Higher Body Mass Index and Black Race Increase Risk of Rhabdomyolysis and Acute Kidney Injury After Trauma

In the paper “Black Race and Body Mass Index are Risk Factors for Rhabdomyolysis and Acute Kidney Injury in Trauma,” the authors investigated body mass index (BMI) and race as risk factors for the development of rhabdomyolysis and acute kidney injury (AKI) in trauma patients. Their results showed that both higher BMI and black race were associated with a significantly increased risk for rhabdomyolysis and AKI after trauma [1]. Trauma is the leading cause of death in patients under the age of 45 and the overall fourth leading cause of death in the United States [2]. Therefore, clinical data analysis, in addition to basic science research, is essential to the overall improvement of mortality and morbidity in trauma patient populations. More specifically, research analyzing risk factors for poor outcomes after trauma can help physicians and nurses better prepare for certain types of patients. Several risk factors that increase mortality after trauma have already been identified. For example, one study published in the Journal of the American College of Surgeons showed that trauma patients with a BMI greater than or equal to 30 were 7.1 times more likely to die in the hospital compared to their non-obese counterparts. This was after they controlled for diabetes, gender, obesity, age, chronic obstructive pulmonary disease (COPD), and Injury Severity Score (ISS) [3]. Furthermore, studies investigating race showed that black trauma patients had worse outcomes than their white counterparts [1,4]. Multiple papers have also documented BMI and black race to be independent risk factors for AKI [1,5]. The paper “Black Race and Body Mass Index are Risk Factors for Rhabdomyolysis and Acute Kidney Injury in Trauma” investigated two important and severe complications as listed in the title [1]. AKI is a potentially fatal condition that can develop in about 1–25% of intensive care unit patients, and it is often associated with increased mortality. The cause of post-traumatic AKI is not well documented; some publications suggest that decreased renal perfusion is the main cause, while others propose that it is caused by rhabdomyolysis [6]. Rhabdomyolysis is a condition where the rapid degradation of damaged or injured skeletal muscle tissue, often after trauma, releases various intracellular muscle components, potentially causing a host of life-threatening complications [7]. The mortality rate for rhabdomyolysis is approximately 10%, and is even higher for patients who subsequently develop AKI [8]. The seriousness of these complications only adds to the need to determine risk factors with the hope to better prevent and treat them. It has previously been shown that blood pressure levels for African American have been increased compared to other races. As a result, African Americans have higher rates of stroke, endstage renal disease, and congestive heart failure [9]. However, the authors found that black race was still a risk factor for rhabdomyolysis and AKI even after controlling for many variables including hypertension, end-stage renal disease, and heart failure. The authors should be applauded in that they utilized the National Trauma Data Bank (NTDB) to its maximum potential. Impactful studies regarding rhabdomyolysis are limited. Many single-centers cannot sufficiently analyze these patients since the incidence is so low, but with the NTDB, the authors were able to analyze over 500 rhabdomyolysis