Acute kidney injury and necessity of renal replacement therapy in acutely intoxicated patients with rhabdomyolysis

Abstract

Introduction/Objective. This study aimed to analyse the characteristics of the selective parameters related to the development of acute kidney injury and the necessity of renal replacement therapy in patients with rhabdomyolysis due to acute intoxication with psychotropic and chemical substances in the first 24 hours. Methods. In a clinically controlled prospective study, 140 patients with rhabdomyolysis were divided into two groups depending on the intoxicating substance, i.e., psychotropic or chemical. Patients were selected according to predetermined inclusion and exclusion criteria. Results. Acute kidney injury occurred in 15% of 140 patients with rhabdomyolysis of whom 14 (66.7%) had psychotropic intoxication and seven (33.3%) had chemical intoxication. Statistical analysis showed significantly increased prevalence in the psychotropic group compared to those with chemical intoxication (p 0.0002). Creatine kinase values for median interquartile range in patients without/with renal replacement therapy were in psychotropic – 753 (446–753) vs. 42,670 (22,357–42,670) U/L; and chemical – 478.3 (321.5–1111.9) vs. 648.6 (495.6–2065) U/L. In psychotropic intoxications this difference was significant (p = 0.00002), while in the chemical ones it was insignificant (p =0.2885). The renal replacement therapy was applied in 13 (9.3%) patients with rhabdomyolysis, nine of which (69.2%) were with psychotropic intoxication and four (30.8%) were with chemical intoxication. Conclusion. The prevalence of acute kidney injury and necessity for necessity for renal replacement therapy was significantly higher in psychotropic intoxication compared to chemical intoxication. The level of creatine kinase and myoglobin on the first day in the group with psychotropic substances, and high-sensitivity troponin I in both groups –psychotropic and chemical substances – are significantly higher in patients who need renal replacement therapy compared to those who do not need this therapy.

Keywords

• toxicity
• creatine kinase
• myoglobin