Skip to main content
Log in

The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis

  • Review Article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript



Identifying the potential effective factors of rhabdomyolysis-induced acute kidney injury (AKI) is of major importance for both treatment and logistic concerns. The present study aimed to evaluate the value of creatine kinase (CK) in predicting the risk of rhabdomyolysis-induced AKI through meta-analysis.


Two reviewers searched the electronic databases of Medline, EMBASE, Cochrane library, Scopus, and Google Scholar. Data regarding study design, patient characteristics, number of cases, mean and screening characteristics of CK, and final patient outcome were extracted from relevant studies. Pooled measures of standardized mean difference, OR, and diagnostic accuracy were calculated using STATA version 11.0.


5997 non-redundant studies were found (143 potentially relevant). 27 articles met the inclusion criteria but 9 were excluded due to lack of data. The correlation between serum CK and AKI occurrence was stronger in traumatic cases (SMD = 1.34, 95 % CI = 1.25–1.42, I 2 = 94 %; p < 0.001). This correlation was more prominent in crush-induced AKI (adjusted OR = 14.7, 95 % CI = 7.63–28.52, I 2 = 0.0 %; p = 0.001). Area under the ROC curve of CK in predicting AKI occurrence was 0.75 (95 % CI = 0.71–0.79).


The results of this meta-analysis declared the significant role of rhabdomyolysis etiology (traumatic/non-traumatic) in predictive performance of CK. There was a significant correlation between mean CK level and risk of crush-induced AKI. The pooled OR of CK was considerable, but its screening performance characteristics were not desirable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Li PKT, Burdmann EA, Mehta RL. Acute kidney injury: global health alert. Kidney Int. 2013;83(3):372–6.

    Article  PubMed  Google Scholar 

  2. Najafi I, van Biesen W, Sharifi A, Hoseini M, Farokhi FR, Sanadgol H, et al. Early detection of patients at high risk for acute kidney injury during disasters: development of a scoring system based on the Bam earthquake experience. J Nephrol. 2008;21(5):776–82.

    PubMed  Google Scholar 

  3. Hu Z, Zeng X, Fu P, Luo Z, Tu Y, Liang J, et al. Predictive factors for acute renal failure in crush injuries in the Sichuan earthquake. Injury. 2012;43(5):613–8.

    Article  PubMed  Google Scholar 

  4. Chen CY, Lin YR, Zhao LL, Yang WC, Chang YJ, Wu HP. Clinical factors in predicting acute renal failure caused by rhabdomyolysis in the ED. Am J Emerg Med. 2013;31(7):1062–6.

    Article  PubMed  Google Scholar 

  5. Delaney KA, Givens ML, Vohra RB. Use of RIFLE criteria to predict the severity and prognosis of acute kidney injury in emergency department patients with rhabdomyolysis. J Emerg Med. 2012;42(5):521–8.

    Article  PubMed  Google Scholar 

  6. Fernandez WG, Hung O, Bruno GR, Galea S, Chiang WK. Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis. Am J Emerg Med. 2005;23(1):1–7.

    Article  PubMed  Google Scholar 

  7. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.

    Article  CAS  PubMed  Google Scholar 

  8. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5(1):13.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions: the Cochrane Collaboration; 2011.

  10. Sistrom CL, Mergo PJ. A simple method for obtaining original data from published graphs and plots. Am J Roentgenol. 2000;174(5):1241–4.

    Article  CAS  Google Scholar 

  11. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882–93.

    Article  PubMed  Google Scholar 

  13. Agency for Healthcare Research and Quality. Methods guide for effectiveness and comparative effectiveness reviews: Agency for Healthcare Research and Quality; 2012. Accessed 2012; 2012 [cited 2012 September 12].

  14. Watanabe T. Rhabdomyolysis and acute renal failure in children. Pediatric Nephrol. 2001;16(12):1072–5.

    Article  CAS  Google Scholar 

  15. Huang KC, Lee TS, Lin YM, Shu KH. Clinical features and outcome of crush syndrome caused by the Chi-Chi earthquake. J Formos Med Assoc. 2002;101(4):249–56.

    PubMed  Google Scholar 

  16. Sever MS, Erek E, Vanholder R, Akoǧlu E, Yavuz M, Ergin H, et al. The Marmara earthquake: epidemiological analysis of the victims with nephrological problems. Kidney Int. 2001;60(3):1114–23.

    Article  CAS  PubMed  Google Scholar 

  17. Brown CV, Rhee P, Chan L, Evans K, Demetriades D, Velmahos GC. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma. 2004;56(6):1191–6.

    Article  PubMed  Google Scholar 

  18. Fine DM, Gelber AC, Melamed ML, Lin JC, Zhang L, Eustace JA. Risk factors for renal failure among 72 consecutive patients with rhabdomyolysis related to illicit drug use. Am J Med. 2004;117(8):607–10.

    Article  PubMed  Google Scholar 

  19. Bhavsar P, Rathod KJ, Rathod D, Chamania CS. Utility of serum creatinine, creatine kinase and urinary myoglobin in detecting acute renal failure due to rhabdomyolysis in trauma and electrical burns patients. Indian J Surg. 2013;75(1):17–21.

    Article  PubMed  PubMed Central  Google Scholar 

  20. El-Abdellati E, Eyselbergs M, Sirimsi H, van Hoof V, Wouters K, Verbrugghe W, et al. An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury. Ann Intensive Care. 2013;3(1):1–8.

    Article  Google Scholar 

  21. Hoffman MD, Stuempfle KJ, Fogard K, Hew-Butler T, Winger J, Weiss RH. Urine dipstick analysis for identification of runners susceptible to acute kidney injury following an ultramarathon. J Sports Sci. 2013;31(1):20–31.

    Article  PubMed  Google Scholar 

  22. Stewart IJ, Cotant CL, Tilley MA, Huzar TF, Aden JK, Snow BD, et al. Association of rhabdomyolysis with renal outcomes and mortality in burn patients. J Burn Care Res. 2013;34(3):318–25.

    Article  PubMed  Google Scholar 

  23. Rodríguez E, Soler MJ, Rap O, Barrios C, Orfila MA, Pascual J. Risk factors for acute kidney injury in severe rhabdomyolysis. PLoS One. 2013;8(12):e82992.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Subramanian A, Sukheeja D, Trikha V, Pandey AK, Albert V, Pandey RM. Evaluation of serum creatine kinase and urinary myoglobin as markers in detecting development of acute renal failure in severely injured trauma patients. ISRN Emerg Med. 2013;2013:1–7.

    Article  Google Scholar 

  25. Amini M, Sharifi A, Najafi I, Eghtesadi-Araghi P, Rasouli MR. Role of dipstick in detection of haeme pigment due to rhabdomyolysis in victims of Bam earthquake. East Mediterr Health J. 2010;16(9):977–81.

  26. Iraj N, Saeed S, Mostafa H, Houshang S, Ali S, Farin RF, et al. Prophylactic fluid therapy in crushed victims of Bam earthquake. Am J Emerg Med. 2011;29(7):738–42.

    Article  PubMed  Google Scholar 

  27. Kasaoka S, Todani M, Kaneko T, Kawamura Y, Oda Y, Tsuruta R, et al. Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis. J Crit Care. 2010;25(4):601–4.

    Article  CAS  PubMed  Google Scholar 

  28. Alavi-Moghaddam M, Safari S, Najafi I, Hosseini M. Accuracy of urine dipstick in the detection of patients at risk for crush-induced rhabdomyolysis and acute kidney injury. Eur J Emerg Med. 2012;19(5):329–32.

    Article  PubMed  Google Scholar 

  29. Mannix R, Tan ML, Wright R, Baskin M. Acute pediatric rhabdomyolysis: causes and rates of renal failure. Pediatrics. 2006;118(5):2119–25.

    Article  PubMed  Google Scholar 

  30. McMahon GM, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med. 2013;173(19):1821–8.

    Article  CAS  PubMed  Google Scholar 

  31. Muckart DJ, Moodley M, Naidu AG, Reddy AD, Meineke KR. Prediction of acute renal failure following soft-tissue injury using the venous bicarbonate concentration. J Trauma. 1992;33(6):813–7.

    Article  CAS  PubMed  Google Scholar 

  32. Paul A, John B, Pawar B, Sadiq S. Renal profile in patients with orthopaedic trauma: a prospective study. Acta Orthop Belg. 2009;75(4):528–32.

    PubMed  Google Scholar 

  33. Skinner DL, Hardcastle TC, Rodseth RN, Muckart DJJ. The incidence and outcomes of acute kidney injury amongst patients admitted to a level I trauma unit. Injury. 2014;45(1):259–64.

    Article  CAS  PubMed  Google Scholar 

  34. Sever MS, Kellum J, Hoste E, Vanholder R. Application of the RIFLE criteria in patients with crush-related acute kidney injury after mass disasters. Nephrol dial Transplant. 2011;26(2):515–24.

    Article  PubMed  Google Scholar 

  35. Wu CT, Huang JL, Lin JJ, Hsia SH. Factors associated with nontraumatic rhabdomyolysis and acute renal failure of children in taiwan population. Pediatr Emerg Care. 2009;25(10):657–60.

    Article  PubMed  Google Scholar 

  36. Mostafa H, Saeed S, Ali S, Manuchehr A, Rashid FF, Houshang S, et al. Wide spectrum of traumatic rhabdomyolysis in earthquake victims. Acta Medica Iranica. 2009;47(6):459–64.

    Google Scholar 

  37. Rodriguez-Capote K, Balion CM, Hill SA, Cleve R, Yang L, El Sharif A. Utility of urine myoglobin for the prediction of acute renal failure in patients with suspected rhabdomyolysis: a systematic review. Clin Chem. 2009;55(12):2190–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Iraj Najafi.

Ethics declarations

Conflict of interest

The authors declare that no conflict of interest exists.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Safari, S., Yousefifard, M., Hashemi, B. et al. The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis. Clin Exp Nephrol 20, 153–161 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: