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Rhabdomyolysis in an HIV cohort: epidemiology, causes and outcomes.

Rhabdomyolysis in an HIV cohort: epidemiology, causes and outcomes.
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Koubar SH, Estrella MM, Warrier R, Moore RD, Lucas GM, Atta MG, Fine DM,


Koubar SH, Estrella MM, Warrier R, Moore RD, Lucas GM, Atta MG, Fine DM, (click to view)

Koubar SH, Estrella MM, Warrier R, Moore RD, Lucas GM, Atta MG, Fine DM,

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BMC nephrology 2017 07 1718(1) 242 doi 10.1186/s12882-017-0656-9

Abstract
BACKGROUND
The Literature on rhabdomyolysis in the HIV-positive population is sparse and limited. We aimed to explore the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a cohort of HIV-positive patients identified through the Johns Hopkins HIV clinical registry between June 1992 and April 2014.

METHODS
A retrospective analysis of 362 HIV-positive patients with non-cardiac CK elevation ≥1000 IU/L was performed. Both inpatients and outpatients were included. Incidence rate and potential etiologies for rhabdomyolysis were ascertained. The development of acute kidney injury (AKI, defined as doubling of serum creatinine), need for dialysis, and death in the setting of rhabdomyolysis were determined. Logistic regression was used to evaluate the association of peak CK level with the development of AKI.

RESULTS
Three hundred sixty two cases of rhabdomyolysis were identified in a cohort of 7079 patients with a 38,382 person years follow-up time. The incidence rate was nine cases per 1000 person-years (95% CI: 8.5-10.5). Infection was the most common etiology followed by compression injury and drug/alcohol use. One-third of cases had multiple potential etiologies. AKI developed in 46% of cases; 20% of which required dialysis. Thirteen percent died during follow-up. After adjustment, AKI was associated with higher CK (OR 2.05 for each 1-log increase in CK [95% CI: 1.40-2.99]), infection (OR 5.48 [95% CI 2.65-11.31]) and higher HIV viral load (OR 1.22 per 1-log increase [95% CI: 1.03-1.45]).

CONCLUSION
Rhabdomyolysis in the HIV-positive population has many possible causes and is frequently multifactorial. HIV-positive individuals with rhabdomyolysis have a high risk of AKI and mortality.

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