Management of renal failure in earthquake-related crush syndrome: Multicenter intensive care outcomes.

BACKGROUND

Crush syndrome (CS) is a clinical condition associated with multisystem organ dysfunction that develops after traumatic rhabdomyolysis and primarily affects the kidneys. The aim of this study was to characterize the incidence, risk factors, and treatment patterns of acute kidney injury (AKI) in earthquake victims with CS, with a particular focus on renal replacement therapy (RRT) use and clinical outcomes.

METHODS

In this retrospective multicenter study, 247 adult patients with earthquake-related CS who were admitted to intensive care units (ICUs) in 22 hospitals after the Kahramanmaraş 2023 earthquakes were analyzed. Demographic data, injury patterns, laboratory parameters, treatment protocols, and outcomes were evaluated during the first 15 days following ICU admission.

RESULTS

AKI developed in 78.5% (n=194) of patients, and RRT was required in 62.4% (n=121) of those with AKI. Multiple logistic regression analysis demonstrated that myoglobin and creatinine levels were associated with an elevated risk of developing AKI (odds ratio [OR]: 1.001; 95% confidence interval CI: 1.000-1.001 and OR: 1.735; 95% CI: 1.151-2.615, respectively). Similarly, creatinine level and reasons for ICU admission were identified as factors influencing RRT administration. (OR: 1.7; 95% CI: 1.28-2.15 and OR: 2.9; 95% CI: 1.26-6.90, respectively). The 30-day mortality rate was higher in patients with AKI than in those without AKI. Mortality rates were similar between patients with AKI who received RRT and those who did not.

CONCLUSION

This study demonstrates the high incidence of AKI in earthquake-related CS, underscores the need for improved disaster preparedness with adequate dialysis capacity and early risk stratification using serum myoglobin and creatinine levels for optimal management.