■已经提出了血清肌酸激酶(CK)水平与劳力性横纹肌溶解症(ERM)患者的肾衰竭风险之间的关联。然而,很少研究ERM住院患者中AKI的实际发生率以及可能增加AKI风险的辅助因素.
■研究住院ERM患者肾损伤的发生率,并确定可能导致ERM患者肾损伤发展的其他辅助因素。
这项回顾性队列研究是在2009年1月1日至2019年12月31日在北加州KaiserPermanente住院的18岁或以上ERM患者的不同社区人群中进行的。患者最初是通过全因横纹肌溶解症入院的电子筛查来确定的,然后进行手动病历审查,以验证他们是否符合研究的资格.AKI和慢性肾脏病(CKD)的诊断使用KDIGO(肾脏疾病改善全球结果)标准来确定,并通过病历审查来确认。从2023年10月1日至2024年1月31日进行数据分析。
■ERM住院前剧烈运动史。
■AKI的发展,CKD,筋膜室综合征和死亡人数。
■在2009年至2019年期间,北加州KaiserPermanente因横纹肌溶解症住院的3790名患者中,200(平均[SD]年龄,30.5[8.5]岁;145[72.5%]男性)通过病历审查确认患有ERM。17名患者(8.5%)发生AKI,没有人发展CKD,1人(0.5%)出现骨筋膜室综合征,也没有人死亡.血清CK水平与AKI风险之间无相关性。然而,入院前使用非甾体抗炎药(NSAIDs)的ERM患者发生AKI的风险明显更高(17例患者中有11例发生AKI[64.7%],而183例无AKI患者中有40例发生AKI[21.9%],P<.001)或经历过脱水(183个中的9个无AKI[52.9%],17个中的9个有AKI[4.9%],P<.001)。该分析表明,消除入院前使用NSAID和脱水可以将ERM患者的潜在AKI风险降低92.6%(95%CI,85.7%-96.1%)。
■这项针对ERM住院患者的队列研究结果表明,血清CK升高不足以作为ERM患者AKI的指标。并发风险因素,如使用NSAID或脱水,可能与ERM患者发生AKI有关。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: History of strenuous physical exercise before hospitalization for ERM.
UNASSIGNED: Development of AKI, CKD, and compartment syndrome and number of deaths.
UNASSIGNED: 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.
UNASSIGNED: 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.