Predictors of Acute Kidney Injury in Children Following the Kahramanmaraş Earthquakes: A Retrospective Analysis

Year 2024, Volume: 8 Issue: 3, 267 - 275, 30.12.2024

Aylin Gençler , Kenan Yilmaz , Hakim Çelik

Abstract

Aim: The twin Kahramanmaraş earthquakes that occurred on February 6th, 2023, caused massive destruction in Turkey and Syria, affecting
more than 16 million people in 11 provinces in Turkey alone. Crush syndrome, a common condition in earthquake survivors, is a significant
risk element for the emergence of acute kidney injury (AKI) due to renal hypoperfusion. Therefore, timely intervention is critical to prevent
renal dysfunction and related complications in earthquake survivors. In this particular situation, the current research was conducted to determine
the occurrence of AKI and clinical and laboratory parameters that may predict the development of AKI, particularly crush injury, in
child survivors of these earthquakes.
Material and Methods: The sample of this retrospective multi-center study comprised child survivors of the Kahramanmaraş earthquakes
admitted to two tertiary referral centers in the Şanlıurfa province of Turkey. Children’s demographic, clinical, and laboratory characteristics
were collected, and statistical tests were carried out to identify predictive factors for AKI development.
Results: The results shows that the median age of the 40 earthquake victims, 22 (55%) female and 18 (45%) male, was 9 years (1-17years).
Of these children, 17 (42.5%) developed AKI (Group-1), while 23 (57.5%) did not (Group-2). Crush injuries were observed in 32 (80.0%)
children. The median age of Group-1 was found significantly higher than Group-2 (p=0.004). The time to extrication from the rubble was also
found significantly higher in Group 1 comparing to in Group 2 (p=0.028). Crush injury characteristics were not found to be associated with
the development of AKI (p>0.05). However, receiving intravenous hydration during the transfer to the hospital was found significantly linked
to a lower incidence of AKI (p=0.014). Hemodialysis was performed in 12 (70.6%) children with AKI. Of the 40 children in the sample, two
(5%) in Group1 had died.
Conclusion: The findings of our study demonstrated the importance of timely implementation of necessary interventions, intravenous
hydration in particular, in preventing AKI in child earthquake victims. This study did not find any significant correlation between crush injury
characteristics and the development of AKI. On the other hand, we determined that children who were older and remained under earthquake
rubble for longer were more likely to develop AKI.

Keywords

Earthquakes, crush injuries, acute kidney injury, trauma, extremities, fractures

Kahramanmaraş Depremleri ile Çocuklarda Oluşan Akut Böbrek Hasarı Risk Faktörlerinin Araştırılması: Retrospektif Bir Analiz

Abstract

Amaç: 6 Şubat 2023 tarihinde meydana gelen ve Türkiye ve Suriye'de büyük yıkıma neden olan ikiz Kahramanmaraş depremleri, yalnızca
Türkiye'de 11 ilde 16 milyondan fazla insanı etkilemiştir. Depremzedelerde sık görülen bir durum olan ezilme (crush) sendromu, böbrek
hipoperfüzyonuna bağlı akut böbrek hasarının (ABH) gelişimi için kayda değer bir risk etmenidir. Bu nedenle depremzedelerde böbrek
fonksiyon bozukluğu ve buna bağlı komplikasyonların önlenmesi için zamanında müdahale çok önemlidir. Bu bağlamda bu çalışma, bu
depremlerden sağ kurtulan çocuklarda ABH görülme sıklığını ve ezilme yaralanması başta olmak üzere ABH gelişimini öngörebilecek klinik
ve laboratuvar parametrelerini belirlemek amacıyla yapılmıştır.
Gereç ve Yöntemler: Bu retrospektif çok merkezli çalışmanın evrenini, Kahramanmaraş depremlerinden sağ kurtularak Türkiye'nin Şanlıurfa
ilindeki iki üçüncü basamak sevk merkezine kabul edilen çocuklar oluşturmuştur. Çocukların demografik, klinik ve laboratuvar özellikleri elde
edilerek, ABH gelişimini öngören faktörleri belirlemek için istatistiksel analizlere tabi tutulmuştur.
Bulgular: Araştırmaya dahil edilen 40 depremzede çocuğun ortanca yaşı 9 yıl (1-17 yıl) idi. Bu çocukların 17(%42,5) 'sinde ABH gelişmiş
(Grup-1), 23(%57,5) 'ünde gelişmemişti (Grup 2). Otuz iki (%80,0) çocukta ezilme yaralanması görülmüştü. Grup-1'in ortanca yaşı Grup-2'den
istatistiksel olarak anlamlı derecede yüksek bulunmuştur (p=0,004). Enkazdan çıkarılma süresi de Grup-1'de Grup-2'ye göre istatistiksel olarak
anlamlı derecede daha yüksek bulunmuştur (p=0,028). Ezilme yaralanması özelliklerinin ABH gelişimi ile ilişkili olmadığı belirlendi (p>0,05).
Öte yandan, hastane öncesi intravenöz hidrasyonun daha düşük ABH insidansı ile anlamlı düzeyde ilişkili olduğu bulundu (p=0,014). ABH'lı
çocukların 12 (%70,6)'sine hemodiyaliz uygulanmıştı. Çalışma grubundaki 40 çocuktan Grup-1'de yer alan iki (%5) çocuk ölmüştü.
Sonuç: Çalışmamızın bulguları, depremzede çocuklarda ABH'nin önlenmesinde başta intravenöz hidrasyon olmak üzere gerekli
müdahalelerin zamanında uygulanmasının önemini ortaya koymuştur. Ezilme yaralanması özellikleri ile AKI gelişimi arasında anlamlı bir
ilişki bulamadık. Öte yandan, yaşı daha büyük olan ve deprem enkazı altında daha uzun süre kalan çocuklarda ABH gelişme olasılığının
daha yüksek olduğunu tespit ettik.

Keywords

Depremler, ezilme yaralanması, akut böbrek hasarı, travma, ekstremiteler, kırıklar

References

• 1. Atmis B, Bayazit AK, Cagli Piskin C, Saribas E, Piskin FC, Bilen S, Ozgur Horoz O, Ekinci F, Turker I, Telefon HA, Unal I, Yilmaz HL, Narli N, Yildizdas D. Factors predicting kidney replacement therapy in pediatric earthquake victims with crush syndrome in the first week following rescue. Eur J Pediatr. 2023 Dec;182(12):5591-5598. doi: 10.1007/s00431-023-05250-3.
• 2. Karakaya D, Yılmaz AÇ, Güngör T, Kenan BU, Çelikkaya E, Çakıcı EK. Is the renal score predictive for kidney replacement therapy in pediatric patients with crush syndrome? Pediatr Nephrol. 2024 Jan;39(1):291-296. doi: 10.1007/s00467-023- 06090-x.
• 3. Sarı H, Özel M, Akkoç MF, Şen A. First-Week Analysis after the Turkey Earthquakes: Demographic and Clinical Outcomes of Victims. Prehosp Disaster Med. 2023 Jun;38(3):294-300. doi: 10.1017/S1049023X23000493.
• 4. Sever MS, Erek E, Vanholder R, Yurugen B, Kantarci G, Yavuz M, Ergin H, Bozfakioglu S, Dalmak S, Tulbek MY, Kiper H, Lameire N. Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake. Kidney Int. 2002 Dec;62(6):2264-71. doi: 10.1046/j.1523-1755.2002.00669.x..
• 5. Dönmez O, Meral A, Yavuz M, Durmaz O. Crush syndrome of children in the Marmara Earthquake, Turkey. Pediatr Int. 2001 Dec;43(6):678-82. doi: 10.1046/j.1442-200x.2001.01469.x.
• 6. Altintepe L, Guney I, Tonbul Z, Türk S, Mazi M, Ağca E, Yeksan M. Early and intensive fluid replacement prevents acute renal failure in the crush cases associated with spontaneous collapse of an apartment in Konya. Ren Fail. 2007;29(6):737- 41. doi: 10.1080/08860220701460095.
• 7. Demirkiran O, Dikmen Y, Utku T, Urkmez S. Crush syndrome patients after the Marmara earthquake. Emerg Med J. 2003 May;20(3):247-50. doi: 10.1136/emj.20.3.247.
• 8. Yalın M, Gölgelioğlu F. A Comparative Analysis of Fasciotomy Results in Children and Adults Affected by Crush-Induced Acute Kidney Injury following the Kahramanmaraş Earthquakes. Medicina (Kaunas). 2023 Sep 3;59(9):1593. doi: 10.3390/medicina59091593.
• 9. Sanadgol H, Najafi I, Rajabi Vahid M, Hosseini M, Ghafari A. Fluid therapy in pediatric victims of the 2003 bam, Iran earthquake. Prehosp Disaster Med. 2009 Sep-Oct;24(5):448-52. doi: 10.1017/s1049023x00007305.
• 10. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31. doi: 10.1186/ cc5713.
• 11. Yasar B, Ozbilgehan P, Sen M, Guvendik A. Influence of systemic inflammatory indices on hospital stay and dialysis post-earthquake: A clinical study. PLoS One. 2024 Feb 28;19(2):e0299737. doi: 10.1371/journal.pone.0299737.
• 12. Safari S, Najafi I, Hosseini M, Sanadgol H, Sharifi A, Alavi Moghadam M, Abdulvand A, Rashid Farrokhi F, Borumand B. Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake. Iran J Kidney Dis. 2011 Jan;5(1):25-8.
• 13. Sever MS, Erek E, Vanholder R, Koc M, Yavuz M, Aysuna N, Ergin H, Ataman R, Yenicesu M, Canbakan B, Demircan C, Lameire N. Lessons learned from the catastrophic Marmara earthquake: factors influencing the final outcome of renal victims. Clin Nephrol. 2004 Jun;61(6):413-21. doi: 10.5414/ cnp61413.
• 14. Hu Z, Zeng X, Fu P, Luo Z, Tu Y, Liang J, Tao Y, Qin W. Predictive factors for acute renal failure in crush injuries in the Sichuan earthquake. Injury. 2012 May;43(5):613-8. doi: 10.1016/j. injury.2010.08.025.
• 15. Oda J, Tanaka H, Yoshioka T, Iwai A, Yamamura H, Ishikawa K, Matsuoka T, Kuwagata Y, Hiraide A, Shimazu T, Sugimoto H. Analysis of 372 patients with Crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma. 1997 Mar;42(3):470-5; discussion 475-6. doi: 10.1097/00005373-199703000-00015.
• 16. Tahmasebi MN, Kiani K, Mazlouman SJ, Taheri A, Kamrani RS, Panjavi B, Harandi BA. Musculoskeletal injuries associated with earthquake. A report of injuries of Iran’s December 26th, 2003 Bam earthquake casualties managed in tertiary referral centers. Injury. 2005 Jan;36(1):27-32. doi: 10.1016/j. injury.2004.06.021. Erratum in: Injury. 2005 Jun;36(6):810. Mohammad Naghi, Tahmasebi [corrected to Tahmasebi, Mohammad Naghi]; Kambiz, Kiani [corrected to Kiani, Kambiz]; Shahriar, Jalali Mazlouman [corrected to Mazlouman, Shahriar Jalali]; Afshin, Taheri [corrected to Taheri, Afshin]; Kamrani Reza, Shahriar [corr. PMID: 15589909.
• 17. Sarisözen B, Durak K. Extremity injuries in children resulting from the 1999 Marmara earthquake: an epidemiologic study. J Pediatr Orthop B. 2003 Jul;12(4):288-91. doi: 10.1097/01. bpb.0000049581.53117.65.
• 18. Mertsoy Y, Altintas M. Clinical Features & Early Treatment Outcomes Of Children With Crush Syndrome After Kahramanmaraş Earthquake. Acta Medica Ruha. 2023;1(3):216-227. https://doi.org/10.5281/zenodo.8174082.
• 19. Kantarci G, Vanholder R, Tuglular S, Akin H, Koç M, Ozener C, Akoglu E. Acute renal failure due to crush syndrome during Marmara earthquake. Am J Kidney Dis. 2002 Oct;40(4):682-9. doi: 10.1053/ajkd.2002.35673.
• 20. van der Tol A, Hussain A, Sever MS, Claus S, Van Biesen W, Hoste E, Khan S, Vanholder R. Impact of local circumstances on outcome of renal casualties in major disasters. Nephrol Dial Transplant. 2009 Mar;24(3):907-12. doi: 10.1093/ndt/gfn557.