Acute kidney injury (AKI) is the major complication of rhabdomyolysis. We aimed to identify the predictive factors for AKI and renal replacement therapy (RRT) requirement in poisoning-associated rhabdomyolysis. We conducted a cohort study including 273 successive poisoned patients (median age, 41 years) who developed rhabdomyolysis defined as creatine kinase (CK) >1000 IU/L. Factors associated with AKI and RRT requirement were identified using multivariate analyses. Poisonings mainly involved psychotropic drugs. AKI occurred in 88 patients (37%) including 43 patients (49%) who required RRT. Peak serum creatinine and CK were weakly correlated (R2 = 0.17, p < 0.001). Death (13%) was more frequent after AKI onset (32% vs. 2%, p < 0.001). On admission, lithium overdose (OR, 44.4 (5.3-371.5)), serum calcium ≤2.1 mmol/L (OR, 14.3 (2.04-112.4)), female gender (OR, 5.5 (1.8-16.9)), serum phosphate ≥1.5 mmol/L (OR, 2.0 (1.0-4.2)), lactate ≥ 3.3 mmol/L (OR, 1.2 (1.1-1.4)), serum creatinine ≥ 125 µmol/L (OR, 1.05 (1.03-1.06)) and age (OR, 1.04 (1.01-1.07)) independently predicted AKI onset. Calcium-channel blocker overdose (OR, 14.2 (3.8-53.6)), serum phosphate ≥ 2.3 mmol/L (OR, 1.6 (1.1-2.6)), Glasgow score ≤ 5 (OR, 1.12; (1.02-1.25)), prothrombin index ≤ 71% (OR, 1.03; (1.01-1.05)) and serum creatinine ≥ 125 µmol/L (OR, 1.01; (1.00-1.01)) independently predicted RRT requirement. We identified the predictive factors for AKI and RRT requirement on admission to improve management in poisoned patients presenting rhabdomyolysis.
Keywords: acute kidney injury; poisoning; predictive factor; renal replacement therapy; rhabdomyolysis.