Predictors of Acute Kidney Injury in Children Following the Kahramanmaraş Earthquakes: A Retrospective Analysis

Aim: The twin Kahramanmaraş earthquakes that occurred on February 6th, 2023, caused massive destruction in Turkey and Syria, affecting more than 16 million people in 11 provinces in Turkey alone. Crush syndrome, a common condition in earthquake survivors, is a significant risk element for the emergence of acute kidney injury (AKI) due to renal hypoperfusion. Therefore, timely intervention is critical to prevent renal dysfunction and related complications in earthquake survivors. In this particular situation, the current research was conducted to determine the occurrence of AKI and clinical and laboratory parameters that may predict the development of AKI, particularly crush injury, in child survivors of these earthquakes. Material and Methods: The sample of this retrospective multi-center study comprised child survivors of the Kahramanmaraş earthquakes admitted to two tertiary referral centers in the Şanlıurfa province of Turkey. Children’s demographic, clinical, and laboratory characteristics were collected, and statistical tests were carried out to identify predictive factors for AKI development. Results: The results shows that the median age of the 40 earthquake victims, 22 (55%) female and 18 (45%) male, was 9 years (1-17years). Of these children, 17 (42.5%) developed AKI (Group-1), while 23 (57.5%) did not (Group-2). Crush injuries were observed in 32 (80.0%) children. The median age of Group-1 was found significantly higher than Group-2 (p=0.004). The time to extrication from the rubble was also found significantly higher in Group 1 comparing to in Group 2 (p=0.028). Crush injury characteristics were not found to be associated with the development of AKI (p>0.05). However, receiving intravenous hydration during the transfer to the hospital was found significantly linked to a lower incidence of AKI (p=0.014). Hemodialysis was performed in 12 (70.6%) children with AKI. Of the 40 children in the sample, two (5%) in Group1 had died. Conclusion: The findings of our study demonstrated the importance of timely implementation of necessary interventions, intravenous hydration in particular, in preventing AKI in child earthquake victims. This study did not find any significant correlation between crush injury characteristics and the development of AKI. On the other hand, we determined that children who were older and remained under earthquake rubble for longer were more likely to develop AKI.