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Trends in Pediatric Rhabdomyolysis and Associated Renal Failure: A 10-Year Population-Based Study
Ladan Agharokh1, Isabella Zaniletti2, Andrew G Yu1
1Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Texas - Southwestern Medical Center, Dallas.
Insights
Pediatric rhabdomyolysis hospitalizations are increasing, with geographic and seasonal variations. While acute renal failure occurs, severe outcomes like death are rare in hospitalized children.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Epidemiology
Background:
- Rhabdomyolysis in children presents variably, from muscle pain to acute kidney injury.
- Limited understanding exists regarding pediatric rhabdomyolysis hospitalizations and associated renal failure rates.
Purpose of the Study:
- To explore demographics and incidence of pediatric rhabdomyolysis hospitalizations.
- To determine rates of rhabdomyolysis-associated acute renal failure in children.
- To identify factors linked to renal failure in pediatric rhabdomyolysis cases.
Main Methods:
- Retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (2006-2016).
- Identification of children hospitalized with a primary rhabdomyolysis diagnosis.
- Analysis of demographic, geographic, and temporal trends; logistic regression for renal failure predictors.
Main Results:
- 8,599 children hospitalized for rhabdomyolysis from 2006-2016; increasing trend over time.
- Geographic peaks in the South and Northeast; seasonal peaks in March and August.
- 8.5% experienced renal morbidity, 0.41% required renal replacement therapy, and 0.03% died; male sex, age >15, and non-Hispanic Black race associated with renal failure.
Conclusions:
- Renal failure is significant in pediatric rhabdomyolysis hospitalizations, but severe complications are rare.
- Hospitalization rates for pediatric rhabdomyolysis show geographic and seasonal variability.
- Further research is needed on rhabdomyolysis etiologies and predictive laboratory values for morbidity/mortality.
Objectives:
Rhabdomyolysis in children is a highly variable condition with presentations ranging from myalgias to more severe complications like acute renal failure. We sought to explore demographics and incidence of pediatric rhabdomyolysis hospitalizations and rates of associated renal failure, as our current understanding is limited.
Methods:
This was a retrospective analysis using the Healthcare Cost and Utilization Project Kids' Inpatient Database to identify children hospitalized with a primary diagnosis of rhabdomyolysis. Data were analyzed for demographic characteristics, as well as geographic and temporal trends. Multivariable logistic regression was used to identify characteristics associated with rhabdomyolysis-associated acute renal failure.
Results:
From 2006 to 2016, there were 8599 hospitalized children with a primary diagnosis of rhabdomyolysis. Overall, hospitalizations for pediatric rhabdomyolysis are increasing over time, with geographic peaks in the South and Northeast regions, and seasonal peaks in March and August. Though renal morbidity was diagnosed in 8.5% of children requiring hospitalization for rhabdomyolysis, very few of these patients required renal replacement therapy (0.41%), and death was rare (0.03%). Characteristics associated with renal failure included male sex, age greater than 15 years, and non-Hispanic Black race.
Conclusions:
Though renal failure occurs at a significant rate in children hospitalized with rhabdomyolysis, severe complications, including death, are rare. The number of children hospitalized with rhabdomyolysis varies by geographic region and month of the year. Future studies are needed to explore etiologies of rhabdomyolysis and laboratory values that predict higher risk of morbidity and mortality in children with rhabdomyolysis.
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