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Kidney Week

Abstract: SA-PO467

Predictors of AKI in Pediatric Rhabdomyolysis

Session Information

  • Pediatric Nephrology - II
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Levy, Rebecca, Children's Hospital at Montefiore/ Albert Einstein College of Medicine, Bronxville, New York, United States
  • Kaskel, Frederick J., Children’s Hospital at Montefiore, Bronx, New York, United States
  • Melamed, Michal L., Albert Einstein College of Medicine, Bronx, New York, United States
  • Reidy, Kimberly J., Children's Hospital at Montefiore/ Albert Einstein College of Medicine, Bronxville, New York, United States
Background

Rhabdomyolysis is an uncommon but serious disease in children. The most serious complication of rhabdomyolysis is acute kidney injury (AKI). Risk factors for AKI include greater hematuria, faster fluid administration, and higher initial creatine kinase (CK). Here, we describe the baseline characteristics of children with rhabdomyolysis and identify predictors of AKI in a large, urban tertiary care children’s hospital.

Methods

This study was a retrospective cohort. Participants included children (aged less than 18 years) evaluated in the Children’s Hospital at Montefiore (CHAM) 1/1/2006-12/31/2015 with CK >1000. The outcome is AKI defined as increase in sCr ≥0.3mg/dL. Potential covariates were identified from biologically plausible variables and include age, sex, race, and biochemical markers at presentation. Bivariate associations were explored using Χ2 tests, t test or Mann-Whitney U test fas appropriate. All analysis was conducted using STATA v15.0. Protocols were approved by the AECOM IRB.

Results

A total of 447 participants were identified, of whom 124 had AKI. Participants with rhabdomyolysis and AKI were younger and more often female than those without; they did not differ by race. Participants with AKI had higher initial CK, were more acidotic, and had higher baseline phosphorus levels than participants without AKI but did not differ in baseline potassium or calcium (Table 1).

Conclusion

Demographic characteristics and baseline biochemistry are associated with increased risk of AKI in pediatric rhabdomyolysis. Strengths of this study include large sample size. Limitations include missing data and inability to confirm etiology; detailed chart review is ongoing. Next steps include regression analysis and validation of adult risk prediction equations.

Baseline Characteristics of Participants
n=447No AKI (n=353)AKI (124)p
Age11 (5, 15)7 (2, 13)0.001
Male75%65%0.033
Race (n=414)

Black

Other
  0.50
45%44% 
43%40% 
Baseline Labs   
CK (U/L)2260 (1339, 5969)3703 (1652, 9546)0.008
Creatinine (mg/dL) (n=422)0.7 (0.4, 0.9)0.7 (0.4, 1)0.26
Potassium (mEq/L) (n=363)4.3 ± 0.674.3 ± 0.890.74
Bicarbonate (mEq/L) (n=386)22.0 ± 4.4719.6 ± 6.940.006
Calcium (mg/dL) (n=384)9.3 ± 0.939.4 ± 1.490.76
Phosphorus (mg/dL) (n=252)4.3 ± 1.575.9 ± 3.050.0002

Funding

  • Other NIH Support