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>The Association Between Illicit Drug Use and the Duration of Renal Replacement Therapy in Patients With Acute Kidney Injury From Severe Rhabdomyolysis
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The Association Between Illicit Drug Use and the Duration of Renal Replacement Therapy in Patients With Acute Kidney Injury From Severe Rhabdomyolysis
Background and aims: Acute kidney injury is a known complication of severe rhabdomyolysis. In patients who present to hospital with rhabdomyolysis, illicit drug use is associated with a higher risk of acute kidney injury needing renal replacement therapy (RRT), independent of the peak serum creatine kinase level. The aim of this study was to assess if RRT duration and renal outcomes were also worse in illicit drug use-associated rhabdomyolysis. Methods: We conducted a cohort study of adult patients who presented to Monash Health (Jan 2011 to June 2020) with rhabdomyolysis and required RRT. Patients with isolated myocardial injury and cardiac arrest were excluded. We used survival analysis to examine the time to RRT independence, utilizing the Fine-Gray competing risks regression and death as the competing event. A subdistribution hazard ratio (SHR) &1.0 represents a relatively greater duration of RRT and a worse outcome. Results: We included 101 patients with a mean age of 58 years, of which 17% were cases associated with illicit drug use. The median peak creatine kinase level was 5473 U/L (interquartile range, 1795-17051 U/L). Most patients (79%) initiated RRT within 72 hours of admission, at a median serum creatinine of 537 µmol/L (interquartile range, 332–749 µmol/L). In the competing risks analysis, the estimated SHR was 1.48 (95% CI: 0.78-2.84, P = 0.23) for illicit drug use, 0.87 (95% CI: 0.76-0.99, P = 0.041) for the log-transformed peak creatine kinase, and 0.41 (95% CI: 0.25-0.67, P &0.001) for sepsis. A 50% cumulative incidence of RRT independence occurred at 11 days (95% CI: 8-16 days). Only 5% of patients remained on RRT at 3 months. Conclusion: In rhabdomyolysis-associated acute kidney injury, it is unlikely that patients with illicit drug use-associated rhabdomyolysis require a longer duration of RRT compared to patients with rhabdomyolysis from other causes.
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机译：背景和目的：急性肾损伤是严重横纹肌的已知复杂化。在患有横纹肌溶解的医院的患者中，非法药物用途与需要肾置换疗法（RRT）的急性肾损伤的风险较高，与峰血清肌酸激酶水平无关。本研究的目的是评估rrt持续时间和肾果菌在非法药物使用相关的横纹肌中也更差。方法：我们对横纹肌分解和所需的RRT进行了曲囊卫生（2011年至6月20日）的成年患者的队列研究。患有孤立的心肌损伤和心脏骤停的患者被排除在外。我们使用生存分析来检查RRT独立性的时间，利用Fine-Grey竞争风险回归和死亡作为竞争事件。分区危险比（SHR）＆ 1.0表示RRT的相对较大的持续时间和更差的结果。结果：我们包括58岁的平均年龄的101名患者，其中17％是与非法药物使用相关的病例。中位数肌酸激酶水平为5473 U / L（四分位数范围，1795-17051 U / L）。大多数患者（79％）在入院的72小时内启动RRT，在537μmol/ L（四分位数范围，332-749μmol/ L）的中位血清肌酐。在竞争风险分析中，估计的SHR为1.48（95％CI：0.78-2.84，p = 0.23），对于对数转化的峰肌酸的0.87（95％CI：0.76-0.99，P = 0.041）激酶和0.41（95％CI：0.25-0.67，P <0.001）用于败血症。 11天发生了50％的RRT独立发病率（95％CI：8-16天）。只有5％的患者在3个月内留在RRT上。结论：在横纹肌溶解相关的急性肾损伤中，与来自其他原因的横纹肌分解患者相比，患有非法药物使用相关的横纹肌的患者需要更长的RRT持续时间。
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