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Paracetamol use and lowered risk of acute kidney injury in patients with rhabdomyolysis

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Abstract

Background

Mortality with rhabdomyolysis-associated acute kidney injury can be as high as 80%. Experimental data from mouse models of rhabdomyolysis showed that paracetamol reduces the expected increase in serum creatinine level. We aimed to assess the association between paracetamol use and the need for starting renal replacement therapy (RRT).

Methods

We conducted a propensity score-matched cohort study in Orléans Hospital, France (a 1136-bed, public, university-affiliated and teaching hospital). All patients with serum creatine phosphokinase (CK) level > 5000 IU/L between January 1st, 2008 and December 31st, 2017 were included. A propensity score was calculated for each included patient by using multivariable logistic regression and all available baseline characteristics. The main outcome was the incidence of RRT initiation from day 1 to day 28 in the propensity score-matched cohort between patients exposed and unexposed to paracetamol.

Results

Over the study period, 1065 patients with at least one CK level measurement > 5000 IU/L were included; 40 (3.8%) had at least one RRT session. Among the 343 matched pairs, 10 (2.9%) exposed and 24 (7.0%) unexposed patients underwent RRT before day 28 (P = 0.021). Primary time-to-event analysis showed that exposure to paracetamol was significantly associated with reduced absolute risk of RRT: absolute risk difference = − 3.18% (95% CI − 5.23 to − 1.20, P = 0.001). All secondary analyses showed a significantly reduced absolute risk of RRT in patients exposed to paracetamol.

Conclusion

Our study showed a significant association between paracetamol exposure and reduced incidence of RRT among patients with rhabdomyolysis.

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Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

not applicable.

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Authors and Affiliations

  1. Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d’Orléans, 14 avenue de l’hôpital, 45100, Orléans, France

    Maxime Desgrouas & Thierry Boulain

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  1. Maxime Desgrouas
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  2. Thierry Boulain
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Contributions

MD: conceptualization; validation; formal analysis; writing–original draft; writing review and editing; ThB: conceptualization; methodology; validation; formal analysis; writing–original draft; writing review and editing; supervision.

Corresponding author

Correspondence to Thierry Boulain.

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Conflict of interest

The authors declare that they have no financial or non-financial competing interests relative to this submission.

Ethical approval

The protocol was approved by the Ethics Committee of the French Society of Intensive Care (#CE SRLF 17-56).

Informed consent

Patients were informed of the study by regular mail, and their right to refuse participation and how to do so was clearly reminded.

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Desgrouas, M., Boulain, T. Paracetamol use and lowered risk of acute kidney injury in patients with rhabdomyolysis. J Nephrol 34, 1725–1735 (2021). https://doi.org/10.1007/s40620-020-00950-7

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  • DOI: https://doi.org/10.1007/s40620-020-00950-7

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