Risk Factors for Renal Replacement Therapy in Patients with Rhabdomyolysis Presenting to the Emergency Department

Abstract Rhabdomyolysis is a clinical syndrome characterized by skeletal muscle breakdown and the release of intracellular components, which can precipitate acute kidney injury (AKI). Early identification of patients at risk for hemodialysis is essential to prevent progression of renal failure and improve outcomes. This study aimed to evaluate the clinical and laboratory characteristics of patients with rhabdomyolysis presenting to the emergency department and to identify predictors associated with the requirement for hemodialysis. In this retrospective cohort study, 135 adult patients diagnosed with rhabdomyolysis between August 1, 2022 and August 1, 2023 were included. Patients were divided into dialysis (n = 28) and non-dialysis (n = 107) groups. Demographic, clinical, and laboratory data at admission were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of hemodialysis requirement. Trauma/crush injuries (33.3%), drugs/toxins (17.8%), and seizures (14.8%) were the most common etiologies. Patients requiring hemodialysis had significantly higher creatine kinase, creatinine, blood urea nitrogen, phosphorus, lactate, and C-reactive protein levels, and lower bicarbonate and sodium levels. Logistic regression identified creatinine (OR = 3.18), phosphorus (OR = 2.87), bicarbonate (OR = 0.78), and age (OR = 0.964) as independent predictors of hemodialysis requirement, with increasing age showing an inverse association. Elevated serum creatinine, hyperphosphatemia, metabolic acidosis, and younger age were independently associated with hemodialysis requirement in patients with rhabdomyolysis. Early recognition of these risk factors, along with aggressive fluid resuscitation and timely nephrology consultation, may improve patient outcomes. Future prospective, multicenter studies are needed to validate these findings and optimize clinical management strategies.