title: Prophylactic fluid therapy in crushed victims of Bam earthquake.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a severe and preventable problem of crushed earthquake victims. Early hydration therapy started before fully removing earthquake rubbles has been claimed to play a decisive role in AKI prevention, which saves the necessity of later dialysis. However, the extent, quality, and appropriateness of its know-how are controversial.
  
  
  METHODS
  Processing clinical and paraclinical data gathered from Bam earthquake victims older than 15 years, we tried to determine correlations between the time of being under the rubbles (TUR), the level of serum creatine phosphokinase (CPK), the delayed onset of fluid therapy (DFT), and finally the volume of intravenous fluid received per day (VFR) with the formation of AKI and the need for dialysis.
  
  
  RESULTS
  There is a direct and significant relation between the intensity of the trauma (TUR and CPK) and DFT with the occurrence of AKI and need for dialysis (P < .001). However, as the VFR increases, the occurrence of AKI and the need for dialysis significantly decrease (P = .005). Based on multivariate analysis, the occurrence of AKI and the need for dialysis are primarily affected by CPK, TUR, and VFR; and DFT has been dropped out. The analysis showed the preventive role of VFR more than 6 L in severe rhabdomyolysis patients and of at least 3 L in moderate ones in development of AKI and dialysis.
  
  
  CONCLUSIONS
  In the severely rhabdomyolized patients (CPK ≥ 15,000), higher volumes of prophylactic fluid (VFR >6 L) are required, whereas in less-traumatized patients, lower volumes (3-6 L) would be effective.
authors.affiliation: Urology Research Center, Tehran, Iran; Department of Nephrology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Najafi
authors.initials: N
authors.lastname: Iraj
authors.forename: Safari
authors.initials: S
authors.lastname: Saeed
authors.forename: Hosseini
authors.initials: H
authors.lastname: Mostafa
authors.forename: Sanadgol
authors.initials: S
authors.lastname: Houshang
authors.forename: Sharifi
authors.initials: S
authors.lastname: Ali
authors.forename: Rashid Farokhi
authors.initials: RF
authors.lastname: Farin
authors.forename: Seirafian
authors.initials: S
authors.lastname: Shiva
authors.forename: Mooraki
authors.initials: M
authors.lastname: Ahmad
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Samimagham
authors.forename: Vahid
authors.initials: V
authors.lastname: Pourfarziani
authors.forename: Atabak
authors.initials: A
authors.lastname: Shahnaz
authors.forename: Osareh
authors.initials: O
authors.lastname: Shahrzad
authors.forename: Boroumand
authors.initials: B
authors.lastname: Behrooz
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003402:Creatine Kinase / Q000097:blood; D003444:Crush Syndrome / Q000209:etiology / Q000628:therapy*; D004190:Disasters; D055866:Earthquakes; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007492:Iran; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003402:Creatine Kinase