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González CP, Bardolia C, Pizzolato K, Amin NS. Utilizing Pharmacogenomics Results to Improve Statin-Associated Muscle Symptoms. Sr Care Pharm 2024; 39:151-158. [PMID: 38528333 DOI: 10.4140/tcp.n.2024.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The objective of this aims to demonstrate the advantage of a pharmacogenomics (PGx)-informed medication review in mitigating adverse drug events (ADEs) and optimizing therapeutic outcomes. PGx testing and PGx-informed medication reviews assist in mitigating ADEs. PGx testing was performed on a 68-year-old male presenting with uncontrolled chronic pain. The PGx results highlighted a drug-gene interaction, aiding in identification of the increased risk of statin-associated muscle symptoms (SAMS) attributing to uncontrolled chronic pain. This patient case report illustrates how incorporating PGx results can help improve chronic pain and mitigate ADEs, such as SAMS.
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Affiliation(s)
- Coral Perez González
- 1 Office of Translational Research and Residency Programs, Tabula Rasa HealthCare, Moorestown, New Jersey
| | - Chandni Bardolia
- 1 Office of Translational Research and Residency Programs, Tabula Rasa HealthCare, Moorestown, New Jersey
| | - Katie Pizzolato
- 1 Office of Translational Research and Residency Programs, Tabula Rasa HealthCare, Moorestown, New Jersey
| | - Nishita Shah Amin
- 1 Office of Translational Research and Residency Programs, Tabula Rasa HealthCare, Moorestown, New Jersey
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Morin AG, Somme D, Corvol A. Rhabdomyolysis in older adults: outcomes and prognostic factors. BMC Geriatr 2024; 24:46. [PMID: 38212712 PMCID: PMC10782688 DOI: 10.1186/s12877-023-04620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/17/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Rhabdomyolysis is a common condition in older adults, often associated with falls. However, prognostic factors for rhabdomyolysis have mainly been studied in middle-aged populations. OBJECTIVE To test the hypothesis that age influences rhabdomyolysis prognostic factors. METHODS This retrospective single-center observational study included all patients with a creatine kinase (CK) level greater than five times normal, admitted to Rennes University Hospital between 2013 and 2019. The primary endpoint was 30-day in-hospital mortality rate. RESULTS 343 patients were included (median age: 75 years). The mean peak CK was 21,825 IU/L. Acute renal failure occurred in 57.7% of the cases. For patients aged 70 years and over, the main etiology was prolonged immobilization after a fall. The 30-day in-hospital mortality rate was 10.5% (23 deaths). The Charlson score, number of medications and CK and creatinine levels varied according to age. Multivariate analysis showed age to be a factor that was associated, although not proportionally, with 30-day in-hospital mortality. CONCLUSION Factors influencing rhabdomyolysis severity were not randomly distributed according to age. The term rhabdomyolysis encompasses various clinical realities and is associated with different mechanisms. More research is needed to better understand the physio-pathological and prognostic factors of rhabdomyolysis, especially in older adults.
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Affiliation(s)
- Anne-Gaëlle Morin
- Geriatric Department, Univ Rennes, CHU Rennes, Rennes, F-35000, France
| | - Dominique Somme
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309, Rennes, F-35000, France
- CHU Pontchaillou, 2 Rue Henri le Guilloux, Rennes, 35000, France
| | - Aline Corvol
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309, Rennes, F-35000, France.
- CHU Pontchaillou, 2 Rue Henri le Guilloux, Rennes, 35000, France.
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Torr L, Mortimore G. The management and diagnosis of rhabdomyolysis-induced acute kidney injury: a case study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:844-852. [PMID: 36094035 DOI: 10.12968/bjon.2022.31.16.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Rhabdomyolysis is characterised by a rapid dissolution of damaged or injured skeletal muscle that can be the result of a multitude of mechanisms. It can range in severity from mild to severe, leading to multi-organ failure and death. Rhabdomyolysis causes muscular cellular breakdown, which can cause fatal electrolyte imbalances and metabolic acidosis, as myoglobin, creatine phosphokinase, lactate dehydrogenase and other electrolytes move into the circulation; acute kidney injury can follow as a severe complication. This article reflects on the case of a person who was diagnosed with rhabdomyolysis and acute kidney injury after a fall at home. Understanding the underpinning mechanism of rhabdomyolysis and the associated severity of symptoms may improve early diagnosis and treatment initiation.
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Affiliation(s)
- Leah Torr
- Acute Kidney Injury Specialist Nurse, Royal Derby Hospital, University Hospitals of Derby and Burton Foundation Trust, Derby
| | - Gerri Mortimore
- Associate Professor in Advanced Clinical Practice, University of Derby, Derby
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Liegetrauma: retrospektive Analyse einer Patientenkohorte aus einer universitären Notaufnahme. Med Klin Intensivmed Notfmed 2022; 118:220-227. [PMID: 35403893 PMCID: PMC10076350 DOI: 10.1007/s00063-022-00912-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund
Bisher fehlen Versorgungsdaten für Patienten mit Liegetrauma (LT).
Methode
Deskriptive retrospektive Analyse aller rettungsdienstlich mit einem LT der Notaufnahme des Universitätsklinikums Köln von 07.2018 bis 12.2020 zugeführten Patienten.
Ergebnis
Insgesamt konnten 50 Patienten mit LT (Altersmedian 76 Jahre, Liegedauer im Median 13,5 h) im Untersuchungszeitraum identifiziert werden. Die zugrunde liegende Ursache für das LT war in 40 % primär neurologisch (ischämischer Schlaganfall: 20 %, intrakranielle Blutung: 16 %, Epilepsie: 4 %), in 12 % eine Intoxikation und in 10 % ein häusliches Trauma. Häufige assoziierte Diagnosen waren Infektionen (52 %), Traumafolgen (22 %), Exsikkose (66 %), akute Nierenfunktionsstörung (20 %), schwere Rhabdomyolyse (Kreatininkinase ≥ 5000 U/l, 21 %) und schwere Hypothermie < 32 °C (20 %). Insgesamt wurden 69 % der Patienten auf einer Intensivstation aufgenommen und die Krankenhausletalität betrug 50 %.
Schlussfolgerung
Das LT beschreibt einen Patientenzustand, bei dem infolge vielfältiger Ursachen plötzlich die eigenständige Mobilisierung und ein selbstständiges Hilfeholen verhindert werden und dadurch weitere Gesundheitsschäden entstehen. Bei diesem Syndrom sind Gewebsschäden als Folge des Liegens keine notwendige Voraussetzung für das Vorliegen eines LT. Aufgrund der hohen Morbidität und Letalität sollten diese Patienten in einem nichttraumatologischen Schockraum aufgenommen werden.
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Eichinger M, Robb HDP, Scurr C, Tucker H, Heschl S, Peck G. Challenges in the PREHOSPITAL emergency management of geriatric trauma patients - a scoping review. Scand J Trauma Resusc Emerg Med 2021; 29:100. [PMID: 34301281 PMCID: PMC8305876 DOI: 10.1186/s13049-021-00922-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite a widely acknowledged increase in older people presenting with traumatic injury in western populations there remains a lack of research into the optimal prehospital management of this vulnerable patient group. Research into this cohort faces many uniqu1e challenges, such as inconsistent definitions, variable physiology, non-linear presentation and multi-morbidity. This scoping review sought to summarise the main challenges in providing prehospital care to older trauma patients to improve the care for this vulnerable group. METHODS AND FINDINGS A scoping review was performed searching Google Scholar, PubMed and Medline from 2000 until 2020 for literature in English addressing the management of older trauma patients in both the prehospital arena and Emergency Department. A thematic analysis and narrative synthesis was conducted on the included 131 studies. Age-threshold was confirmed by a descriptive analysis from all included studies. The majority of the studies assessed triage and found that recognition and undertriage presented a significant challenge, with adverse effects on mortality. We identified six key challenges in the prehospital field that were summarised in this review. CONCLUSIONS Trauma in older people is common and challenges prehospital care providers in numerous ways that are difficult to address. Undertriage and the potential for age bias remain prevalent. In this Scoping Review, we identified and discussed six major challenges that are unique to the prehospital environment. More high-quality evidence is needed to investigate this issue further.
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Affiliation(s)
- Michael Eichinger
- Major Trauma and Cutrale Perioperative and Ageing Group, Imperial College Healthcare NHS Trust, London, UK
| | - Henry Douglas Pow Robb
- Academic Clinical Fellow in General Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Cosmo Scurr
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | | | - Stefan Heschl
- Department of Cardiac, Thoracic and Vascular Anaesthesiology and Intensive Care, Medical University Hospital, Graz, Austria
| | - George Peck
- Cutrale Peri-operative and Ageing Group, Imperial College London, London, UK
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Yang CW, Li S, Dong Y, Paliwal N, Wang Y. Epidemiology and the Impact of Acute Kidney Injury on Outcomes in Patients with Rhabdomyolysis. J Clin Med 2021; 10:jcm10091950. [PMID: 34062839 PMCID: PMC8125267 DOI: 10.3390/jcm10091950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Currently, no large, nationwide studies have been conducted to analyze the demographic factors, underlying comorbidities, clinical outcomes, and health care utilization in rhabdomyolysis patients with and without acute kidney injury (AKI). Methods: We queried the National Inpatient Sample of Healthcare Cost and Utilization Project (HCUP) with patients with rhabdomyolysis from 2016 to 2018. The chi-squared test was used to compare categorical variables, and the adjusted Wald test was employed to compare quantitative variables. The logistic regression model was applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) to estimate the impact of AKI on outcomes in patients with rhabdomyolysis. Results: Among 111,085 rhabdomyolysis-related hospitalizations, a higher prevalence of AKI was noticed in older patients (mean age ± SD, 58.2 ± 21.6 vs. 53.8 ± 22.2), Medicare insurance (48.5% vs. 43.2%), and patients with a higher Charlson Comorbidity Index score (CCI 3–5, 15.1% vs. 5.5%). AKI was found to be independently associated with higher mortality (adjusted odds ratio [aOR] 3.33, 95% CI 2.33–4.75), longer hospital stays (adjusted difference 1.17 days, 95% CI: 1.00−1.34), and higher cost of hospital stay (adjusted difference $11,315.05, 95% CI: $9493.02–$13,137.07). Conclusions: AKI in patients hospitalized with rhabdomyolysis is related to adverse clinical outcomes and significant economic and survival burden.
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Affiliation(s)
- Chien-Wen Yang
- Renal Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA;
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, 501 S Washington Ave, Scranton, PA 18505, USA;
- Correspondence:
| | - Yishan Dong
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621, USA;
| | - Nitpriya Paliwal
- Department of Internal Medicine, Wright Center for Graduate Medical Education, 501 S Washington Ave, Scranton, PA 18505, USA;
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, 271 Carew St, Springfield, MA 01104, USA;
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A nonagenarian patient with rhabdomyolysis and multiple organ dysfunction: a case report. J Geriatr Cardiol 2020; 17:787-789. [PMID: 33424947 PMCID: PMC7762691 DOI: 10.11909/j.issn.1671-5411.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Weidhase L, de Fallois J, Haußig E, Kaiser T, Mende M, Petros S. Myoglobin clearance with continuous veno-venous hemodialysis using high cutoff dialyzer versus continuous veno-venous hemodiafiltration using high-flux dialyzer: a prospective randomized controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:644. [PMID: 33176824 PMCID: PMC7659077 DOI: 10.1186/s13054-020-03366-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Background Myoglobin clearance in acute kidney injury requiring renal replacement therapy is important because myoglobin has direct renal toxic effects. Clinical data comparing different modalities of renal replacement therapy addressing myoglobin clearance are limited. This study aimed to compare two renal replacement modalities regarding myoglobin clearance. Methods In this prospective, randomized, single-blinded, single-center trial, 70 critically ill patients requiring renal replacement therapy were randomized 1:1 into an intervention arm using continuous veno-venous hemodialysis with high cutoff dialyzer and a control arm using continuous veno-venous hemodiafiltration postdilution with high-flux dialyzer. Regional citrate anticoagulation was used in both groups to maintain the extracorporeal circuit. The concentrations of myoglobin, urea, creatinine, β2-microglobulin, interleukin-6 and albumin were measured before and after the dialyzer at 1 h, 6 h, 12 h, 24 h and 48 h after initiating continuous renal replacement therapy. Results Thirty-three patients were allocated to the control arm (CVVHDF with high-flux dialyzer) and 35 patients to the intervention arm (CVVHD with high cutoff dialyzer). Myoglobin clearance, as a primary endpoint, was significantly better in the intervention arm than in the control arm throughout the whole study period. The clearance values for urea and creatinine were higher in the control arm. There was no measurable albumin clearance in both arms. The clearance data for β2-microglobulin and interleukin-6 were non-inferior in the intervention arm compared to those for the control arm. Dialyzer lifespan was 57.0 [38.0, 72.0] hours in the control arm and 70.0 [56.75, 72.0] hours in the intervention arm (p = 0.029). Conclusions Myoglobin clearance using continuous veno-venous hemodialysis with high cutoff dialyzer and regional citrate anticoagulation is better than that with continuous veno-venous hemodiafiltration with regional citrate anticoagulation. Trial registration German Clinical Trials Registry (DRKS00012407); date of registration 23/05/2017. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012407.
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Affiliation(s)
- Lorenz Weidhase
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Saxony, Germany.
| | - Jonathan de Fallois
- Division of Nephrology, Medical Department III, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Elena Haußig
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Thorsten Kaiser
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Meinhard Mende
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig, Saxony, Germany
| | - Sirak Petros
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Saxony, Germany
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Liu X, Meng X, Zhang C, Chen J, Li P, Wu X, Fan H. Rhabdomyolysis in a Civil Aviation Pilot. Aerosp Med Hum Perform 2020; 91:901-903. [PMID: 33334412 DOI: 10.3357/amhp.5573.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Rhabdomyolysis is a potentially fatal disease caused by trauma, infections, and toxins. Rhabdomyolysis has not been reported in Chinese civil aircrew, but in our case report a male civil copilot contracted rhabdomyolysis after excessive exercise, showing potential for morbidity in pilots.CASE REPORT: After excessive exercise, a 29-yr-old male civil aviation copilot complained of serious myalgia and weakness in lower limb muscles and gross hematuria, whose values of alanine transaminase (ALT), aspartate transaminase (AST), myohemoglobin (Mb), creatine kinase (CK), CK-MB, lactate dehydrogenase (LDH), and -hydroxybutyrate dehydrogenase (-HBDH) were conspicuously increased. Magnetic resonance imaging showed abnormal signal intensities in the lower limbs. The patient was diagnosed with rhabdomyolysis. He was treated with hydration and urine alkalinization. When his condition was stabilized, the patient was discharged. After remaining asymptomatic for 3 mo and getting documentation of normalized lab results, he was granted a first-class medical certificate and returned to work.DISCUSSION: This was the first case of rhabdomyolysis reported in Chinese civil aircrew. Excessive exercise in an overweight pilot may induce rhabdomyolysis. This condition can be controlled and cured by early and effective treatment. Rhabdomyolysis could occur in a population suffering from overweight, obesity, or hyperlipidemia. This case fits in with several other cases of military pilots exercising excessively. The progression could lead to acute kidney injury without prompt and effective intervention. And common symptoms like muscular weakness or myalgia may induce sudden in-flight incapacitation, so early medical intervention should be adopted. Moreover, recurrence of rhabdomyolysis should be considered when resuming flying duties.Liu X, Meng X, Zhang C, Chen J, Li P, Wu X, Fan H. Rhabdomyolysis in a civil aviation pilot. Aerosp Med Hum Res. 2020; 91(11):901903.
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Rogliano PF, Voicu S, Labat L, Deye N, Malissin I, Laplanche JL, Vodovar D, Mégarbane B. Acute Poisoning with Rhabdomyolysis in the Intensive Care Unit: Risk Factors for Acute Kidney Injury and Renal Replacement Therapy Requirement. TOXICS 2020; 8:toxics8040079. [PMID: 32998294 PMCID: PMC7711436 DOI: 10.3390/toxics8040079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 01/04/2023]
Abstract
Acute kidney injury (AKI) is the major complication of rhabdomyolysis. We aimed to identify the predictive factors for AKI and renal replacement therapy (RRT) requirement in poisoning-associated rhabdomyolysis. We conducted a cohort study including 273 successive poisoned patients (median age, 41 years) who developed rhabdomyolysis defined as creatine kinase (CK) >1000 IU/L. Factors associated with AKI and RRT requirement were identified using multivariate analyses. Poisonings mainly involved psychotropic drugs. AKI occurred in 88 patients (37%) including 43 patients (49%) who required RRT. Peak serum creatinine and CK were weakly correlated (R2 = 0.17, p < 0.001). Death (13%) was more frequent after AKI onset (32% vs. 2%, p < 0.001). On admission, lithium overdose (OR, 44.4 (5.3–371.5)), serum calcium ≤2.1 mmol/L (OR, 14.3 (2.04–112.4)), female gender (OR, 5.5 (1.8–16.9)), serum phosphate ≥1.5 mmol/L (OR, 2.0 (1.0–4.2)), lactate ≥ 3.3 mmol/L (OR, 1.2 (1.1–1.4)), serum creatinine ≥ 125 µmol/L (OR, 1.05 (1.03–1.06)) and age (OR, 1.04 (1.01–1.07)) independently predicted AKI onset. Calcium-channel blocker overdose (OR, 14.2 (3.8–53.6)), serum phosphate ≥ 2.3 mmol/L (OR, 1.6 (1.1–2.6)), Glasgow score ≤ 5 (OR, 1.12; (1.02–1.25)), prothrombin index ≤ 71% (OR, 1.03; (1.01–1.05)) and serum creatinine ≥ 125 µmol/L (OR, 1.01; (1.00–1.01)) independently predicted RRT requirement. We identified the predictive factors for AKI and RRT requirement on admission to improve management in poisoned patients presenting rhabdomyolysis.
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Affiliation(s)
- Pierre-François Rogliano
- Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France; (P.-F.R.); (S.V.); (N.D.); (I.M.); (D.V.)
- Inserm UMRS 1144, University of Paris, 75010 Paris, France; (L.L.); (J.-L.L.)
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France; (P.-F.R.); (S.V.); (N.D.); (I.M.); (D.V.)
- Inserm UMRS 1144, University of Paris, 75010 Paris, France; (L.L.); (J.-L.L.)
| | - Laurence Labat
- Inserm UMRS 1144, University of Paris, 75010 Paris, France; (L.L.); (J.-L.L.)
- Laboratory of Toxicology, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France
| | - Nicolas Deye
- Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France; (P.-F.R.); (S.V.); (N.D.); (I.M.); (D.V.)
| | - Isabelle Malissin
- Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France; (P.-F.R.); (S.V.); (N.D.); (I.M.); (D.V.)
- Inserm UMRS 1144, University of Paris, 75010 Paris, France; (L.L.); (J.-L.L.)
| | - Jean-Louis Laplanche
- Inserm UMRS 1144, University of Paris, 75010 Paris, France; (L.L.); (J.-L.L.)
- Laboratory of Biochemistry, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France
| | - Dominique Vodovar
- Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France; (P.-F.R.); (S.V.); (N.D.); (I.M.); (D.V.)
- Inserm UMRS 1144, University of Paris, 75010 Paris, France; (L.L.); (J.-L.L.)
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France; (P.-F.R.); (S.V.); (N.D.); (I.M.); (D.V.)
- Inserm UMRS 1144, University of Paris, 75010 Paris, France; (L.L.); (J.-L.L.)
- Correspondence: ; Tel.: +33-(0)1-4995-8961; Fax: +33-(0)1-4995-6578
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Nielsen FE, Cordtz JJ, Rasmussen TB, Christiansen CF. The Association Between Rhabdomyolysis, Acute Kidney Injury, Renal Replacement Therapy, and Mortality. Clin Epidemiol 2020; 12:989-995. [PMID: 33061646 PMCID: PMC7522418 DOI: 10.2147/clep.s254516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/06/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We examined the association between creatine phosphokinase level in rhabdomyolysis patients and risk of acute kidney injury, renal replacement therapy, and death within 30 days. METHODS The cohort included patients admitted with rhabdomyolysis from November 1, 2011 to March 1, 2014. Rhabdomyolysis was defined as a creatine phosphokinase level higher than 1000 U/L. Information on laboratory variables was obtained from a laboratory database. Medical data were obtained from registries. Acute kidney injury was defined according to the Kidney Disease Improving Global Outcome (KDIGO) guidelines. The 30-day risk of outcomes was estimated using the cumulative incidence method. Spline regression applied to imputed datasets with adjustment for baseline variables was used to assess the appropriateness of the categorization chosen for creatine phosphokinase (1000-5000 U/L, 5001-15,000 U/L, and 15,000+ U/L). RESULTS The study included 1027 patients (58.2% male) with a median age of 73.5 years. The median creatine phosphokinase level at rhabdomyolysis diagnosis was 2257 U/L (interquartile range=1404-3961 U/L). The 30-day risks of acute kidney injury according to the three creatinine phosphokinase levels were 42% (95% CI=38-45%), 44% (95% CI=36-52%), and 74% (95% CI=57-85%), respectively, and the risks of renal replacement therapy for the three levels were 3% (95% CI=2-5%), 4% (95% CI=2-7%), and 11% (3-23%), respectively. The 30-day risk of death was 17% (95% CI=14-20%), 16% (95% CI=11-22%), and 11% (95% CI=3-23%), respectively. With increasing creatine phosphokinase levels, the spline plots supported the increasing risk of acute kidney injury and renal replacement therapy, as well as a decreasing risk of death. However, the risk estimates for renal replacement therapy and death were imprecise. CONCLUSION Elevated initial creatine phosphokinase values were associated with an increased risk of acute kidney injury, while estimates of the risk of renal replacement therapy and death were imprecise.
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Affiliation(s)
- Finn Erland Nielsen
- Department of Emergency Medicine, Slagelse Hospital, SlagelseDK-4200, Denmark
- Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, CopenhagenDK-2400 NV, Denmark
| | - Johan Joakim Cordtz
- Department of Emergency Medicine, Slagelse Hospital, SlagelseDK-4200, Denmark
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Pre-hospital Care and the Emergency Department. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-48126-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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13
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Fleet JL, McArthur E, Patel A, Weir MA, Montero-Odasso M, Garg AX. Risk of rhabdomyolysis with donepezil compared with rivastigmine or galantamine: a population-based cohort study. CMAJ 2020; 191:E1018-E1024. [PMID: 31527187 DOI: 10.1503/cmaj.190337] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Donepezil, rivastigmine and galantamine are popular cholinesterase inhibitors used to manage the symptoms of Alzheimer disease and other dementias; regulatory agencies in several countries warn about a possible risk of rhabdomyolysis with donepezil, based on information from case reports. Our goal was to investigate the 30-day risk of admission to hospital with rhabdomyolysis associated with initiating donepezil versus other cholinesterase inhibitors. METHODS We conducted a retrospective cohort study in Ontario, Canada, from 2002 to 2017. Participants were adults aged 66 years or older with a newly dispensed prescription for donepezil compared with rivastigmine or galantamine. The primary outcome was hospital admission with rhabdomyolysis (assessed using hospital diagnostic codes) within 30 days of a new prescription of a cholinesterase inhibitor. Odds ratios were estimated using logistic regression, with inverse probability of treatment weights calculated from propensity scores. RESULTS The average age in our 2 groups was 81.1 years, and 61.4% of our population was female. Donepezil was associated with a higher risk of hospital admission with rhabdomyolysis compared with rivastigmine or galantamine (88 events in 152 300 patients [0.06%] v. 16 events in 68 053 patients [0.02%]; weighted odds ratio of 2.21, 95% confidence interval [CI] 1.52-3.22). Most hospital admissions with rhabdomyolysis after donepezil use were not severe, and no patient was treated with acute dialysis or mechanical ventilation. INTERPRETATION Initiating donepezil is associated with a higher 30-day risk of admission to hospital with rhabdomyolysis compared with initiating rivastigmine or galantamine. The proportion of patients who develop severe rhabdomyolysis within 30 days of initiating donepezil is very low.
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Affiliation(s)
- Jamie L Fleet
- Department of Physical Medicine and Rehabilitation (Fleet), McMaster University, Hamilton, Ont.; ICES (Fleet, McArthur, Weir, Garg); Divisions of Nephrology (Patel, Weir, Garg) and Geriatrics (Montero-Odasso), Departments of Medicine and Epidemiology & Biostatistics (Montero-Odasso, Garg), Western University, London, Ont.
| | - Eric McArthur
- Department of Physical Medicine and Rehabilitation (Fleet), McMaster University, Hamilton, Ont.; ICES (Fleet, McArthur, Weir, Garg); Divisions of Nephrology (Patel, Weir, Garg) and Geriatrics (Montero-Odasso), Departments of Medicine and Epidemiology & Biostatistics (Montero-Odasso, Garg), Western University, London, Ont
| | - Aakil Patel
- Department of Physical Medicine and Rehabilitation (Fleet), McMaster University, Hamilton, Ont.; ICES (Fleet, McArthur, Weir, Garg); Divisions of Nephrology (Patel, Weir, Garg) and Geriatrics (Montero-Odasso), Departments of Medicine and Epidemiology & Biostatistics (Montero-Odasso, Garg), Western University, London, Ont
| | - Matthew A Weir
- Department of Physical Medicine and Rehabilitation (Fleet), McMaster University, Hamilton, Ont.; ICES (Fleet, McArthur, Weir, Garg); Divisions of Nephrology (Patel, Weir, Garg) and Geriatrics (Montero-Odasso), Departments of Medicine and Epidemiology & Biostatistics (Montero-Odasso, Garg), Western University, London, Ont
| | - Manuel Montero-Odasso
- Department of Physical Medicine and Rehabilitation (Fleet), McMaster University, Hamilton, Ont.; ICES (Fleet, McArthur, Weir, Garg); Divisions of Nephrology (Patel, Weir, Garg) and Geriatrics (Montero-Odasso), Departments of Medicine and Epidemiology & Biostatistics (Montero-Odasso, Garg), Western University, London, Ont
| | - Amit X Garg
- Department of Physical Medicine and Rehabilitation (Fleet), McMaster University, Hamilton, Ont.; ICES (Fleet, McArthur, Weir, Garg); Divisions of Nephrology (Patel, Weir, Garg) and Geriatrics (Montero-Odasso), Departments of Medicine and Epidemiology & Biostatistics (Montero-Odasso, Garg), Western University, London, Ont
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14
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Thongprayoon C, Hansrivijit P, Kovvuru K, Kanduri SR, Torres-Ortiz A, Acharya P, Gonzalez-Suarez ML, Kaewput W, Bathini T, Cheungpasitporn W. Diagnostics, Risk Factors, Treatment and Outcomes of Acute Kidney Injury in a New Paradigm. J Clin Med 2020; 9:E1104. [PMID: 32294894 PMCID: PMC7230860 DOI: 10.3390/jcm9041104] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) is a common clinical condition among patients admitted in the hospitals. The condition is associated with both increased short-term and long-term mortality. With the development of a standardized definition for AKI and the acknowledgment of the impact of AKI on patient outcomes, there has been increased recognition of AKI. Two advances from past decades, the usage of computer decision support and the discovery of AKI biomarkers, have the ability to advance the diagnostic method to and further management of AKI. The increasingly widespread use of electronic health records across hospitals has substantially increased the amount of data available to investigators and has shown promise in advancing AKI research. In addition, progress in the finding and validation of different forms of biomarkers of AKI within diversified clinical environments and has provided information and insight on testing, etiology and further prognosis of AKI, leading to future of precision and personalized approach to AKI management. In this this article, we discussed the changing paradigms in AKI: from mechanisms to diagnostics, risk factors, and management of AKI.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17105, USA;
| | - Karthik Kovvuru
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA; (K.K.); (S.R.K.); (M.L.G.-S.)
| | - Swetha R. Kanduri
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA; (K.K.); (S.R.K.); (M.L.G.-S.)
| | - Aldo Torres-Ortiz
- Department of Medicine, Ochsner Medical Center, New Orleans, LA 70121, USA;
| | - Prakrati Acharya
- Division of Nephrology, Department of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA;
| | - Maria L. Gonzalez-Suarez
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA; (K.K.); (S.R.K.); (M.L.G.-S.)
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand;
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85724, USA;
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA; (K.K.); (S.R.K.); (M.L.G.-S.)
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15
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Horiuchi K, Asakura T, Ikeda N. Rhabdomyolysis diagnosed in an older woman with dementia on examination after a wandering episode. Geriatr Gerontol Int 2019; 19:956-957. [DOI: 10.1111/ggi.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Kohei Horiuchi
- Department of Internal MedicineEiju General Hospital Tokyo Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of MedicineKeio University School of Medicine Tokyo Japan
- Department of Pulmonary MedicineEiju General Hospital Tokyo Japan
| | - Nobuhiro Ikeda
- Department of Internal MedicineEiju General Hospital Tokyo Japan
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16
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Key MN, Zwilling CE, Talukdar T, Barbey AK. Essential Amino Acids, Vitamins, and Minerals Moderate the Relationship between the Right Frontal Pole and Measures of Memory. Mol Nutr Food Res 2019; 63:e1801048. [PMID: 31245921 DOI: 10.1002/mnfr.201801048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/23/2019] [Indexed: 02/02/2023]
Abstract
SCOPE Nutrition has increasingly been recognized for its ability to help prevent and protect against disease, inspiring new programs of research that translate findings from nutritional science into innovative assessment tools, technologies, and therapies to advance the practice of modern medicine. A central aim in this effort is to discover specific dietary patterns that promote healthy brain aging and moderate the engagement of neural systems known to facilitate cognitive performance in later life. METHODS AND RESULTS The present study therefore investigates estimates of nutrient intake derived from food frequency questionnaires, structural measures of brain volume via high-resolution magnetic resonance imaging, and standardized neuropsychological measures of memory performance in nondemented elders (n = 111) using a moderation analysis. The results reveal that the essential amino acids, vitamins, and minerals nutrient pattern moderates the positive relationship between the volume of the right frontal pole and measures of both delayed and auditory memory. CONCLUSIONS Our findings demonstrate that a nutrient pattern including macro- and micronutrients moderate the effect of brain structure on cognitive function in old age and support the efficacy of interdisciplinary methods in nutritional cognitive neuroscience for the study of healthy brain aging.
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Affiliation(s)
- Mickeal N Key
- Decision Neuroscience Laboratory, University of Illinois, Urbana, IL, 61801, USA.,Neuroscience Program, University of Illinois, Urbana, IL, 61801, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL, 61801, USA
| | - Christopher E Zwilling
- Decision Neuroscience Laboratory, University of Illinois, Urbana, IL, 61801, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL, 61801, USA
| | - Tanveer Talukdar
- Decision Neuroscience Laboratory, University of Illinois, Urbana, IL, 61801, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL, 61801, USA
| | - Aron K Barbey
- Decision Neuroscience Laboratory, University of Illinois, Urbana, IL, 61801, USA.,Neuroscience Program, University of Illinois, Urbana, IL, 61801, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL, 61801, USA.,Carl R. Woese Institute for Genomic Biology, University of Illinois, Urbana, IL, 61801, USA.,Center for Brain Plasticity, University of Illinois, Urbana, IL, 61801, USA.,Department of Psychology, University of Illinois, Champaign, IL, 61820, USA.,Department of Bioengineering, University of Illinois, Urbana, IL, 61801, USA.,Division of Nutritional Sciences, University of Illinois, Urbana, IL, 61801, USA
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17
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Effects of aging on brain volumes in healthy individuals across adulthood. Neurol Sci 2019; 40:1191-1198. [DOI: 10.1007/s10072-019-03817-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/27/2019] [Indexed: 12/17/2022]
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18
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Nagaraj G, Hullick C, Arendts G, Burkett E, Hill KD, Carpenter CR. Avoiding anchoring bias by moving beyond 'mechanical falls' in geriatric emergency medicine. Emerg Med Australas 2018; 30:843-850. [PMID: 30091183 DOI: 10.1111/1742-6723.13129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Guruprasad Nagaraj
- Hornsby Ku-ring-gai Hospital, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Carolyn Hullick
- Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Glenn Arendts
- Department of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Ellen Burkett
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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