Factors associated with acute kidney injury in rhabdomyolysis: Insights from a prospective study

Rhabdomyolysis is a common condition in intensive care units (ICUs), but data on acute kidney injury (AKI) associated with rhabdomyolysis remain limited, particularly in North Africa.

To determine the incidence of AKI during rhabdomyolysis and to identify its associated factors among ICU patients.

We conducted a prospective, single-center correlational study from January to July 2024 in the ICU of Rabta University Hospital in Tunisia, including patients diagnosed with rhabdomyolysis. Clinical and laboratory parameters, along with the McMahon score, were assessed at the time of inclusion. Patients were then monitored during their ICU stay to detect the occurrence of AKI.

AKI occurred in 51.9% of the 54 patients included in the study. Univariate analysis identified several admission parameters associated with AKI, including elevated levels of creatine phosphokinase, lactate dehydrogenase (LDH), phosphorus, creatinine, and transaminases, as well as low bicarbonate and albumin levels. The optimal McMahon score threshold for predicting AKI was 4.75, with a sensitivity of 78.6% and specificity of 76.9%. In multivariate analysis, only initial LDH [P = 0.012; odds ratio (OR) = 0.993; 95%CI: 0.988-0.999] and initial bicarbonate (P = 0.025; OR = 1.553; 95%CI: 1.058-2.280) levels were independently associated with AKI occurrence.

Simple admission biomarkers such as LDH and bicarbonate should be considered for early AKI risk assessment in rhabdomyolysis, particularly in settings with limited access to advanced diagnostic tools.