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Kidney Week

Abstract: PO0072

Bicarbonate May Not Be the Best Treatment for Rhabdomyolysis: A Retrospective Cohort Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Kim, Hye Won, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Lee, Yunseo, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
Background

It is controversial whether the use of bicarbonate solution, which has been traditionally attempted to treat rhabdomyolysis, has the beneficial effect of reducing acute kidney injury (AKI) and mortality, compared with the use of non-bicarbonate solution. The purpose of this study is to analyze whether bicarbonate therapy versus non-bicarbonate therapy may be effective in preventing AKI and death in patients with rhabdomyolysis.

Methods

We collected 4077 hospitalized patients with creatinine kinase (CK) > 1000 U/L and divided them into 2 groups: patients who received fluid with bicarbonate and who received fluid without bicarbonate. Patients were subgrouped into low (<2ml/kg/hr), middle (2-4ml/kg/hr) and high (≥4 ml/kg/hr) amounts of fluid to receive in first 72 hours of admission. Cox regression analysis models were used to identify risks for dialysis and mortality. Safety profiles were assessed by volume overload and electrolyte imbalances.

Results

In a total of patients with a mean age of 57.9 years (male 66.7%), bicarbonate-containing solution was used in 61.1% of the participants. The proportion of the subjects were 34.6%, 36.5%, and 28.9% for the low, middle, and high fluid group, respectively. The bicarbonate group showed higher incidence rate of AKI (OR 4.5), higher 1-year mortality (OR 3.1) and longer hospital stay (26.6 ± 54.4 vs. 22.0 ± 22.7 days) than the non-bicarbonate group. Patients given high amount of fluid therapy showed higher incidence rate of AKI (OR 3.1), higher rate of dialysis dependency (OR 2.7) and higher 1-year mortality (OR 1.4), compared with low fluid group, regardless of the use of bicarbonate. The use of bicarbonate (adjusted HR [aHR] 1.55), volume overload (aHR 1.28) were associated with higher mortality while the use of furosemide (aHR 0.8) showed the preventive effect. Baseline CK or peak CK were not related to the risk of dialysis or death. Volume overload was significantly higher in the bicarbonate group compared with the non-bicarbonate group.

Conclusion

We showed bicarbonate therapy or high-volume fluid management in patients with rhabdomyolysis were not beneficial in preventing AKI and death, compared with the non-bicarbonate therapy or low-volume fluid management. It suggests that limited use of bicarbonate and adjustment of fluid volume may improve the short-term and long-term outcome of rhabdomyolysis.

Funding

  • Clinical Revenue Support