Ethnicity Risk and Exertional Rhabdomyolysis: A Narrative Review

Exertional rhabdomyolysis is a serious condition that happens when skeletal muscle breaks down due to intense physical activity. This leads to the release of substances like creatine kinase, myoglobin, and enzymes into the bloodstream, which can damage the kidneys and cause serious complications if not treated promptly. This narrative review aimed to examine the pathophysiology, risk factors, and complications of exertional rhabdomyolysis (ER), with a specific focus on how ethnicity, particularly sickle cell trait and social determinants of health, influences who develops ER and how severe it becomes.

Patients with ER often show symptoms like muscle pain, weakness, and dark-colored urine. If the condition becomes severe, it can result in acute kidney injury, electrolyte imbalances, and even death.

ER is commonly linked to factors such as dehydration, obesity, certain medications, genetic conditions, and sickle cell trait. It is especially seen in athletes and military members. Studies that explore these risk factors include a genome-wide association study focused on African Americans with sickle cell trait, a retrospective cohort study of US Army soldiers, and a population-based study on ER incidence. These articles highlight that those individuals with sickle cell trait, especially in African American populations, face a higher risk of developing ER because their red blood cells can sickle under physical stress. Other studies have emphasized that limited access to healthcare, poor nutrition, and social challenges also contribute to increased risk in minority communities.

Across many of the studies, including observational research and military health data, there is a consistent pattern showing that racial and ethnic disparities play a role in ER outcomes. African Americans with sickle cell trait, in particular, are disproportionately affected. This suggests a need for targeted prevention strategies and improved access to care for those at highest risk.

There is a clear need for further research to better understand how genetic and social factors related to ethnicity influence the development and severity of ER. Although the current literature includes genetic studies, cohort analyses, population data, and expert reviews, significant gaps remain. Addressing these gaps is critical for improving clinical care, guiding future research, and supporting patient education. A deeper understanding of these factors will help clinicians identify individuals at higher risk, encourage researchers to explore more inclusive and diverse populations, and empower patients, particularly those in underserved communities, to take preventive action. This will ultimately lead to more equitable and effective approaches to the prevention, diagnosis, and treatment of ER.