Browsing by Author "Vanholder, Raymond"
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Item Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake(Oxford Univ Press, 2002-11) Sever, Mehmet Şükrü; Erek, Ekrem; Vanholder, Raymond; Akoğlu, Emel; Ergin, Hülya Karadayı; Türkmen, Funda Muşerref; Korular, Didem; Yenicesu, Müjdat; Erbilgin, Dilaver; Hoeben, Heidi; Lameire, Norbert; Yavuz, Mahmut; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Nefroloji Bilim Dalı.Background. The clinical course of acute renal failure (ARF) related to crush syndrome is very complex, because of co-existing surgical and/or medical complications. After the devastating Marmara earthquake that struck Turkey in August 1999, 639 patients were identified with nephrological problems, whose clinical findings have been the subject of this analysis. Methods. Specific questionnaires asking about 63 variables were sent to 35 reference hospitals that treated the victims. Clinical findings of the renal victims were analysed. Results. At admission, high fever was noted in 31.8% of the patients; the temperature of non-survivors was higher (P = 0.027). Mean blood pressure was higher in survivors (P = 0.004) and dialysed victims (P < 0.001). Most (61.4%) patients were oligo-anuric; oliguria lasted for 10.8 +/- 7.2 days. Thoracic and abdominal traumas were associated with a higher risk of mortality. 397 fasciotomies and 121 amputations were performed in 790 traumatized extremities. Fasciotomies were associated with sepsis (P < 0.001) and dialysis needs (P < 0.0001), while amputations were associated with mortality (P < 0.0001). Medical complications, which were associated with dialysis needs (P < 0.0001) and mortality (P < 0.0001), were observed in 51.5% of patients. In a multivariate analysis model of medical complications, disseminated intravascular coagulation (DIC) (P < 0.0001, OR = 5.81), and adult respiratory distress syndrome (ARDS) (P = 0.0001, OR = 4.53) were predictors of mortality. Conclusions. In the aftermath of catastrophic earthquakes, clinical findings of the renal victims can predict the final outcome. While fasciotomies indicate dialysis needs, extremity amputations, abdominal and thoracic traumas are associated with higher rates of mortality in addition to DIC and ARDS.Item Lessons learned from the catastrophic Marmara earthquake: Factors influencing the final outcome of renal victims(Dustri-Verlag Dr Karl Feistle, 2004-06) Sever, Mehmet Şükrü; Erek, Ekrem; Vanholder, Raymond; Koç, Mehmet; Aysuna, Nilgün; Ergin, Hülya; Ataman, Müveddet Rezzan; Yenicesu, Müjdat; Canbakan, İkbal Billur; Lameire, N.; Yavuz, Mahmut; Demircan, Celaleddin; Uludağ Üniversitesi/Tıp Fakültesi.; 7006244754; 6507741676Background: During catastrophic earthquakes, crush syndrome is the second most frequent cause of death after the direct impact of trauma. The Marmara earthquake, which struck Northwestern Turkey in August 1999, was characterized by 639 crush syndrome victims with acute renal problems. The factors influencing their final outcome have been the subject of this study. Patients methods: Within the first week of the disaster questionnaires asking about 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information obtained by means of these questionnaires, including the factors with a potential influence on outcome, was submitted to analysis. Results: Overall mortality rate was 15.2%. In univariate analysis, nonsurvivors were older (p = 0.048); the highest mortality rates were observed among the victims coming from the closest cities to the reference hospitals. Admission within the first 3 days of the disaster (p = 0.016), with oliguria (p = 0.042), lower figures for blood pressure (p < 0.001), platelets (p = 0.004) and serum albumin (p = 0.005) were associated with mortality. Also, higher body temperature (p = 0.013) and serum potassium (p < 0.001) as well as suffering from thoracic or abdominal traumas, extremity amputations and medical complications other than renal failure (for all 4: p < 0.0001) in addition to need of dialysis support (p = 0.015) and mechanical ventilation (p < 0.0001) indicated higher risk of death. In the multivariate analysis, age (p = 0.030, OR =1.02), presence of disseminated intravascular coagulation (p = 0.001, OR = 4.49), abdominal trauma (p 0.012, OR = 4.05) and amputations (p = 0.010, OR = 2.81) were predictors of mortality. Dialyzed patients were characterized by higher mortality rates than nondialyzed victims (17.2% versus 9.3%, p 0.015). Conclusion: Outcome of the renal victims of catastrophic earthquakes is influenced by the type of trauma, comorbid events and complications observed during the clinical course as well as epidemiological features such as age, distance to reference hospitals and time lapse between disaster and admission to reference hospitals.Item Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake(Blackwell Publishing, 2002-12) Sever, Mehmet Şükrü; Erek, Ekrem; Vanholder, Raymond; Yürügen, Birsen; Gülçin, Kantarcı; Hülya, Ergin; Bozfakioğlu, Semra; Dalmak, S.; Tülbek, M. Yaşar; Kiper, Halil; Lameire, N.; Yavuz, Mahmut; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Nefroloji Bilim Dalı.Background. Renal replacement therapy is of vital importance in the treatment of crush syndrome victims, who are frequently encountered after catastrophic earthquakes. The Marmara earthquake, which struck Northwestern Turkey in August 1999, was characterized by 477 victims who needed dialysis. Method. Within the first week of the disaster, questionnaires containing 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information considering the features of dialyses obtained through these questionnaires was submitted to analysis. Results. Overall, 639 casualties with renal complications were registered, 477 of whom (mean age 32.3 +/- 13.7 years, 269 male) needed dialysis. Among these, 452 were treated by a single dialysis modality (437 intermittent hemodialysis, 11 continuous renal replacement therapy and 4 peritoneal dialysis), while 25 victims needed more than one type of dialysis. In total, 5137 hemodialysis sessions were performed (mean 11.1 +/- 8.0 sessions per patient) and mean duration of hemodialysis support was 13.4 +/-9.0 days; this duration was shorter in the non-survivors (7.0 +/-8.7 vs. 10.0 +/- 9.8 days, P = 0.005). Thirty-four victims who underwent continuous renal replacement therapy had higher mortality rates (41.2 vs. 13.7%, P < 0.0001). Only eight victims were treated by peritoneal dialysis, four of whom also required hemodialysis or continuous renal replacement therapy. The mortality rate in the dialyzed victims was 17.2%, a significantly higher figure compared to the mortality rate of the non-dialyzed patients with renal problems (9.3%; P = 0.015). Conclusion. 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.Item Serum potassium in the crush syndrome victims of the Marmara disaster(Dustri-verlag Dr Karl Feistle, 2003-05) Sever, Mehmet Şükrü; Erek, Ekrem; Vanholder, Raymond; Kantarcı, Gülçin; Türkmen, A.; Ergin, Hülya; Tülbek, M. Yaşar; Duranay, Murat; Manga, Gabriel; Sevinir, Şeniz; Lameire, N.; Yavuz, Mahmut; Uludağ Üniversitesi/Tıp Fakültesi/Nefroloji Bilim Dalı.; AAY-6272-2020; 7006244754Background: Hyperkalemia is a major cause of mortality in the patients who suffer from crush syndrome in the aftermath of major earthquakes. The aim of this study is to investigate the frequency and effects of hyperkalemia in the 639 victims of catastrophic Marmara earthquake that struck northwestern Turkey, in August 1999. Patients and methods: Within the first week of disaster, questionnaires were sent to 35 reference hospitals that treated the victims. Information on serum potassium which was provided in 595 out of 639 questionnaires was submitted to analysis. Results: In the patients who were admitted within the first 3 days of the disaster (n = 401) serum potassium was 5.4 +/- 1.3 mEq/l, which was higher than in those admitted thereafter ( n = 171) ( 4.5 +/- 1.1 mEq/l) ( p = 0.02). Considering the whole series, males ( p = 0.01), patients needing dialysis support ( p < 0.001) and non-survivors ( p = 0.001) were characterized by higher serum potassium at admission. Seventy patients' serum potassium was above 7 mEq/l, while 22 patients were hypokalemic (< 3.5 mEq/l). Admission potassium correlated with many clinical and laboratory variables indicating the severity of the trauma, and a logistic regression model with clinical and laboratory parameters upon admission, revealed potassium as the most significant predictor of dialysis needs in the victims admitted within the first 3 days ( p = 0.008, OR = 3.33). Among the victims who were admitted to hospitals 1 week after the disaster, 8 had serum potassium levels above 6.5 mEq/l; among 4 of them were complicated by hyperkalemia even higher than 7.5 mEq/l. These findings undeline the importance of hyperkalemia during clinical course. Conclusion: The most important and fatal medical complication in crush syndrome patients is hyperkalemia. Risk of fatal hyperkalemia continues even after hospitalization. Empirical therapy at the scene is indicated especially in male victims with severe soft tissue traumas. Early detection and treatment of hyperkalemia may improve the final outcome of renal disaster victims.Item The Marmara earthquake: Epidemiological analysis of the victims with nephrological problems(Elsevier Science Bv, 2001-09) Sever, Mehmet Şükrü; Erek, Ekrem; Vanholder, Raymond; Akoğlu, Emel; Ergin, Hülya; Tekçe, Mustafa; Korular, Didem; Tülbek, M. Yaşar; Keven, Kenan; Vlem, Bruno Van; Lameire, Norbert; Yavuz, Mahmut; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Nefroloji Bilim Dalı.Background. Crush syndrome resulting from earthquakes is a major cause of morbidity and mortality, as seen during the catastrophic Marmara earthquake that struck Northwestern Turkey in August 1999. This report analyzes the epidemiological characteristics of the crush syndrome victims of this disaster. Methods. In order to analyze the nephrological problems caused by this earthquake, questionnaires were prepared within the first week of the disaster and sent to 35 reference hospitals that treated the victims. Data obtained by these questionnaires are the subject of this report. Results. Of the 5302 hospitalized patients in reference hospitals, 639 (12.0%) suffered from nephrological problems, and 477 (9.0%) needed dialysis support. Considering the patients with renal problems, there was not any significant difference in gender; however, the incidence of children younger than 10 years and the older population (older than 60 years of age) was significantly lower as compared with the resident population of the affected area (P < 0.001). Nonsurvivors were older (34.5 +/- 16.1 years) than survivors (31.2 +/- 14.4 years, P = 0.048), while no deaths were recorded under the age of 10. Most patients (70.1%) were admitted within the first three days after the earthquake, and the mortality rate among these victims was higher (17.7%) as compared with victims admitted thereafter (10.0%, P = 0.016). The average time period under the rubble was 11.7 +/- 14.3 hours, which was not significantly different between survivors and nonsurvivors, while the victims who required dialysis support spent shorter durations under the rubble, as compared with the ones who were not dialyzed at all (10.3 +/- 9.5 vs. 15.9 +/- 23.1 hours, P < 0.001). Conclusion. Victims of catastrophic earthquakes are characterized by a high incidence of renal problems and the need for dialysis support. The incidence of nephrological problems is lower in children, while the period of time under the rubble is not a prognostic indicator of survival.Item Treatment modalities and outcome of the renal victims of the Marmara earthquake(Karger, 2002-09) Sever, Mehmet Şükrü; Erek, Ekrem; Vanholder, Raymond; Koç, Mehmet; Yavuz, Mahmut; Ergin, Hülya; Kazancıoğlu, Rümeyza; Serdengeçti, Kamil; Okumuş, Gülen; Özdemir, Nebile; Schindler, R.; Lameire, N.; Yavuz, Mahmut; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Nefroloji Bilim Dalı.Background/Aims: Treatment of renal problems during natural catastrophes is highly complicated both for medical and logistic reasons. The therapeutic interventions applied to and the outcome of 639 victims with acute renal problems during the catastrophic Marmara earthquake have been the subject of this study. Methods: Questionnaires regarding information about 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information considering therapeutic interventions and outcome obtained through these questionnaires was submitted to analysis. Results: At least one form of renal replacement therapy was administered to 477 (74.6%) of the 639 victims. Of these, 437, 11, and 4 were treated solely by intermittent hemodialysis, continuous renal replacement therapy, and peritoneal dialysis, respectively; 25 victims needed more than one dialysis modality. In total, 5,137 hemodialysis sessions were performed. Also, 2,981, 2,837 and 2,594 units of blood, fresh frozen plasma, and human albumin were administered, respectively. Transfusion of these products was usually associated with higher rates of dialysis needs and mortality. Ninety-seven patients (15.2%) died. The mortality rate of dialyzed victims was higher as compared to nondialyzed ones (17.2 vs. 9.3%, p = 0.015). Conclusions: Massive amounts of dialysis treatment as well as blood and blood product transfusions can be necessary in the treatment of catastrophic earthquake victims with nephrological problems. Despite the potential risk of a high mortality, in the case of appropriate and energetic medical interventions, reasonable final outcomes can be achieved. Copyright (C) 2002 S. Karger AG, Basel.