Department of Neurology, The Permanente Medical Group, Walnut Creek, California.
Department of Neurology, The Permanente Medical Group, San Francisco, California.
JAMA Netw Open. 2024 Aug 1;7(8):e2427464. doi: 10.1001/jamanetworkopen.2024.27464.
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.
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.
History of strenuous physical exercise before hospitalization for ERM.
Development of AKI, CKD, and compartment syndrome and number of deaths.
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.
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.
已有研究表明，血清肌酸激酶（CK）水平与运动性横纹肌溶解症（ERM）患者发生肾衰竭的风险之间存在关联。然而，住院 ERM 患者中急性肾损伤（AKI）的实际发生率以及可能增加 AKI 风险的其他协同因素很少被研究。
研究住院 ERM 患者的肾损伤发生率，并确定可能导致 ERM 患者肾损伤的其他协同因素。
设计、地点和参与者：本回顾性队列研究纳入了 2009 年 1 月 1 日至 2019 年 12 月 31 日期间在 Kaiser Permanente 北加州因 ERM 住院的 18 岁及以上的患者，患者来自多样化的社区人群。首先通过电子筛查所有病因引起的横纹肌溶解症住院患者来确定患者，然后通过手动病历审查来确认其研究资格。AKI 和慢性肾脏病（CKD）的诊断采用 KDIGO（肾脏病：改善全球预后）标准，并通过病历审查确认。数据分析于 2023 年 10 月 1 日至 2024 年 1 月 31 日进行。
住院前剧烈体力活动史。
AKI、CKD 和筋膜室综合征的发展以及死亡人数。
在 Kaiser Permanente 北加州 2009 年至 2019 年间因横纹肌溶解症住院的 3790 例患者中，通过病历审查确认 200 例（平均[标准差]年龄 30.5[8.5]岁；145[72.5%]为男性）患有 ERM。17 例（8.5%）发生 AKI，无 CKD 发生，1 例（0.5%）发生筋膜室综合征，无死亡病例。血清 CK 水平与 AKI 风险之间无关联。然而，与入院前使用非甾体抗炎药（NSAIDs）（AKI 17 例中的 11 例[64.7%] vs 无 AKI 183 例中的 40 例[21.9%]，P<.001）或经历脱水（无 AKI 183 例中的 9 例[52.9%] vs AKI 17 例中的 9 例[4.9%]，P<.001）的 ERM 患者相比，AKI 的风险显著更高。该分析表明，在该人群中，通过消除 ERM 患者入院前 NSAID 的使用和脱水，可能将 AKI 的潜在风险降低 92.6%（95%CI，85.7%-96.1%）。
这项对住院 ERM 患者的队列研究结果表明，血清 CK 升高本身不足以作为 ERM 患者 AKI 的指标。同时存在的风险因素，如 NSAID 应用或脱水，可能与 ERM 患者 AKI 的发生有关。
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