Prophylactic fluid therapy in crushed victims of Bam earthquake.
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.
Iraj
Najafi
N
Urology Research Center, Tehran, Iran; Department of Nephrology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Saeed
Safari
S
Mostafa
Hosseini
H
Houshang
Sanadgol
S
Ali
Sharifi
S
Farin
Rashid Farokhi
RF
Shiva
Seirafian
S
Ahmad
Mooraki
M
Samimagham
Hamidreza
H
Pourfarziani
Vahid
V
Shahnaz
Atabak
A
Shahrzad
Osareh
O
Behrooz
Boroumand
B
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
D003402:Creatine Kinase