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Abstract: SA-PO100

The Rise of Rhabdomyolysis in Philadelphia's Fentanyl Crisis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Bzeih, Rami, Temple University Hospital, Philadelphia, Pennsylvania, United States
  • Jimenez, David, Temple University Hospital, Philadelphia, Pennsylvania, United States
  • Lee, Jean, Temple University Hospital, Philadelphia, Pennsylvania, United States
  • Gillespie, Avrum, Temple University Hospital, Philadelphia, Pennsylvania, United States

Philadelphia has experienced a recent surge of fentanyl use and unintentional overdose, particularly the area served by the Temple University Hospital System (TUHS). Patients admitted to the hospital for overdose are often found to have rhabdomyolysis and acute kidney injury (AKI). While opioids like heroin have been previously associated with causing rhabdomyolysis, it is our belief that fentanyl has exacerbated this problem. In this study, we determine whether there has been a rise in patients developing AKI from drug-associated rhabdomyolysis that correlates with the 50% increase of fatal fentanyl overdoses in Philadelphia over the past 6 years.


We conducted a retrospective cross-sectional study to examine trends in fentanyl-associated rhabdomyolysis and AKI. Our sample comprised 1060 patients aged 18-60 admitted to TUHS for drug-associated rhabdomyolysis. Data were collected from electronic medical records and screened for inclusion criteria. Patients with end-stage kidney disease or a hospital stay of less than 24 hours were excluded.


From 2016 to 2022, the incidence of drug-associated rhabdomyolysis at TUHS has increased from 8.8 cases per month to 16.4 cases per month. Among those cases, the incidence of AKI rose from 5.8 cases per month to 13.8 cases per month. The greatest increase was noted between 2019 and 2020 (6.5 to 10 cases per month). Fentanyl was first tested in late 2018, and 60% of included patients since then were tested for fentanyl. Of those who were tested for fentanyl, positivity rate steadily increased from 52% in 2019 to 75% in 2023. Since 2016, AKI cases associated with other opioids declined from 67% to 16%. AKI cases positive for cocaine has remained around 43%.


Our findings suggest a strong correlation between the increased incidence of drug-associated rhabdomyolysis and AKI at TUHS and rising fentanyl abuse. This correlation was not observed with other drugs included in toxicology screens. Further research is required to ascertain the potential contribution of adulterants such as xylazine and phenylbutazone, and to develop effective harm reduction strategies to mitigate fentanyl-associated rhabdomyolysis and AKI.