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

This study addresses the characteristics, kidney replacement therapy (KRT) modalities, and outcomes in children diagnosed with crush syndrome following an earthquake in Turkey. To analyze the associations of different KRT modalities with long-term dialysis dependency and length of stay (LOS) in the pediatric intensive care unit (PICU). This 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. Children diagnosed with crush syndrome who underwent KRT. The primary outcome was dialysis dependency at discharge. Secondary outcomes included LOS in the PICU. The 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 < .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 < .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%). This 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.