Kidney Replacement Therapies and Outcomes in Children With Crush Syndrome–Associated Kidney Injury
Authors: Demirkol Demet , Besci Tolga , Havan Merve , Karacanoğlu Dilek , Kıhtır Hasan Serdar , Yıldızdaş Dinçer , Duyu Muhterem , Özel Abdulrahman , Kocaoğlu Damla Pınar Yavaş , Gökay Naime , Durak Fatih , Mısırlıoğlu Merve , Kılınç Mehmet Arda , Sincar Şahin , Varol Fatih , Köker Alper , Dalkıran Tahir , Yaman Ayhan , Akçay Nihal , Göncü Sultan , Talip Mey , Akkuzu Emine , Uçmak Hacer , Kendirli Tanıl , Barlas Koçoğlu Ülkem , Tufan Erennur , Çebişli Erdem , Ekinci Faruk , Kutlu Nurettin Onur , Kocaoğlu Çelebi , Koç Gülizar , Alakayav Mehmet , Çolak Mustafa , Önder Cihan , Güvenç Kübra Boydağ , Ülgen Tekerek Nazan , Dursun Oğuz , Aygüler Emrullah , Gençay Ali Genco , Bayrakçı Benan 
Published: January 2025

ImportanceThis study addresses the characteristics, kidney replacement therapy (KRT) modalities, and outcomes in children diagnosed with crush syndrome following an earthquake in Turkey.ObjectiveTo analyze the associations of different KRT modalities with long-term dialysis dependency and length of stay (LOS) in the pediatric intensive care unit (PICU).Design, Setting, and ParticipantsThis multicenter, prospective, and retrospective cohort study was conducted across 20 PICUs in Turkey. Participants included children diagnosed with crush syndrome after the 2023 Kahramanmaraş earthquake, and eligibility criteria included age, diagnosis, and need for KRT. Data were analyzed from August to October 2024.ExposureChildren diagnosed with crush syndrome who underwent KRT.Main Outcomes and MeasuresThe primary outcome was dialysis dependency at discharge. Secondary outcomes included LOS in the PICU.ResultsThe study included 183 pediatric patients (median [IQR] age, 158 (108-192) months; 49 [54.4%] males) with earthquake-related injury, of whom 90 required KRT. The median (IQR) time under the rubble was 25.7 (1-137) hours. At admission, 51 patients (56.6%) had stage 3 acute kidney injury, and the median (IQR) serum creatinine phosphokinase level was 15 555 (9386-59 274) IU/L. There was a significant association between the Kidney Disease—Improving Global Outcomes (KDIGO) stage at admission and serum creatinine phosphokinase level (area under the curve, 0.750; 95% CI, 0.621-0.879; P &amp;lt; .001). Among patients undergoing KRT, 33 (36.7%) received continuous venovenous hemodiafiltration, and 23 (25.6%) underwent intermittent hemodialysis (IHD). IHD treatment was the only independent factor associated with shorter PICU LOS (odds ratio [OR], 6.87; 95% CI, 1.54-30.67; P = .01). The dialysis dependency at discharge was higher in children who were transferred late to the PICU (β = 0.003; 95% CI, 0.001-0.005; P &amp;lt; .001) and those with a high Pediatric Trauma Score (β = 0.022; 95% CI, 0.003-0.041; P = 02). IHD was not statistically significantly associated with remaining dialysis-dependent at discharge (OR, 2.18; 95% CI, 0.53-8.98; P = .28). The overall mortality rate in the cohort was 6 patients (6.6%).Conclusions and RelevanceThis cohort study found that children who were transferred late to intensive care and those with a high trauma score after earthquake-related crush injury were more likely to remain dialysis-dependent at discharge. Furthermore, KDIGO stage at admission was associated with elevated serum creatinine phosphokinase levels. These findings highlight the critical importance of early intervention and appropriate treatment in children with AKI following prolonged entrapment.