Comparison of acute kidney injury and renal replacement therapy in patients with rhabdomyolysis acutely intoxicated with psychotropic or chemical substances
Journal
Clinical toxicology
Date Issued
2021-05
Author(s)
Jurukov, Irena
Naumovski, Kiril
Abstract
Objective: We determine the risk factors for the development of
acute kidney injury and the necessity of renal replacement ther-
apy (RRT) for patients with rhabdomyolysis due to acute intoxica-
tion with psychotropic and chemical substances.
Methods: This was a prospective clinical study conducted from 1
January to 31 December 2019 at the University Clinic for
Toxicology in Skopje. The study included patients with rhabdo-
myolysis divided in to two groups in accordance with the sub-
stance used for intoxication (psychotropic or chemical).
Rhabdomyolysis was defined as a creatine phosphokinase
(CPK) >250U/L. The diagnosis and the stages of the acute kidney
injury were defined using the Kidney Disease: Improving Global
Outcomes (KDIGO) classification. Data were statistically analyzed
in SPSS software, version 22.0 for Windows (SPSS, Chicago,
IL, USA).
Results: Acute kidney injury occurred in 15% of 140 patients
with rhabdomyolysis of whom 66.7% (n ¼14) had psychotropic
intoxication and 33.3% had chemical intoxication (n ¼7).
Statistical analysis showed significantly increased prevalence in
the psychotropic group compared to those with chemical intoxi-
cation (p ¼0.0002). The highest prevalence of acute kidney injury
in the psychotropic intoxication group was heroin (60%) and
methadone (40%), followed by neuroleptics (25%), anticonvul-
sants (17.7%) and antidepressants (8.3%). In the chemical intoxi-
cation group, acute kidney injury was registered in 15.9% of
patients. The highest prevalence of acute kidney injury in this
group was due to ethylene glycol (100%) and fungus poisoning
(33.3%), followed by pesticides (20%) and corrosives (16.7%).
With regards to RRT, there was a significantly higher prevalence
in patients with psychotropic intoxication compared to chemical
intoxication (p ¼0.0001). Patients intoxicated by psychotropic or
chemical substances, with acute kidney injury and rhabdomyoly-
sis had higher values for aspartate aminotransferase (AST), ala-
nine aminotransferase (ALT), creatine phosphokinase (CPK),
troponin and myoglobin. In the group with chemical intoxication,
patients with acute kidney injury had higher values for AST
(p ¼0.3277), ALT (p ¼0.9616) and troponin (p ¼0.0051) com-
pared to those without acute kidney injury. The quantity/value of
CPK (p ¼0.8348) and myoglobin (p ¼0.1127) was higher in
patients with acute kidney injury intoxicated by chemical
substances.
Conclusion: The prevalence of acute kidney injury and necessity
for RRT was significantly higher in psychotropic intoxication com-
pared to chemical intoxication. Certain toxic agents in acutely
intoxicated patients with rhabdomyolysis may have an important
role in the development of acute kidney injury. Patients with
acute kidney injury and rhabdomyolysis as well as those intoxi-
cated with psychotropic substances have significantly higher
564 EAPCCT 2021 ABSTRACTS
values for CPK, AST, ALT, troponin, and myoglobin compared to values for CPK, AST, ALT, troponin, and myoglobin compared to
those without acute kidney injury.
acute kidney injury and the necessity of renal replacement ther-
apy (RRT) for patients with rhabdomyolysis due to acute intoxica-
tion with psychotropic and chemical substances.
Methods: This was a prospective clinical study conducted from 1
January to 31 December 2019 at the University Clinic for
Toxicology in Skopje. The study included patients with rhabdo-
myolysis divided in to two groups in accordance with the sub-
stance used for intoxication (psychotropic or chemical).
Rhabdomyolysis was defined as a creatine phosphokinase
(CPK) >250U/L. The diagnosis and the stages of the acute kidney
injury were defined using the Kidney Disease: Improving Global
Outcomes (KDIGO) classification. Data were statistically analyzed
in SPSS software, version 22.0 for Windows (SPSS, Chicago,
IL, USA).
Results: Acute kidney injury occurred in 15% of 140 patients
with rhabdomyolysis of whom 66.7% (n ¼14) had psychotropic
intoxication and 33.3% had chemical intoxication (n ¼7).
Statistical analysis showed significantly increased prevalence in
the psychotropic group compared to those with chemical intoxi-
cation (p ¼0.0002). The highest prevalence of acute kidney injury
in the psychotropic intoxication group was heroin (60%) and
methadone (40%), followed by neuroleptics (25%), anticonvul-
sants (17.7%) and antidepressants (8.3%). In the chemical intoxi-
cation group, acute kidney injury was registered in 15.9% of
patients. The highest prevalence of acute kidney injury in this
group was due to ethylene glycol (100%) and fungus poisoning
(33.3%), followed by pesticides (20%) and corrosives (16.7%).
With regards to RRT, there was a significantly higher prevalence
in patients with psychotropic intoxication compared to chemical
intoxication (p ¼0.0001). Patients intoxicated by psychotropic or
chemical substances, with acute kidney injury and rhabdomyoly-
sis had higher values for aspartate aminotransferase (AST), ala-
nine aminotransferase (ALT), creatine phosphokinase (CPK),
troponin and myoglobin. In the group with chemical intoxication,
patients with acute kidney injury had higher values for AST
(p ¼0.3277), ALT (p ¼0.9616) and troponin (p ¼0.0051) com-
pared to those without acute kidney injury. The quantity/value of
CPK (p ¼0.8348) and myoglobin (p ¼0.1127) was higher in
patients with acute kidney injury intoxicated by chemical
substances.
Conclusion: The prevalence of acute kidney injury and necessity
for RRT was significantly higher in psychotropic intoxication com-
pared to chemical intoxication. Certain toxic agents in acutely
intoxicated patients with rhabdomyolysis may have an important
role in the development of acute kidney injury. Patients with
acute kidney injury and rhabdomyolysis as well as those intoxi-
cated with psychotropic substances have significantly higher
564 EAPCCT 2021 ABSTRACTS
values for CPK, AST, ALT, troponin, and myoglobin compared to values for CPK, AST, ALT, troponin, and myoglobin compared to
those without acute kidney injury.
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