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World J Nephrol. Mar 6, 2018; 7(2): 58-64
Published online Mar 6, 2018. doi: 10.5527/wjn.v7.i2.58
Diabetic muscle infarction in end-stage renal disease: A scoping review on epidemiology, diagnosis and treatment
Tuck Yean Yong, Kareeann Sok Fun Khow
Tuck Yean Yong, Internal Medicine, Flinders Private Hospital, Bedford Park, SA 5042, Australia
Kareeann Sok Fun Khow, Geriatric Training Research and Aged Care Centre, The University of Adelaide, Paradise, SA 5075, Australia
Author contributions: Yong TY and Khow KSF designed the study, performed the research and wrote the paper.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Tuck Yean Yong, FRACP, MBBS, Consultant Physician, Internal Medicine, Flinders Private Hospital, Flinders Drive, Bedford Park, SA 5042, Australia. tyyong@hotmail.com
Telephone: +61-8-82412121 Fax: +61-8-82400879
Received: November 9, 2017
Peer-review started: November 10, 2017
First decision: December 13, 2017
Revised: December 25, 2017
Accepted: January 23, 2018
Article in press: January 23, 2018
Published online: March 6, 2018
Abstract

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.

Keywords: Diabetic muscle infarction, Dialysis, End-stage renal disease, Kidney transplant, Renal replacement therapy

Core tip: Diabetic muscle infarction (DMI) is an uncommon complication in patients with end-stage renal disease, including kidney transplant recipients. Early recognition of DMI is vital to initiation of prompt treatment. Magnetic resonance imaging is the investigation of choice for diagnosing DMI. Non-surgical treatment involving analgesia, optimization of glycemic control and initial bed rest appears to improve recovery rate. However, recurrence of DMI is relatively common.