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2018 ; 7
(2
): 58-64
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Diabetic muscle infarction in end-stage renal disease: A scoping review on
epidemiology, diagnosis and treatment
#MMPMID29527509
Yong TY
; Khow KSF
World J Nephrol
2018[Mar]; 7
(2
): 58-64
PMID29527509
show ga
Diabetic muscle infarction (DMI) refers to spontaneous ischemic necrosis of
skeletal muscle among people with diabetes mellitus, unrelated to arterial
occlusion. People with DMI may have coexisting end-stage renal disease (ESRD) but
little is known about its epidemiology and clinical outcomes in this setting.
This scoping review seeks to investigate the characteristics, clinical features,
diagnostic evaluation, management and outcomes of DMI among people with ESRD.
Electronic database (PubMed/MEDLINE, CINAHL, SCOPUS and EMBASE) searches were
conducted for ("diabetic muscle infarction" or "diabetic myonecrosis") and
("chronic kidney disease" or "renal impairment" or "dialysis" or "renal
replacement therapy" or "kidney transplant") from January 1980 to June 2017.
Relevant cases from reviewed bibliographies in reports retrieved were also
included. Data were extracted in a standardized form. A total of 24 publications
with 41 patients who have ESRD were included. The mean age at the time of
presentation with DMI was 44.2 years. Type 2 diabetes was present in 53.7% of
patients while type 1 in 41.5%. In this cohort, 60.1% were receiving
hemodialysis, 21% on peritoneal dialysis and 12.2% had kidney transplantation.
The proximal lower limb musculature was the most commonly affected site. Muscle
pain and swelling were the most frequent manifestation on presentation. Magnetic
resonance imaging (MRI) provided the most specific findings for DMI. Laboratory
investigation findings are usually non-specific. Non-surgical therapy is usually
used in the management of DMI. Short-term prognosis of DMI is good but recurrence
occurred in 43.9%. DMI is an uncommon complication in patients with diabetes
mellitus, including those affected by ESRD. In comparison with unselected
patients with DMI, the characteristics and outcomes of those with ESRD are
generally similar. DMI may also occur in kidney transplant recipients, including
pancreas-kidney transplantation. MRI is the most useful diagnostic investigation.
Non-surgical treatment involving analgesia, optimization of glycemic control and
initial bed rest can help to improve recovery rate. However, recurrence of DMI is
relatively frequent.