Objective: We assessed the primary causes of rhabdomyolysis, the factors associated with the
development of acute renal failure (ARF), and the need for hemodialysis (HD) among a series of
patients presenting to an urban emergency department with rhabdomyolysis.
Methods: A chart review between January 1992 and December 1995 was conducted of patients aged
18 years or older with a diagnosis of rhabdomyolysis and an initial serum creatine phosphokinase greater
than 1000 U/L. Patients were excluded if they had evidence of myocardial ischemia, cerebrovascular
insufficiency, or the development of rhabdomyolysis after hospitalization. Demographic information,
presumed causative factors, past medical history, medication usage, and laboratory data were collected.
Results: Ninety-seven patients (93 men, 4 women) were enrolled, with a mean age of 35.7 years. The
most common causes of rhabdomyolysis were cocaine (30), exercise (29), and immobilization (18).
Seventeen of 97 (17.5%) patients developed ARF; 8 patients (8.25%) needed HD. Several clinical and
laboratory factors were statistically associated with development of ARF and need for HD. The only
variable that was predictive of both ARF and need for HD in separate multivariate regression models was
the initial creatinine (Cr). Initial blood urea nitrogen also was predictive of the need for HD. No patient
developed ARF with an initial Cr less than 1.7 mg/dL.
Conclusion: Acute renal failure and need for HD are common complications of rhabdomyolysis. Except
for initial serum Cr and blood urea nitrogen, clinical and laboratory factors were not reliable predictors for
the development of ARF or need for HD.
Peer Reviewed
http://deepblue.lib.umich.edu/bitstream/2027.42/40388/1/Fernandez_Factors predictive of acute renal failure_2005.pdf