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. 2024 Aug 30;39(9):1514-1522.
doi: 10.1093/ndt/gfae033.

Pediatric kidney care experience after the 2023 Türkiye earthquake

Sevcan A Bakkaloğlu  1 Ali Delibaş  2 Serra Sürmeli Döven  2 Sevgin Taner  3 Sevgi Yavuz  4 Gökçen Erfidan  5 Esra Danacı Vatansever  6 Fatma Aynacı  6 Kenan Yilmaz  7 Mehmet Taşdemir  8 Okan Akacı  9 Nurver Akıncı  10 Serçin Güven  11 Neslihan Çiçek  11 Ismail Dursun  12 Emre Keleşoğlu  13 Muhammet Sancaktar  14 Demet Alaygut  15 Seha Saygılı  16 Önder Yavaşcan  17 Alev Yılmaz  18 Kaan Gülleroğlu  19 Pelin Ertan  20 Belde Kasap Demir  21 Hakan Poyrazoğlu  12 Seda Pınarbaşı  22 Aylin Gençler  23 Funda Baştuğ  24 Neslihan Günay  24 Kübra Çeleğen  24 Aytül Noyan  25 Gönül Parmaksız  25 Begüm Avcı  25 Fatma Şemsa Çaycı  26 Umut Bayrakçı  26 Sare Gülfem Özlü  26 Özlem Yüksel Aksoy  26 Sibel Yel  12 Güldane Aylin İnal  12 Seçil Köse  12 Aysun Karabay Bayazıt  27 Bahriye Atmış  27 Emel Sarıbaş  27 Çağla Çağlı  27 Yılmaz Tabel  28 Ahmet Taner Elmas  28 Şenay Zırhlı Selçuk  28 Beltinge Demircioğlu Kılıç  29 Mehtap Akbalık Kara  29 Mithat Büyükçelik  29 Ayşe Balat  29 Betül Durucu Tiryaki  29 Bilge Erdoğdu  29 Bağdagül Aksu  18 Günay Mahmudova  18 Hasan Dursun  30 Cengiz Candan  13 Nilüfer Göknar  13 Fatma Mutlubaş  15 Seçil Arslansoyu Çamlar  15 Cemaliye Başaran  31 Burcu Bulum Akbulut  32 Ali Düzova  33 Bora Gülhan  33 Çiğdem Oruç  33 Harun Peru  34 Harika Alpay  11 Özde Nisa Türkkan  11 Rüveyda Gülmez  16 Mehtap Çelakıl  35 Kenan Doğan  36 Ilmay Bilge  37 Cemile Pehlivanoğlu  37 Bahar Büyükkaragöz  1 Emre Leventoğlu  1 Nuray Alpman  38 Cengiz Zeybek  39 Sebahat Tülpar  40 Rümeysa Yasemin Çiçek Gülşan  40 Aslıhan Kara  41 Metin Kaya Gürgöze  41 Esra Nagehan Akyol Önder  42 Yeşim Özdemir Atikel  43 Serim Pul  44 Ferah Sönmez  45 Gizem Yıldız  46 Sema Akman  47 Midhat Elmacı  48 Nuran Küçük  49 Selçuk Yüksel  50 Aslı Kavaz  51 Hülya Nalçacıoğlu  52 Caner Alparslan  53 Nida Dinçel  54 Atilla H Elhan  55 Lale Sever  16
Affiliations

Pediatric kidney care experience after the 2023 Türkiye earthquake

Sevcan A Bakkaloğlu et al. Nephrol Dial Transplant. .

Abstract

Background: Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death.

Method: Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded.

Results: A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of >120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% at 3000-4000 mL/m2 BSA and only 2% at >4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age >15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume <3000-4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived.

Conclusions: These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.

Keywords: Türkiye; acute kidney injury; children; crush syndrome; earthquake.

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Conflict of interest statement

None declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Patient distribution by age groups and by earthquake city.
Figure 2:
Figure 2:
Overall patient-important events in pediatric dialysis victims (Number of the patients were given on the top of the bars). CI: crush injury; AKI: acute kidney injury; CS-AKI: crush-related acute kidney injury.
Figure 3:
Figure 3:
Associations among patient survival and ventilator support, use of inotropic drugs, and creatinine levels higher than twice the upper limit of age- and sex-referenced normal levels.

References

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