NDT Advance Access published online on October 8, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn557
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Impact of local circumstances on outcome of renal casualties in major disasters
1 Renal Division, Department of Internal Medicine, University Hospital, Ghent, Belgium 2 Department of Nephrology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan 3 Department of Internal Medicine, Istanbul School of Medicine, Istanbul, Turkey 4 Intensive Care Unit 1K12-C, University Hospital, Ghent 5 Chairman Renal Disaster Relief Task Force, International Society of Nephrology, Brussels, Belgium
Correspondence and offprint requests to: Arjan van der Tol, Renal Division, Department of internal Medicine, University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. Tel: +32-9-2404509; Fax: +3253-764212; E-mail: arjan.vandertol{at}ugent.be
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Abstract |
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Background. In the aftermath of earthquakes, the cumulative incidence of crush-induced acute kidney injury (AKI) is difficult to predict. Insight into factors determining this risk is indispensable to allow adequate logistical planning, which is a prerogative for success in disaster management.
Methods. Data of 88 crush-related AKI patients in the aftermath of the Kashmir earthquake were collected and outcome measures were analysed. Then the findings were compared with the data of 596 crush-related AKI patients of the Marmara earthquake.
Results. The earthquake in Kashmir occurred in a rural area with lack of medical facilities and difficult transportation conditions while the earthquake in Marmara occurred in an urban area with more efficient transport possibilities. In Kashmir we reported fewer patients with treated AKI (1.2 AKI per 1000 deaths, 1.3 AKI per 1000 victims) than in Marmara (34.1 AKI per 1000 deaths; P < 0.001, 13.6 AKI per 1000 victims; P < 0.001). Time lag between earthquake and admission to hospitals was longer in Kashmir (5.8 ± 5.8 days) than in Marmara (3.5 ± 3.7 days; P < 0.001). The frequencies of fasciotomies (P < 0.001), amputations (P < 0.001) and dialysis (P = 0.005) were lower in Kashmir, than in Marmara AKI patients.
Conclusions. The cumulative incidence of treated AKI related to number of deaths or victims might differ substantially among earthquakes. Many factors may affect the frequency of AKI: hampered rescue and transport possibilities; destroyed medical facilities on the spot; availability or not of sophisticated therapeutic possibilities and structure of the buildings might all have impacted on different cumulative incidence between Kashmir and Marmara.
Keywords: acute kidney injury; crush syndrome; earthquakes; Kashmir; Marmara
Received for publication: 23. 2.08
Accepted in revised form: 12. 9.08
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