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The association between rhabdomyolysis, acute kidney injury, renal replacement therapy, and mortality

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Background
We examined the association between creatine phosphokinase level in rhabdomyolysis patients and risk of acute kidney injury, renal replacement therapy, and death within 30 days.
Methods
The cohort included patients admitted with rhabdomyolysis from November 1, 2011 to March 1, 2014. Rhabdomyolysis was defined as a creatine phosphokinase level higher than 1,000 U/L. Information on laboratory variables was obtained from a laboratory database. Medical data were obtained from registries. Acute kidney injury was defined according to the Kidney Disease Improving Global Outcome (KDIGO) guidelines. The 30-day risk of outcomes was estimated using the cumulative incidence method. Spline regression applied to imputed datasets with adjustment for baseline variables was used to assess the appropriateness of the categorization chosen for creatine phosphokinase (1,000-5,000 U/L, 5,001-15,000 U/L, and 15,000+ U/L).
Results
The study included 1,027 patients (58.2% male) with a median age of 73.5 years. The median creatine phosphokinase level at rhabdomyolysis diagnosis was 2,257 U/L (interquartile range: 1,404-3,961 U/L). The 30-day risks of acute kidney injury according to the three creatinine phosphokinase levels were 42% (95% CI 38%-45%), 44% (95% CI 36%-52%), and 74% (95% CI 57%-85%), respectively, and the risks of renal replacement therapy for the three levels were 3% (95% CI 2%-5%), 4% (95% CI 2%-7%), and 11% (3%-23%), respectively. The 30-day risk of death was 17% (95% CI 14%-20%), 16% (95% CI 11%-22%), and 11% (95% CI 3%-23%), respectively. With increasing creatine phosphokinase levels, the spline plots supported the increasing risk of acute kidney injury and renal replacement therapy, as well as a decreasing risk of death. However, the risk estimates for renal replacement therapy and death were imprecise.
Conclusion
Elevated initial creatine phosphokinase values were associated with an increased risk of acute kidney injury, while estimates of the risk of renal replacement therapy and death were imprecise.
Original languageEnglish
JournalClinical Epidemiology
Volume12
Pages (from-to)989-995
Number of pages7
ISSN1179-1349
DOIs
Publication statusPublished - Sep 2020

Bibliographical note

© 2020 Nielsen et al.

    Research areas

  • Health Sciences
  • Acute kidney injury, Cohort study, Mortality, Renal replacement therapy, Rhabdomyolysis, Spline plots

ID: 60189285