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Aging and disease    2018, Vol. 9 Issue (1) : 1-7     DOI: 10.14336/AD.2017.0304
Orginal Article |
The Study of Rhabdomyolysis in the Elderly: An Epidemiological Study and Single Center Experience
Wongrakpanich Supakanya*, Kallis Christos, Prasad Prithiv, Rangaswami Janani, Rosenzweig Andrew
Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
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Abstract  

Rhabdomyolysis is a syndrome caused by injury to skeletal muscle. There is limited data of rhabdomyolysis in the elderly. The objective of this study is to investigate demographic data, etiologies, laboratory values, prognostic factors, and mortality of rhabdomyolysis in the geriatric population. A 4-years retrospective chart review study was conducted. Our inclusion criteria were age above 65 years and creatinine kinase level excess five times of normal upper limit. Among 167 patients, 47.3% were male. The median age at diagnosis was 80.11 (66-101) years. The duration of follow up in the study ranged from 0 to 48 months. Fall (with or without immobilization) was the most frequent cause of rhabdomyolysis in 56.9%. The mean baseline glomerular filtration rate (GFR), GFR at diagnosis, and peak decline in GFR was 76.94, 48.96, and 54.41 cc/min respectively. The mean CK at diagnosis and peak CK was 5097.22 and 6320.07. There were 45 deaths (21%) over the span of 4 years. Multivariate analysis demonstrated that number of medications pre-admission (Meds No.), peak decline in GFR, and acute kidney injury (AKI) are independent predictors for overall survival for rhabdomyolysis in the elderly. To our knowledge, this is the first epidemiological study of rhabdomyolysis in the elderly. Falls (with and without immobilization) were the most common etiology. Meds No. (>8), peak decline in GFR (<30 cc/min), and evidence of AKI are associated with shorter overall survival and can serve as potential independent prognostic markers for rhabdomyolysis in elderly patients.

Keywords rhabdomyolysis      elderly      immobilization      fall      polypharmarcy     
Corresponding Authors: Wongrakpanich Supakanya   
About author:

These authors equally contributed to this work.

Issue Date: 01 February 2018
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Wongrakpanich Supakanya
Kallis Christos
Prasad Prithiv
Rangaswami Janani
Rosenzweig Andrew
Cite this article:   
Wongrakpanich Supakanya,Kallis Christos,Prasad Prithiv, et al. The Study of Rhabdomyolysis in the Elderly: An Epidemiological Study and Single Center Experience[J]. Aging and disease, 2018, 9(1): 1-7.
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http://www.aginganddisease.org/EN/10.14336/AD.2017.0304     OR     http://www.aginganddisease.org/EN/Y2018/V9/I1/1
CharacteristicsNon-AKI (n=50)AKI (n=115)P values
Age81.36(9.41)79.57(9.05)0.251*
Duration of follow up (months)13.21(13.83)12.26(12.99)0.679*
Body mass index21.94(8.89)20.43(9.19)0.728*
Number of medications pre-admission6.98(4.48)7.75(4.71)0.336*
Cr baseline1.33(1.46)1.22(0.62)0.631*
GFR baseline83.6(39.80)73.72(27.53)0.085*
CK at diagnosis3984.94(6652.55)5643.71(6608.37)0.146*
Cr at diagnosis1.68(2.69)2.90(2.91)0.012*
GFR at diagnosis75.60(37.68)37.72(23.24)<0.001*
CK peak5837.22(10171.41)6612.12(7155.41)0.578*
Potassium on admission4.32(0.80)4.47(1.01)0.363*
Phosphorus on admission3.65(1.36)4.37(1.22)0.034*
Albumin on admission3.01(0.76)2.67(0.72)0.025*
Cr peak1.72(2.69)3.34(3.19)0.001*
Peak decline in GFR81.72(43.99)42.55(26.95)<0.001*
CK discharge1443.13(3367.84)1531.25(4309.98)0.900*
Cr discharge1.23(1.25)1.75(1.97)0.091*
Race
African American37 (74%)86 (74.78%)0.582**
Caucasian10 (20%)22 (19.13%)
Hispanic1 (2%)1 (0.87%)
Asian2 (4%)2 (1.73%)
Other0 (0%)4 (3.47%)
Sex
Male20 (40%)58 (50.43%)0.217**
Female30 (60%)57 (49.56%)
Death in the same admission1 (2%)15 (13.04%)0.030**
HTN39 (78%)96 (83.48%)0.337**
DM12 (24%)42 (36.52%)0.107**
CHF7 (14%)22 (19.13%)0.426**
CAD6 (12%)25 (21.74%)0.141**
Parkinson’s disease0 (0%)3 (2.61%)0.249**
Dementia11 (22%)25 (21.74%)0.970**
Ambulatory dysfunction21 (42%)56 (48.69%)0.428**
CVA5 (10%)24 (20.87%)0.092**
CKD9 (18%)33 (28.70%)0.287**
Cause of rhabdomyolysis0.381**
Fall and/or immobilization38 (76%)64 (55.65%)
Statin induced0 (0%)2 (1.73%)
Accident/Trauma1 (2%)2 (1.73%)
Unknkown4 (8%)16 (13.91%)
Medication induced0 (0%)3 (2.61%)
Surgery1 (2%)2 (1.73%)
Burn0 (0%)1 (0.87%)
Seizure2 (4%)7 (6.09%)
Sepsis0 (0%)8 (6.95%)
Diabetes ketoacidosis0 (0%)2 (1.73%)
Neuroleptic Malignant Syndrome1 (2%)1 (0.87%)
Vigorous exercise1 (2%)0 (0%)
Alcohol1 (2%)1 (0.87%)
Post cardiac arrest0 (0%)1 (0.87%)
Lower extremity ischemia1 (2%)0 (0%)
Infection0 (0%)1 (0.87%)
Fall and statin induced0 (0%)2 (1.73%)
Fall24 (48%)46 (0.40%)0.339**
Table 1  Clinical characteristics in rhabdomyolysis elderly patients between AKI and non-AKI groups.
CharacteristicsHazard Ratio95% Confident intervalP value
Age1.0160.984-1.0500.325
Sex1.3.5436940.900-3.1900.102
BMI1.0160.737-1.4000.925
Hypertension0.4540.199-1.0310.590
Diabetes1.2160.577-2.5610.607
Congestive heart failure1.6810.690-4.0970.253
Coronary artery disease0.9540.408-2.2300.913
Parkinson’s disease3.5430.431-29.1270.239
Dementia1.7610.843-3.6800.133
Ambulatory dysfunction0.4260.203-0.8950.024
Cerebrovascular accident1.5800.678-3.6820.289
Chronic kidney disease1.6200.825-3.1800.161
Number of medications0.9470.882-1.0170.135
Baseline Creatinine0.9480.075-11.9800.967
Baseline GFR0.9600.896-1.0280.247
CK at diagnosis1.0000.999-1.0000.757
Creatinine at diagnosis0.2760.022-3.4500.318
GFR at diagnosis0.9280.822-1.0480.227
Peak CK1.0001.000-1.0010.506
Serum Potassium at diagnosis1.0250.377-2.7920.961
Serum Phosphorus at diagnosis0.9780.479-1.9960.951
Serum troponin at diagnosis1.0000.999-1.0000.287
Serum albumin at diagnosis1.2680.460-3.4950.646
Peak creatinine3.2000.340-30.0910.309
Peak GFR1.0960.960-1.2530.176
CK at discharge1.0010.999-1.0020.265
Creatinine at discharge0.9630.191-4.8620.964
Acute kidney injury (Yes/No)3.0431.90-7.7810.020
Need for dialysis (Yes/No/ESRD)2.0130.884-4.5820.096
Table 2  Univariate analysis using Cox proportional hazard regression between overall survival and rhabdomyolysis variables.
CharacteristicsHazard Ratio95% Confident intervalP value
Number of Medications (<8 vs ≥8)2.3911.166-4.9020.017
Peak GFR (<30 vs ≥ 30 mg/dL)2.0391.004-4.1410.049
Acute kidney injury3.3261.139-9.7150.028
Table 3  Multivariate analysis using backward selection model
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