Kidney replacement therapies and outcomes in children with crush syndrome-associated kidney injury

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dc.authorscopusidAyhan Yaman / 55697653700
dc.authorwosidAyhan Yaman / AAO-2530-2020
dc.contributor.authorDemirkol, Demet
dc.contributor.authorBesci, Tolga
dc.contributor.authorHavan, Merve
dc.contributor.authorKaracanoğlu, Dilek
dc.contributor.authorYaman, Ayhan
dc.date.accessioned2025-04-18T06:53:35Z
dc.date.available2025-04-18T06:53:35Z
dc.date.issued2025
dc.departmentİstinye Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü
dc.description.abstractImportance This study addresses the characteristics, kidney replacement therapy (KRT) modalities, and outcomes in children diagnosed with crush syndrome following an earthquake in Turkey. Objective 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). Design, Setting, and Participants This multicenter, prospective, and retrospective cohort study was conducted across 20 PICUs in Turkey. Participants included children diagnosed with crush syndrome after the 2023 Kahramanmara & scedil; earthquake, and eligibility criteria included age, diagnosis, and need for KRT. Data were analyzed from August to October 2024. Exposure Children diagnosed with crush syndrome who underwent KRT. Main Outcomes and Measures The primary outcome was dialysis dependency at discharge. Secondary outcomes included LOS in the PICU. Results 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 (beta = 0.003; 95% CI, 0.001-0.005; P < .001) and those with a high Pediatric Trauma Score (beta = 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 Relevance 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.
dc.identifier.citationDemirkol, D., Besci, T., Havan, M., Karacanoğlu, D., Kıhtır, H. S., Yıldızdaş, D., ... & Bayrakçı, B. (2025). Kidney Replacement Therapies and Outcomes in Children With Crush Syndrome–Associated Kidney Injury. JAMA Network Open, 8(1), e2456793-e2456793.
dc.identifier.doi10.1001/jamanetworkopen.2024.56793
dc.identifier.endpage13
dc.identifier.issn2574-3805
dc.identifier.issue1
dc.identifier.pmid39869334
dc.identifier.scopus2-s2.0-8521709863
dc.identifier.scopusqualityQ1
dc.identifier.startpage1
dc.identifier.urihttp://dx.doi.org/10.1001/jamanetworkopen.2024.56793
dc.identifier.urihttps://hdl.handle.net/20.500.12713/6388
dc.identifier.volume8
dc.identifier.wosWOS:001411685500008
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorYaman, Ayhan
dc.institutionauthoridAyhan Yaman / 0000-0002-5651-1286
dc.language.isoen
dc.publisherAmer medical assoc
dc.relation.ispartofJama network open
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.titleKidney replacement therapies and outcomes in children with crush syndrome-associated kidney injury
dc.typeArticle

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