Pediatric kidney care experience after the 2023 Türkiye earthquake
Authors: Bakkaloğlu Sevcan A , Delibaş Ali , Sürmeli Döven Serra , Taner Sevgin , Yavuz Sevgi , Erfidan Gökçen , Danacı Vatansever Esra , Aynacı Fatma , Yilmaz Kenan , Taşdemir Mehmet , Akacı Okan , Akıncı Nurver , Güven Serçin , Çiçek Neslihan , Dursun Ismail , Keleşoğlu Emre , Sancaktar Muhammet , Alaygut Demet , Saygılı Seha , Yavaşcan Önder , Yılmaz Alev , Gülleroğlu Kaan , Ertan Pelin , Demir Belde Kasap , Poyrazoğlu Hakan , Pınarbaşı Seda , Gençler Aylin , Baştuğ Funda , Günay Neslihan , Çeleğen Kübra , Noyan Aytül , Parmaksız Gönül , Avcı Begüm , Çaycı Fatma Şemsa , Bayrakçı Umut , Özlü Sare Gülfem , Aksoy Özlem Yüksel , Yel Sibel , İnal Güldane Aylin , Köse Seçil , Bayazıt Aysun Karabay , Atmış Bahriye , Sarıbaş Emel , Çağlı Çağla , Tabel Yılmaz , Elmas Ahmet Taner , Zırhlı Selçuk Şenay , Demircioğlu Kılıç Beltinge , Akbalık Kara Mehtap , Büyükçelik Mithat , Balat Ayşe , Durucu Tiryaki Betül , Erdoğdu Bilge , Aksu Bağdagül , Mahmudova Günay , Dursun Hasan , Candan Cengiz , Göknar Nilüfer , Mutlubaş Fatma , Çamlar Seçil Arslansoyu , Başaran Cemaliye , Akbulut Burcu Bulum , Düzova Ali , Gülhan Bora , Oruç Çiğdem , Peru Harun , Alpay Harika , Türkkan Özde Nisa , Gülmez Rüveyda , Çelakıl Mehtap , Doğan Kenan , Bilge Ilmay , Pehlivanoğlu Cemile , Büyükkaragöz Bahar , Leventoğlu Emre , Alpman Nuray , Zeybek Cengiz , Tülpar Sebahat , Çiçek Gülşan Rümeysa Yasemin , Kara Aslıhan , Gürgöze Metin Kaya , Akyol Önder Esra Nagehan , Özdemir Atikel Yeşim , Pul Serim , Sönmez Ferah , Yıldız Gizem , Akman Sema , Elmacı Midhat , Küçük Nuran , Yüksel Selçuk , Kavaz Aslı , Nalçacıoğlu Hülya , Alparslan Caner , Dinçel Nida , Elhan Atilla H , Sever Lale 
Published: February 2024

ABSTRACT

Background
Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related–acute kidney injury (Crush-AKI) and death.

Method
Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded.

Results
A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of &gt;120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000–3000 mL/m2 body surface area (BSA), 40% at 3000–4000 mL/m2 BSA and only 2% at &gt;4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age &gt;15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume &lt;3000–4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived.

Conclusions
These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of &gt;20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000–4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.