria phase; and was associated with reduced time in hospital, no significant differences were found in mortality rates compared with conventional therapy (RR 0.17, 95% CI 0.02 to 1.37). The included studies did not report on long-term outcomes or prevention of AKI.Overall, we found that study quality was suboptimal: blinding and randomisation allocation were not reported by any of the included studies, leading to the possibility of selection, performance and detection bias. AUTHORS' CONCLUSIONS Although CRRT may provide some benefits for people with rhabdomyolysis, the poor methodological quality of the included studies and lack of data relating to clinically important outcomes limited our findings about the effectiveness of CRRT for people with rhabdomyolysis.There was insufficient evidence to discern any likely benefits of CRRT over conventional therapy for people with rhabdomyolysis and prevention of rhabdomyolysis-induced AKI.
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Affiliation(s)
- Xiaoxi Zeng
- West China Hospital, Sichuan UniversityDepartment of Nephrology37 Guo Xue XiangChengduSichuanChina610041
| | - Ling Zhang
- West China Hospital, Sichuan UniversityDepartment of Nephrology37 Guo Xue XiangChengduSichuanChina610041
| | - Taixiang Wu
- West China Hospital, Sichuan UniversityChinese Clinical Trial Registry, Chinese Ethics Committee of Registering Clinical TrialsNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Ping Fu
- West China Hospital, Sichuan UniversityDepartment of Nephrology37 Guo Xue XiangChengduSichuanChina610041
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Thakrar R, Shulman R, Bellingan G, Singer M. Management of a mixed overdose of calcium channel blockers, β-blockers and statins. BMJ Case Rep 2014; 2014:bcr-2014-204732. [PMID: 24907219 DOI: 10.1136/bcr-2014-204732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of extreme mixed overdose of calcium channel blockers, β-blockers and statins. The patient was successfully treated with aggressive resuscitation including cardiac pacing and multiorgan support, glucagon and high-dose insulin for toxicity related to calcium channel blockade and β-blockade, and ubiquinone for treating severe presumed statin-induced rhabdomyolysis and muscle weakness.
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Affiliation(s)
- Reena Thakrar
- Department of Critical Care, University College London Hospital Foundation Trust, London, UK
| | - Rob Shulman
- Pharmacy Department, University College London Hospital Foundation Trust, London, UK
| | - Geoff Bellingan
- Department of Critical Care, University College London Hospital Foundation Trust, London, UK Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
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Kashima I, Tsutsumi K, Okamoto M. Salvage of severe ischemic lower limb having peak creatine phosphokinase level exceeding 200,000 IU/L treated by continuous hemodiafiltration. Ann Vasc Surg 2014; 28:1795.e15-8. [PMID: 24858593 DOI: 10.1016/j.avsg.2014.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/05/2014] [Accepted: 04/08/2014] [Indexed: 11/16/2022]
Abstract
We performed revascularization by an anti-anatomical bypass in a 40-year-old man with extended ischemia of both legs beyond 12 hr after onset because of traumatic aortic dissection. This patient developed myonephropathic metabolic syndrome, including renal and circulatory failure accompanied by a creatine phosphokinase level above 200,000 IU/L. Nevertheless, his bilateral affected limbs were salvaged by intensive care based on aggressive hemocatharsis with continuous hemodiafiltration with treatment for poor hemodynamics and respiratory distress.
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Affiliation(s)
- Ichiro Kashima
- Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan.
| | - Koji Tsutsumi
- Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
| | - Masahiko Okamoto
- Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
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Zhang L, Kang Y, Fu P, Cao Y, Shi Y, Liu F, Hu Z, Su B, Tang W, Qin W. Myoglobin clearance by continuous venous-venous haemofiltration in rhabdomyolysis with acute kidney injury: a case series. Injury 2012; 43:619-23. [PMID: 20843513 DOI: 10.1016/j.injury.2010.08.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 07/26/2010] [Accepted: 08/20/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clearance of circulating myoglobin is a critical measure to prevent further damage in patients with rhabdomyolysis (RM) and acute kidney injury (AKI). Continuous venous-venous haemofiltration has emerged to be a novel approach for this purpose. The objective of present study is to evaluate the efficacy and safety of CVVH in myoglobin clearance for patients with RM complicated with AKI. METHOD We prospectively analysed 15 patients with acute RM and AKI due to crush syndrome (n=7), bee stings (n=5), polymyositis (n=2) and heroin poisoning (n=1). All of them presented oliguria with high serum myoglobin and creatine kinase concentration. They were treated by CVVH for at least 48h until the conditions turned to be stable, then replaced by intermittent renal replacement therapy (intermittent haemofiltration or haemodialysis). Meanwhile intravascular volume expansion, urinary alkalinisation, and forced diuresis were administered. During the procedure, serum and effluent concentrations of myoglobin and creatinine were measured simultaneously at 2, 6, 12 and 24h. RESULT The mean sieving coefficients for myoglobin were 0.28±0.06, 0.21±0.06, 0.15±0.02 and 0.11±0.02 during 2, 6, 12 and 24h of CVVH intervention, whilst mean clearance of myoglobin was 14.3±3.1ml/min during 2h and reduced to 11.5±3.2, 7.5±0.9, 5.6±1.0ml/min during 6, 12 and 24h. In contrast to myoglobin, the sieving coefficient for creatinine remained stable at 0.95±0.25, 1.02±0.12, 0.89±0.32, 0.98±0.27 during 24h of CVVH. In all of the 15 patients, serum myoglobin and creatine kinase were dramatically decreased in 24h (-56.2 and -32.1%), 3 days (-72.9 and -50.3%) and in 7 days (-97.6 and -96.7%). Seven patients (46.7%) complicated with hypophosphatemia during CVVH intervention improved in natural course after the cessation of CVVH. After 16±12 days, all of 15 patients came to polyuria stage and finally, discharged with normal renal function after 31±15 days. CONCLUSION Our study showed CVVH can be employed to clear myoglobin effectively in patients with RM and AKI and presented oliguria. This indicate that CVVH would be better than other modes of renal replement treatment in acute RM with AKI because of the additional benefit of myoglobin removal, but large sample randomised controlled trials are still required to confirm it.
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Abstract
Rhabdomyolysis is a clinical syndrome defined by muscle breakdown and subsequent release of intracellular contents. There are many etiologies of rhabdomyolysis, classified here as congenital and acquired; compartment syndrome secondary to trauma with reperfusion injury is one common precipitating factor. Regardless of the underlying etiology, the pathophysiology follows a similar pathway via myocyte destruction and release of myoglobin into the systemic circulation. Rhabdomyolysis-induced renal failure is caused by the precipitation of myoglobin in the renal tubules which is enhanced under acidic conditions. A high index of clinical suspicion is required to promptly recognize rhabdomyolysis, especially in the unconscious patient. Presenting symptoms include tea-colored urine and muscle weakness or fatigue. The diagnosis is confirmed most reliably with the finding of elevated serum creatine kinase levels. Early, aggressive resuscitation with either normal saline or lactated Ringer's solution to maintain an adequate urine output is the most important intervention in preventing the development of acute renal failure. There is insufficient clinical evidence supporting the routine administration of diuretics and bicarbonate to protect against the development of acute renal failure.
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Affiliation(s)
- Mark L Shapiro
- Duke University Medical Center, Division of Trauma and Surgical Critical Care, Durham, NC, USA
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Abstract
BACKGROUND Acute kidney injury (AKI) with renal replacement therapy (RRT) is rare in trauma patients. The primary aim of the study was to assess incidence, mortality and chronic RRT dependency in this patient group. METHODS Adult trauma patients with AKI receiving RRT at a regional trauma referral center over a 12-year period were retrospectively reviewed. RESULTS Population-based incidence of post-traumatic AKI with RRT was 1.8 persons per million inhabitants per year (p.p.m./year) [95% confidence the interval (CI) 1.5-2.1 p.p.m./year]. In trauma patients admitted to hospital, incidence was 0.5 per thousand (95% CI 0.3-0.7 per thousand) of those treated in intensive care unit (ICU), it was 8.3% (95% CI 5.9-10.8%). The median age was 46 years. Odds ratio (OR) for post-traumatic AKI requiring RRT was higher in males than in females in general population (OR 5.6, 95% CI 2.2-14.0), and in trauma patients admitted to hospital (OR 4.4, 95% CI 1.9-10.3) and ICU (OR 4.5, 95% CI 1.9-10.7). The in-hospital mortality rate was 24% (95% CI 11-37%), 3-month mortality 36% (95% CI 21-51%) and 1-year mortality 40% (95% CI 25-55%). Age was a risk factor for death after 1 year, with 57% (95% CI 7-109%) increased risk for each 10 years added. None of the survivors was dialysis-dependent 3 months or 1 year after trauma. CONCLUSION AKI in trauma patients requiring RRT was rare in this single-center study. More males than females were affected. Mortality was modest, and renal recovery was excellent as none of the survivors became dependent on chronic RRT.
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Affiliation(s)
- S Beitland
- Department of Anaesthesiology, Oslo University Hospital Ullevaal, Oslo, Norway.
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