American Journal of Respiratory and Critical Care Medicine · May 2026
C49-27 A Double Hit: Statin-induced Rhabdomyolysis Requiring Dialysis Complicated By Hemodialysis-induced Acute Coronary Syndrome
By Siddenthi S, Suddapalli S, Vedantam D et al.
Abstract Introduction Statins are widely used lipid-lowering agents with well-documented cardiovascular benefits. However, rare complications such as severe rhabdomyolysis and acute kidney injury (AKI) may occur, especially in predisposed individuals. Hemodialysis, a lifesaving intervention for severe AKI, may itself precipitate Acute Coronary Syndrome (ACS) due to rapid hemodynamic shifts. This case highlights the dual insult of statin-induced AKI and dialysis-induced ACS in a high-risk cardiac patient. Description A 70-year-old male with past medical history of coronary artery disease (CAD), percutaneous coronary interventions (PCIs), and chronic kidney disease (CKD), presented with two weeks of progressive weakness and diffuse myalgias. He had recently been switched from atorvastatin 20 mg daily to rosuvastatin 40 mg daily, 3 weeks prior. Laboratory results showed markedly elevated CPK (73,347 U/L), AST (1127 U/L), ALP (246 U/L), and creatinine (12.48 mg/dL), consistent with severe rhabdomyolysis causing AKI. Nephrology was consulted and emergent hemodialysis had to be initiated due to uremia (170 mg/dl) and hyperkalemia (6.2 mmol/L). During his first dialysis session, the patient developed chest pain with elevated troponins, and ST depressions in II, III, aVF, consistent with non-ST-elevation myocardial infarction (NSTEMI). Hemodialysis was prematurely terminated, and the patient was taken for urgent cardiac catheterization, which revealed significant right coronary artery (RCA) disease. He underwent successful stent placement to RCA. Post-PCI, the patient tolerated subsequent dialysis sessions without ischemic events. His CPK and renal function gradually improved. Statin therapy was permanently discontinued, and he was discharged in a stable condition with cardiology and nephrology follow-up. Discussion This case underscores the importance of vigilance for rhabdomyolysis in patients who have recently initiated or changed statin therapy, especially in elderly individuals and those with CKD. It also highlights the need for careful cardiac monitoring during hemodialysis in patients with pre-existing CAD. Early recognition and multidisciplinary management were critical in addressing this rare but serious sequence of complications. Permanent discontinuation of statins and consideration of alternative lipid-lowering therapies are essential in such cases. This abstract is funded by: None