• Najafi Iraj, Safari Saeed, Hosseini Mostafa, Sanadgol Houshang, Rashid Farokhi Farin, Hamidreza Samimagham, Vahid Pourfarziani, Atabak Shahnaz, Osareh Shahrzad, and Boroumand Behrooz.
• Urology Research Center, Tehran, Iran; Department of Nephrology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
• Am J Emerg Med. 2011 Sep 1;29(7):738-42.

BackgroundAcute kidney injury (AKI) is a severe and preventable problem of crushed earthquake victims. Early hydration therapy started before fully removing earthquake rubbles has been claimed to play a decisive role in AKI prevention, which saves the necessity of later dialysis. However, the extent, quality, and appropriateness of its know-how are controversial.MethodsProcessing clinical and paraclinical data gathered from Bam earthquake victims older than 15 years, we tried to determine correlations between the time of being under the rubbles (TUR), the level of serum creatine phosphokinase (CPK), the delayed onset of fluid therapy (DFT), and finally the volume of intravenous fluid received per day (VFR) with the formation of AKI and the need for dialysis.ResultsThere is a direct and significant relation between the intensity of the trauma (TUR and CPK) and DFT with the occurrence of AKI and need for dialysis (P < .001). However, as the VFR increases, the occurrence of AKI and the need for dialysis significantly decrease (P = .005). Based on multivariate analysis, the occurrence of AKI and the need for dialysis are primarily affected by CPK, TUR, and VFR; and DFT has been dropped out. The analysis showed the preventive role of VFR more than 6 L in severe rhabdomyolysis patients and of at least 3 L in moderate ones in development of AKI and dialysis.ConclusionsIn the severely rhabdomyolized patients (CPK ≥ 15,000), higher volumes of prophylactic fluid (VFR >6 L) are required, whereas in less-traumatized patients, lower volumes (3-6 L) would be effective.Copyright © 2011 Elsevier Inc. All rights reserved.

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