Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake

Abstract

Substantial amounts of dialysis support may be necessary for treating the victims of mass disasters complicated with crush syndrome. Dialyzed patients are characterized by higher rates of morbidity and mortality.

Lessons Learnt from Influences of the Marmara Earthquake on Glycemic Control and Quality of Life in People with Type 1 Diabetes

“…The relation between QOL and metabolic control is controversial [13,[41][42][43][44]. Some studies reported an association between QOL and metabolic control [41,42], whereas others found no association [13,43,44]. This study confirmed previous studies reporting that no association was found between glycemic control and QOL in type 1 diabetes.…”

“…The DQOL is a disease-specific measure designed specifically for use in DCCT but with applicability to a wider range of people with type 1 diabetes [32]. The relation between QOL and metabolic control is controversial [13,[41][42][43][44]. Some studies reported an association between QOL and metabolic control [41,42], whereas others found no association [13,43,44].…”

“…The impact of the earthquake affects many patients in various ways [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], with morbidity and mortality from chronic diseases increasing following an earthquake [5-9, 12, 23]. Diabetes mellitus is affected negatively after a lengthy duration in an unfavorable environment [5].…”

Management of Crush Victims in Mass Disasters

“…However, energetic fluid administration prevents crush syndrome. After the Bingol-Turkey earthquake in 2003, early fluid resuscitation was associated with a lower percentage of crush cases requiring dialysis (11) than in other contemporaneous disasters (12,13). Similarly, in the recent Haiti earthquake, dialysis could be avoided in several victims because of intensive fluid administration (14).…”

Successful CAVH in an austere environment using readily available disposable hospital supplies

“…Lack of standard haemodialysis equipment, supplies and trained personnel; unreliable and/or unsafe water sources; and non-functional or unreliable electrical systems, are some of the factors that limit the ability to care for victims with renal failure requiring renal replacement therapy. Man-made or natural disasters, such as the 1999 Marmara earthquake in Turkey, may threaten to overwhelm existing local dialytic resources, if they remain functional at all [2]. The challenge is not limited to disasters in which patients develop de novo renal failure; the chronic dialysis population itself may require the immediate implementation of alternative renal replacement therapies if patients are unable to access haemodialysis centres or hospitals, as observed during the flooding of New Orleans in the aftermath of Hurricane Katrina in 2005 [3].…”