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Sever MS, Luyckx V, Tonelli M, Kazancioglu R, Rodgers D, Gallego D, Tuglular S, Vanholder R. Disasters and kidney care: pitfalls and solutions. Nat Rev Nephrol 2023; 19:672-686. [PMID: 37479903 DOI: 10.1038/s41581-023-00743-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.
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Affiliation(s)
- Mehmet Sukru Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey.
| | - Valerie Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard, Medical School, Boston, MA, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Darlene Rodgers
- Independent Nurse Consultant, American Society of Nephrology, Washington, DC, USA
| | - Dani Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
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Hsiao LL, Shah KM, Liew A, Abdellatif D, Balducci A, Haris Á, Kumaraswami LA, Liakopoulos V, Lui SF, Ulasi I, Langham RG. Kidney health for all: preparedness for the unexpected in supporting the vulnerable. Kidney Int 2023; 103:436-443. [PMID: 36822747 DOI: 10.1016/j.kint.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 02/23/2023]
Abstract
As the rate of natural disasters and other devastating events caused by human activities increases, the burden on the health and well-being of those affected by kidney disease has been immeasurable. Health system preparedness, which involves creating a resilient system that is able to deal with the health needs of the entire community during times of unexpected disruptions to usual care, has become globally important. In the wake of the COVID-19 pandemic, there is a heightened awareness of the amplification of negative effects on the renal community. Paradoxically, the complex medical needs of those who have kidney diseases are not met by systems handling crises, often compounded by an acute increase in burden via new patients as a result of the crisis itself. Disruptions in kidney care as a result of unexpected events are becoming more prevalent and likely to increase in the years to come. It is therefore only appropriate that the theme for this year's World Kidney Day will focus on Kidney Health for All: preparedness for the unexpected in supporting the vulnerable.
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Affiliation(s)
- Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Kavya M Shah
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrian Liew
- Department of Renal Medicine, Mount Elizabeth Novena Hospital, Singapore
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | | | - Ágnes Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Latha A Kumaraswami
- Tamilnad Kidney Research (TANKER) Foundation, The International Federation of Kidney Foundations-World Kidney Alliance (IFKF-WKA), Chennai, India
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Siu-Fai Lui
- International Federation of Kidney Foundations-World Kidney Alliance, Hong Kong, China; The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Robyn G Langham
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Vanholder R, Sükrü Sever M, Lameire N. Kidney problems in disaster situations. Nephrol Ther 2021; 17S:S27-S36. [PMID: 33910695 DOI: 10.1016/j.nephro.2020.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/12/2020] [Indexed: 11/30/2022]
Abstract
Mass disasters, particularly earthquakes, cause many medical problems, including kidney problems, but an organized approach to cope with them was initiated only at the end of previous century, subsequent to the Armenian Spitak earthquake in 1988. Originally, interventions were focused on acute kidney injury (AKI) following crush injury and rhabdomyolysis in victims who had been trapped under the debris of collapsed buildings. However, similar problems were also registered in the context of other catastrophic events, especially man-made disasters like wars and torture. Other kidney-related problems, such as the preservation of treatment continuity in chronic kidney disease (CKD), especially in maintenance dialysis patients, deserved attention as well. Specific therapeutic principles apply to disaster-related kidney problems and these may differ from usual day-to-day clinical practice. Those approaches have been formulated in global and specific country-related guidelines and recommendations. It is clear that a well-conceived and organized management of kidney diseases in disasters benefits outcomes. Furthermore, it may be useful if the model and philosophy that were applied over the last three decades could be adapted by broadening the scope of disasters leading to intervention. Actions should be guided and coordinated by a panel of experts steering ad hoc interventions, rather than applying the "old" static model where a single coordinating center instructs and uses volunteers listed long before a potential event occurs.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 10, Corneel Heymanslaan, B9000 Gent, Belgium.
| | - Mehmet Sükrü Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Millet Caddesi, 34093 Istanbul, Turkey
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 10, Corneel Heymanslaan, B9000 Gent, Belgium
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Cognition and Implementation of Disaster Preparedness among Japanese Dialysis Facilities. Int J Nephrol 2021; 2021:6691350. [PMID: 33489374 PMCID: PMC7803413 DOI: 10.1155/2021/6691350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Few quantitative studies have explored disaster preparedness in dialysis facilities worldwide. This study examined the levels of disaster preparedness and their related factors in dialysis facilities in Japan. Methods We conducted a mail survey using a self-administered questionnaire for key persons responsible for disaster preparedness in dialysis facilities (N = 904) associated with the Japanese Association of Dialysis Physicians. Levels of disaster preparedness were evaluated by the implementation rates of four domains: (1) patient, (2) administration, (3) network, and (4) safety. Additionally, we focused on cognitive factors related to disaster preparedness, such as risk perception, outcome expectancy, self-efficacy, self-responsibility, and support from the surroundings. Results A total of 517 participants answered the survey (response rate: 57.2%). Implementation rates differed according to the domains of disaster preparedness. While the average implementation rate of the safety domain was 81.8%, each average implementation rate was 57.9%, 48.3%, and 38.4% for the administration, network, and patient domains, respectively. The study found that self-efficacy and support from the surroundings of the participants were significantly associated with the four domains of disaster preparedness. Alternatively, risk perception and support from surroundings were significantly associated with one particular domain each. Conclusion Our results suggest that boosting self-efficacy and support from surroundings among key persons of disaster preparedness in dialysis facilities may contribute to the advancement of the different domains of disaster preparedness.
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Roumeliotis A, Roumeliotis S, Leivaditis K, Salmas M, Eleftheriadis T, Liakopoulos V. APD or CAPD: one glove does not fit all. Int Urol Nephrol 2020; 53:1149-1160. [PMID: 33051854 PMCID: PMC7553382 DOI: 10.1007/s11255-020-02678-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/03/2020] [Indexed: 12/16/2022]
Abstract
The use of Automated Peritoneal Dialysis (APD) in its various forms has increased over the past few years mainly in developed countries. This could be attributed to improved cycler design, apparent lifestyle benefits and the ability to achieve adequacy and ultrafiltration targets. However, the dilemma of choosing the superior modality between APD and Continuous Ambulatory Peritoneal Dialysis (CAPD) has not yet been resolved. When it comes to fast transporters and assisted PD, APD is certainly considered the most suitable Peritoneal Dialysis (PD) modality. Improved patients’ compliance, lower intraperitoneal pressure and possibly lower incidence of peritonitis have been also associated with APD. However, concerns regarding increased cost, a more rapid decline in residual renal function, inadequate sodium removal and disturbed sleep are APD’s setbacks. Besides APD superiority over CAPD in fast transporters, the other medical advantages of APD still remain controversial. In any case, APD should be readily available for all patients starting PD and the most important indication for its implementation remains patient’s choice.
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Affiliation(s)
- Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Konstantinos Leivaditis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece.
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Abstract
Acute kidney injury (AKI) is frequent during wars and other man-made disasters, and contributes significantly to the overall death toll. War-related AKI may develop as a result of polytrauma, traumatic bleeding and hypovolemia, chemical and airborne toxin exposure, and crush syndrome. Thus, prerenal, intrinsic renal, or postrenal AKI may develop at the battlefield, in field hospitals, or tertiary care centers, resulting not only from traumatic, but also nontraumatic, etiologies. The prognosis usually is unfavorable because of systemic and polytrauma-related complications and suboptimal therapeutic interventions. Measures for decreasing the risk of AKI include making preparations for foreseeable disasters, and early management of polytrauma-related complications, hypovolemia, and other pathogenetic mechanisms. Transporting casualties initially to field hospitals, and afterward to higher-level health care facilities at the earliest convenience, is critical. Other man-made disasters also may cause AKI; however, the number of patients is mostly lower and treatment possibilities are broader than in war. If there is no alternative other than prolonged field care, the medical community must be prepared to offer health care and even perform dialysis in austere conditions, which in that case, is the only option to decrease the death toll resulting from AKI.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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7
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Lameire N, Sever MS, Van Biesen W, Vanholder R. Role of the International and National Renal Organizations in Natural Disasters: Strategies for Renal Rescue. Semin Nephrol 2020; 40:393-407. [DOI: 10.1016/j.semnephrol.2020.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Rhabdomyolysis is caused by the breakdown and necrosis of muscle tissue and the release of intracellular content into the blood stream. There are multiple and diverse causes of rhabdomyolysis but central to the pathophysiology is the destruction of the sarcolemmal membrane and release of intracellular components into the systemic circulation. The clinical presentation may vary, ranging from an asymptomatic increase in serum levels of enzymes released from damaged muscles to worrisome conditions such as volume depletion, metabolic and electrolyte abnormalities, and acute kidney injury (AKI). The diagnosis is confirmed when the serum creatine kinase (CK) level is > 1000 U/L or at least 5x the upper limit of normal. Other important tests to request include serum myoglobin, urinalysis (to check for myoglobinuria), and a full metabolic panel including serum creatinine and electrolytes. Prompt recognition of rhabdomyolysis is important in order to allow for timely and appropriate treatment. A McMahon score, calculated on admission, of 6 or greater is predictive of AKI requiring renal replacement therapy. Treatment of the underlying cause of the muscle insult is the first component of rhabdomyolysis management. Early and aggressive fluid replacement using crystalloid solution is the cornerstone for preventing and treating AKI due to rhabdomyolysis. Electrolyte imbalances must be treated with standard medical management. There is, however, no established benefit of using mannitol or giving bicarbonate infusion. In general, the prognosis of rhabdomyolysis is excellent when treated early and aggressively.
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Affiliation(s)
- Brian Michael I Cabral
- Clinical Associate Professor, Department of Medicine, Section of Nephrology, University of the Philippines - Philippine General Hospital, Manila, Philippines.
| | - Sherida N Edding
- Resident Physician, Department of Internal Medicine, St. Luke's Medical Center - Global City, Taguig City, Philippines
| | - Juan P Portocarrero
- Resident Physician, Department of Internal Medicine, Macneal Hospital, Berwyn, Illinois
| | - Edgar V Lerma
- Clinical Professor of Medicine, Section of Nephrology, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, Illinois
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Yoo KD, Kim HJ, Kim Y, Park JY, Shin SJ, Han SH, Kim DK, Lim CS, Kim YS. Disaster preparedness for earthquakes in hemodialysis units in Gyeongju and Pohang, South Korea. Kidney Res Clin Pract 2019; 38:15-24. [PMID: 30776874 PMCID: PMC6481979 DOI: 10.23876/j.krcp.18.0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022] Open
Abstract
In 2016 and 2017, there were earthquakes greater than 5.0 in magnitude on the Korean Peninsula, which has previously been considered an earthquake-free zone. Patients with chronic kidney disease are particularly vulnerable to earthquakes, as the term “renal disaster” suggests. In the event of a major earthquake, patients on hemodialysis face the risk of losing maintenance dialysis due to infrastructure disruption. In this review, we share the experience of an earthquake in Pohang that posed a serious risk to patients on hemodialysis. We review the disaster response system in Japan and propose a disaster preparedness plan with respect to hemodialysis. Korean nephrologists and staff in dialysis facilities should be trained in emergency response to mitigate risk from natural disasters. Dialysis staff should be familiar with the action plan for natural disaster events that disrupt hemodialysis, such as outages and water treatment system failures caused by earthquakes. Patients on hemodialysis also need to be educated about disaster preparedness. In the event of a disaster situation that results in dialysis failure, patients need to know what to do. At the local and national government level, long-term preparations should be made to handle renal disaster and patient safety logistics. Moreover, Korean nephrologists should also be prepared to manage cardiovascular disease and diabetes in disaster situations. Further evaluation and management of social and national disaster preparedness of hemodialysis units to earthquakes in Korea are needed.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea.,Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea.,Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Yunmi Kim
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea.,Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea.,Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Nephrology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Kawabata C, Hamanoue S, Maekawa A, Toyoda M, Miyata A, Uekihara S. Communication with Peritoneal Dialysis Patients Post-Kumamoto Earthquake. Perit Dial Int 2017; 37:484-485. [PMID: 28676517 DOI: 10.3747/pdi.2016.00310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C Kawabata
- Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - S Hamanoue
- Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - A Maekawa
- Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - M Toyoda
- Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - A Miyata
- Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - S Uekihara
- Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
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12
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Morita T, Tsubokura M, Furutani T, Nomura S, Ochi S, Leppold C, Takahara K, Shimada Y, Fujioka S, Kami M, Kato S, Oikawa T. Impacts of the 2011 Fukushima nuclear accident on emergency medical service times in Soma District, Japan: a retrospective observational study. BMJ Open 2016; 6:e013205. [PMID: 27683521 PMCID: PMC5051455 DOI: 10.1136/bmjopen-2016-013205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the influence of the 3.11 triple disaster (earthquake, tsunami and nuclear accident) on the emergency medical service (EMS) system in Fukushima. METHODS Total EMS time (from EMS call to arrival at a hospital) was assessed in the EMS system of Soma district, located 10-40 km north of the nuclear plant, from 11 March to 31 December 2011. We defined the affected period as when total EMS time was significantly extended after the disasters compared with the historical control data from 1 January 2009 to 10 March 2011. To identify risk factors associated with the extension of total EMS time after the disasters, we investigated trends in 3 time segments of total EMS time; response time, defined as time from an EMS call to arrival at the location, on-scene time, defined as time from arrival at the location to departure, and transport time, defined as time from departure from the location to arrival at a hospital. RESULTS For the affected period from week 0 to week 11, the median total EMS time was 36 (IQR 27-52) minutes, while that in the predisaster control period was 31 (IQR 24-40) min. The percentage of transports exceeding 60 min in total EMS time increased from 8.2% (584/7087) in the control period to 22.2% (151/679) in the affected period. Among the 3 time segments, there was the most change in transport time (standardised mean difference: 0.41 vs 0.13-0.17). CONCLUSIONS EMS transport was significantly delayed for ∼3 months, from week 1 to 11 after the 3.11 triple disaster. This delay may be attributed to malfunctioning emergency hospitals after the triple disaster.
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Affiliation(s)
- Tomohiro Morita
- Department of Internal Medicine, Soma Central Hospital, Soma City, Fukushima, Japan
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Masaharu Tsubokura
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Tomoyuki Furutani
- Faculty of Policy Management, Keio University, Fujisawa, Kanagawa, Japan
| | - Shuhei Nomura
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sae Ochi
- Department of Internal Medicine, Soma Central Hospital, Soma City, Fukushima, Japan
| | - Claire Leppold
- Department of Research, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Kazuhiro Takahara
- Fire Suppression Division, the Soma Regional Fire Department, Minamisoma City, Fukushima, Japan
| | - Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Sho Fujioka
- Department of Gastroenterology, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Masahiro Kami
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Shigeaki Kato
- Department of Radiation Protection, Soma Central Hospital, Soma City, Fukushima, Japan
| | - Tomoyoshi Oikawa
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
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13
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Gray NA, Wolley M, Liew A, Nakayama M. Natural disasters and dialysis care in the Asia-Pacific. Nephrology (Carlton) 2015; 20:873-80. [DOI: 10.1111/nep.12522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Nicholas A Gray
- Department of Renal Medicine; Nambour General Hospital; Nambour Queensland Australia
- The University of Queensland; Sunshine Coast Clinical School; Nambour General Hospital; Nambour Queensland Australia
| | - Martin Wolley
- Department of Renal Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Adrian Liew
- Department of Renal Medicine; Tan Tock Seng Hospital; Singapore
| | - Masaaki Nakayama
- Department of Nephrology and Hypertension; Fukushima Medical University School of Medicine; Fukushima Japan
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14
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Sever MS, Lameire N, Van Biesen W, Vanholder R. Disaster nephrology: a new concept for an old problem. Clin Kidney J 2015; 8:300-9. [PMID: 26034592 PMCID: PMC4440471 DOI: 10.1093/ckj/sfv024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/30/2015] [Indexed: 11/20/2022] Open
Abstract
Natural and man-made mass disasters directly or indirectly affect huge populations, who need basic infrastructural help and support to survive. However, despite the potentially negative impact on survival chances, these health care issues are often neglected by the authorities. Treatment of both acute and chronic kidney diseases (CKDs) is especially problematic after disasters, because they almost always require complex technology and equipment, whereas specific drugs may be difficult to acquire for the treatment of the chronic kidney patients. Since many crush victims in spite of being rescued alive from under the rubble die afterward due to lack of dialysis possibilities, the terminology of ‘renal disaster’ was introduced after the Armenian earthquake. It should be remembered that apart from crush syndrome, multiple aetiologies of acute kidney injury (AKI) may be at play in disaster circumstances. The term ‘seismonephrology’ (or earthquake nephrology) was introduced to describe the need to treat not only a large number of AKI cases, but the management of patients with CKD not yet on renal replacement, as well as of patients on haemodialysis or peritoneal dialysis and transplanted patients. This wording was later replaced by ‘disaster nephrology’, because besides earthquakes, many other disasters such as hurricanes, tsunamis or wars may have a negative impact on the ultimate outcome of kidney patients. Disaster nephrology describes the handling of the many medical and logistic problems in treating kidney patients in difficult circumstances and also to avoid post-disaster chaos, which can be made possible by preparing medical and logistic scenarios. Learning and applying the basic principles of disaster nephrology is vital to minimize the risk of death both in AKI and CKD patients.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Internal Medicine/Nephrology , Istanbul School of Medicine , Istanbul , Turkey
| | - Norbert Lameire
- Department of Internal Medicine, Nephrology Section , University Hospital , Ghent , Belgium
| | - Wim Van Biesen
- Renal Disaster Relief Task Force (RDRTF) of the International Society of Nephrology (ISN) European Branch , University Hospital , Ghent , Belgium
| | - Raymond Vanholder
- Department of Internal Medicine, Nephrology Section , University Hospital , Ghent , Belgium
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15
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Haga N, Hata J, Yabe M, Ishibashi K, Takahashi N, Kumagai K, Ogawa S, Kataoka M, Akaihata H, Kojima Y. The Great East Japan Earthquake affected the laboratory findings of hemodialysis patients in Fukushima. BMC Nephrol 2013; 14:239. [PMID: 24171717 PMCID: PMC4228435 DOI: 10.1186/1471-2369-14-239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the impact of the Great East Japan Earthquake on laboratory findings in chronic hemodialysis (HD) patients in Fukushima. METHODS Changes in laboratory findings and cardiothoracic ratio (CTR) between before and after the earthquake were retrospectively analyzed in 90 adult HD patients with end-stage renal disease (ESRD). Two hospitals located within 80 km from the Fukushima Daiichi Nuclear Power Plant, where American government recommended to evacuate from the area, participated in the study. HD duration was shortened by 0.5-1 hour for 1 month after the earthquake. Multivariate analyses were performed to identify the factors contributing to change of measurement values. RESULTS Blood urea nitrogen (BUN) value was significantly transiently decreased for 1-2 weeks after the earthquake (P=0.002). In multivariate analysis, age showed a tendency to be related to the decrease of BUN level (P=0.05). Hematocrit value was significantly elevated after two months compared with that at baseline (P=0.02), although the elevation was small. The other measured values and CTR were not significantly changed compared with those before the earthquake. CONCLUSIONS Laboratory findings and CTR did not worsen despite the shortening of HD duration. Hence, in this disaster, as far as chronic HD patients with ESRD were concerned, it was possible for the duration of HD treatment to be safely decreased.
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Affiliation(s)
- Nobuhiro Haga
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan 1 Hikarigaoka, Fukushima 960-1295, Japan.
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Report of a transient increase in tunneled catheter infections following dialysis facility transfer to a prefabricated structure. J Vasc Access 2012; 14:152-6. [PMID: 23258586 DOI: 10.5301/jva.5000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite the efforts to promote the native artero-venous fistula as dialysis access, the use of tunneled central venous catheters (tCVC) is increasing. Main complications remain infections of the access, and the environment plays an important role in determining them; however, no studies are available that report dialysis provided in prefabricated temporary buildings. The aim of our study was to assess the incidence of tCVC infections in a container building. METHODS Since May 2009 our Dialysis Center has been located in a container building. The occurrence of local and systemic infections of tCVC when dialysis was provided in the container was compared with the previous two years, when dialysis was provided at the "Home" center. Each year was also divided into semesters to maintain the temporary relationship between the new location and the infections. RESULTS tCVCs represented approximately 13% of all vascular accesses. In the first six months in the temporary building, 50% of patients presented infections, compared to 13% to 20% during the other periods (P=0.02). In the first six months in the container the incidence of infections was 1.44 per 1000 catheters-days, higher than in any other semester (P=0.02). More infections requiring systemic antibacterial agents occurred over this period. CONCLUSIONS Our study demonstrates that, when a dialysis center is moved to a prefabricated temporary building, the likelihood of tCVC infections increases within the initial months and returns back to the previous levels after a period of adaptation.
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Chan YF, Alagappan K, Gandhi A, Donovan C, Tewari M, Zaets SB. Disaster Management following the Chi-Chi Earthquake in Taiwan. Prehosp Disaster Med 2012; 21:196-202. [PMID: 16892885 DOI: 10.1017/s1049023x00003678] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe earthquake that occurred in Taiwan on 21 September 1999 killed >2,000 people and severely injured many survivors. Despite the large scale and sizeable impact of the event, a complete overview of its consequences and the causes of the inadequate rescue and treatment efforts is limited in the literature. This review examines the way different groups coped with the tragedy and points out the major mistakes made during the process. The effectiveness of Taiwan's emergency preparedness and disaster response system after the earthquake was analyzed.Problems encountered included: (1) an ineffective command center; (2) poor communication; (3) lack of cooperation between the civil government and the military; (4) delayed prehospital care; (5) overloading of hospitals beyond capacity; (6) inadequate staffing; and (7) mismanaged public health measures.The Taiwan Chi-Chi Earthquake experience demonstrates that precise disaster planning, the establishment of one designated central command, improved cooperation between central and local authorities, modern rescue equipment used by trained disaster specialists, rapid prehospital care, and medical personnel availability, as well earthquake-resistant buildings and infrastructure, are all necessary in order to improve disaster responses.
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Affiliation(s)
- Yu-Feng Chan
- Department of Surgery, Division of Emergency Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
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Crush syndrome and acute kidney injury in the Wenchuan Earthquake. ACTA ACUST UNITED AC 2011; 70:1213-7; discussion 1217-8. [PMID: 21610435 DOI: 10.1097/ta.0b013e3182117b57] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Wenchuan Earthquake resulted in calamitous destruction and massive death. We report the characteristics of crush syndrome (CS) and acute kidney injury (AKI) brought by the earthquake, which took place in a mountainous area. METHODS We conducted a cross-section survey of total 2,316 consecutive admissions because of seismic trauma, of which 1,827 had complete data available after we excluded those victims with mild injuries. The characteristics of CS and AKI in the mountainous earthquake were analyzed. RESULTS A total of 149 patients (8.2%) were diagnosed with CS. They had various complications, including different kinds of infection or sepsis, AKI, hematological abnormality, adult respiratory distress syndrome, congestive heart failure, multiple organs dysfunction syndrome, etc. The incidence of hyperkalemia was 15.9% in patients with CS. The hyperkalemia relapsed in five patients after hemodialysis in the first 3 days. AKI occurred in 62 patients (41.6% of CS patients) with CS and 33 of them received renal replacement therapy. In our hospital, 5 of them died. The overall mortality rate was 1.0% and mortality of patients with CS was 6.7%. Twelve patients (50%) died in the first 3 days. CONCLUSIONS Although the mountains hampered rescue actions, causing more loss of life, CS and AKI were still common and life-threatening events in the Wenchuan Earthquake. Most patients with CS and/or AKI had severe complications, especially hyperkalemia.
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Abstract
Extensive rhabdomyolysis is often lethal unless treated immediately. Early mortality arises from hypovolemic shock, hyperkalemia, acidosis and myoglobinuric acute kidney injury (AKI). Many individuals with rhabdomyolysis could be saved, and myoglobinuric AKI prevented, by early vigorous fluid resuscitation with ≥12 l daily intravenous infusion of alkaline solution started at the scene of injury. This regimen stabilizes the circulation and mobilizes edema fluids sequestered in the injured muscles into the circulation, corrects hyperkalemia and acidosis, and protects against the nephrotoxic effects of myoglobinemia and hyperuricosuria. This regime results in a large positive fluid balance, which is well tolerated in young, carefully monitored individuals. In patients with rhabdomyolysis caused by muscle crush syndrome, mortality has been reduced from nearly 100% to <20% over the past 70 years through utilization of this intervention. This Perspectives discusses the lifesaving and limb-saving potential of early vigorous fluid resuscitation in patients with extensive traumatic and nontraumatic rhabdomyolysis.
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Affiliation(s)
- Ori S Better
- Department of Physiology and Biophysics, Faculty of Medicine Technion IIT, Rambam Hospital, Haifa 31096, Israel.
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Yuan CM, Perkins RM. Renal replacement therapy in austere environments. Int J Nephrol 2011; 2011:748053. [PMID: 21603109 PMCID: PMC3097065 DOI: 10.4061/2011/748053] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 02/08/2011] [Accepted: 02/22/2011] [Indexed: 11/22/2022] Open
Abstract
Myoglobinuric renal failure is the classically described acute renal event occurring in disaster environments-commonly after an earthquake-which most tests the ingenuity and flexibility of local and regional nephrology resources. In recent decades, several nephrology organizations have developed response teams and planning protocols to address disaster events, largely focusing on patients at risk for, or with, acute kidney injury (AKI). In this paper we briefly review the epidemiology and outcomes of patients with dialysis-requiring AKI after such events, while providing greater focus on the management of the end-stage renal disease population after a disaster which incapacitates a pre-existing nephrologic infrastructure (if it existed at all). "Austere" dialysis, as such, is defined as the provision of renal replacement therapy in any setting in which traditional, first-world therapies and resources are limited, incapacitated, or nonexistent.
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Affiliation(s)
- Christina M. Yuan
- Nephrology Service, Department of Medicine, Walter Reed Army Medical Center, 6900 Georgia Avenue Northwest, Washington, DC 20012, USA
| | - Robert M. Perkins
- Department of Nephrology, Center for Health Research, Geisinger Medical Center, MC 44-00, 100 North Academy Avenue, Danville, PA 17822, USA
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Bonomini M, Stuard S, Dal Canton A. Dialysis practice and patient outcome in the aftermath of the earthquake at L'Aquila, Italy, April 2009. Nephrol Dial Transplant 2011; 26:2595-603. [DOI: 10.1093/ndt/gfq783] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carlos Zúñiga S. Hemodiálisis en tiempo de terremoto informe desde la región del biobío-chile. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Chronic diseases and natural hazards: impact of disasters on diabetic, renal, and cardiac patients. Prehosp Disaster Med 2008; 23:185-94. [PMID: 18557300 DOI: 10.1017/s1049023x00005835] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response phase of disasters. Chronic disease exacerbations (CDE) account for one of the largest patient populations during disasters, and patients are at increased risk for adverse outcomes. OBJECTIVE The objective of this study was to assess the burden of chronic renal failure, diabetes, and cardiovascular disease during disasters due to natural hazards, identify impediments to care, and propose solutions to improve the disaster preparation and management of CDE. METHODS A thorough search of the PubMed, Ovid, and Medline databases was performed. Dr. Miller's personal international experiences treating CDE after disasters due to natural hazards, such as the 2005 Kashmir earthquake, are included. DISCUSSION Chronic disease exacerbations comprise a sizable disease burden during disasters related to natural hazards. Surveys estimate that 25-40% of those living in the regions affected by hurricanes Katrina and Rita lived with at least one chronic disease. Chronic illness accounted for 33% of visits, peaking 10 days after hurricane landfall. The international nephrology community has responded to dialysis needs by forming a well-organized and effective organization called the Renal Disaster Relief Task Force (RDRTF). The response to the needs of diabetic and cardiac patients has been less vigorous. Patients must be familiar with emergency diet and renal fluid restriction plans, possible modification of dialysis schedules and methods, and rescue treatments such as the administration of kayexalate. Facilities may consider investing in water-independent extracorporeal dialysis techniques as a rescue treatment. In addition to patient databases and medical alert identification, diabetics should maintain an emergency medical kit. Diabetic patients must be taught and practice the carbohydrate counting technique. In addition to improved planning, responding agencies and organizations must bring adequate supplies and medications to care for diabetic, cardiac, and renal patients during relief efforts. CONCLUSIONS By recognizing and addressing impediments to the care of chronic disease exacerbations after natural disasters, the quality, delivery, and effectiveness of the care provided to diabetic patients during relief efforts can be improved.
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Vanholder R, van der Tol A, De Smet M, Hoste E, Koç M, Hussain A, Khan S, Sever MS. Earthquakes and crush syndrome casualties: lessons learned from the Kashmir disaster. Kidney Int 2006; 71:17-23. [PMID: 17063177 DOI: 10.1038/sj.ki.5001956] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Major earthquakes may provoke a substantial number of crush casualties complicated by acute kidney injury (AKI). After the 1988 Armenian earthquake, the International Society of Nephrology (ISN) established the Renal Disaster Relief Task Force (RDRTF) to organize renal care in large disasters; this approach proved to be useful in several recent disasters. This paper depicts the organizational aspects of the rescue intervention during the Kashmir earthquake, in 2005. Specific problems were fierce geographic circumstances, lack of pre-registered local keymen, transportation problems, and inexperience of local teams to cope with problems related to mass disasters. Once treatment was installed, global outcomes were favorable. It is concluded that well-organized international help in renal disasters can be effective in saving many lives, but still necessitates conceptual adaptations owing to specific local circumstances.
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Affiliation(s)
- R Vanholder
- Renal Disaster Relief Task Force of the International Society of Nephrology, Gent, Belgium
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Lin H, Chie W, Lien H. Epidemiological analysis of factors influencing an episode of exertional rhabdomyolysis in high school students. Am J Sports Med 2006; 34:481-6. [PMID: 16260462 DOI: 10.1177/0363546505281243] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An episode of rhabdomyolysis occurred after an endurance test in high school students in Taipei County in November 2003. PURPOSE To determine the incidence, outcome, and risk factors in an episode of exertional rhabdomyolysis in high school students. STUDY DESIGN Descriptive epidemiology study. METHODS We enrolled all 225 high school students who had performed an endurance test. Using data from retrospective questionnaires, we estimated the incidence and assessed risk factors of exertional rhabdomyolysis among these students. Multiple logistic regression was used to determine risk factors associated with exertional rhabdomyolysis. RESULTS The completed questionnaire was returned by 70% (157 of 225) of the students. Of these, 43.3% (68 of 157) were identified as having exertional rhabdomyolysis, and the incidence was not statistically different between male and female students (P = .49). Dark urine was noted in only 25% of the students. None of the students developed acute renal failure. The risk of exertional rhabdomyolysis was significantly higher in those students who had not exercised 1 day before the endurance test (odds ratio [OR], 6.10; 95% confidence interval [CI], 2.00-18.00) and those who had performed postexercise stretching of the legs (OR, 3.13; 95% CI, 1.28-7.69) or performed complete squats during the test (OR, 3.21; 95% CI, 1.12-10.00). There were no statistically significant differences in gender, body mass index, presence of flulike symptoms, previous exercise routine, and medication history between students with or without exertional rhabdomyolysis. CONCLUSION Our findings suggest that exertional rhabdomyolysis is not uncommon in strenuous eccentric exercise in both men and women, but the risk of developing acute renal failure is very low. Exercise 1 day before eccentric exercise was significantly associated with a reduced risk of exertional rhabdomyolysis, whereas postexercise stretching of the involved extremities might increase the risk.
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Affiliation(s)
- Hsingwen Lin
- Department of Family Medicine, Taipei County Hospital, Taipei, Taiwan
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