title: Acute Kidney Injury Facilitates Hypocalcemia by Exacerbating the Hyperphosphatemic Effect of Muscle Damage in Rhabdomyolysis.
abstract: OBJECTIVE
  Hypocalcemia is an important complication of rhabdomyolysis for which several pathogenic factors, including acute kidney injury (AKI), have been proposed. To gain insight regarding the hypocalcemic roles of AKI in rhabdomyolysis, we retrospectively examined patients with rhabdomyolysis.
  
  
  METHODS
  Of 28,387 patients admitted to the Department of Internal Medicine, 51 patients met the inclusion criteria for the study. Serum calcium was analyzed based on laboratory data including indicators of AKI, serum creatine kinase (CK) and serum inorganic phosphate (iP).
  
  
  RESULTS
  Twenty-two patients (43%) had hypocalcemia. Compared with patients without hypocalcemia, they had a higher prevalence of AKI (82 vs. 55%; p = 0.046), higher levels of peak CK (39,100 ± 50,600 vs. 9,800 ± 11,900 IU/l; p = 0.003) and higher levels of peak iP (1.77 ± 1.10 vs. 1.10 ± 0.35 mmol/l; p = 0.007). Indicators of AKI were correlated with peak CK and peak iP and were not significant variables in the regression analysis for hypocalcemia. Peak CK and peak iP were not correlated with each other. Impaired phosphate use by muscle contributed to the increased iP.
  
  
  CONCLUSIONS
  These findings indicate that muscle damage is the primary hypocalcemic factor in rhabdomyolysis. AKI facilitated hypocalcemia by exacerbating the hyperphosphatemic effects of muscle damage. Aggressive hydration, which could increase oxygen supply and subsequently repair phosphate use in muscle, might reduce the incidence of hypocalcemia in rhabdomyolysis.
authors.affiliation: Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Higaki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tanemoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shiraishi
authors.forename: Kei
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Fujigaki
authors.forename: Shunya
authors.initials: S
authors.lastname: Uchida
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000150:complications; D000368:Aged; D003402:Creatine Kinase / Q000378:metabolism; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood* / Q000209:etiology; D006996:Hypocalcemia / Q000097:blood* / Q000150:complications; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D010710:Phosphates / Q000097:blood; D015995:Prevalence; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000209:etiology / Q000473:pathology*
chemical_list: D010710:Phosphates; D003402:Creatine Kinase