Impact of local circumstances on outcome of renal casualties in major disasters.
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.
Department of internal Medicine, Renal Division, University Hospital, Ghent, Belgium. arjan.vandertol@ugent.be
Arjan
A
van der Tol
Asrar
A
Hussain
Memhet Sukru
MS
Sever
Stefaan
S
Claus
Wim
W
Van Biesen
Eric
E
Hoste
Samuel
S
Khan
Raymond
R
Vanholder
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003444:Crush Syndrome / Q000453:epidemiology* / Q000628:therapy; D003695:Delivery of Health Care / Q000458:organization & administration*; D004190:Disasters / Q000706:statistics & numerical data*; D055866:Earthquakes / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007668:Kidney / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult