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Taner S, Ozdemir U, Kandemir Gulmez T, Güven S, Cicek N, Kelesoglu E, Arslan I, Celik U. Pediatric crush-related acute kidney injury and risk factors: a single center experience. J Nephrol 2024:10.1007/s40620-024-02043-1. [PMID: 39215957 DOI: 10.1007/s40620-024-02043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/15/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVES Crush injury, the most important trauma complication encountered in earthquake victims, occurs as a result of prolonged compression of muscle mass. Crush syndrome, resulting from crush injury, and acute kidney injury (AKI) are the most common causes of in-hospital deaths after earthquakes. The aim of this study is to convey our experience after the devastating Turkey-Syria earthquake and to identify the risk factors of crush syndrome and crush-related AKI. METHODS Of the 1134 children admitted to the emergency department, 265 with crush injury were included the study. Demographic information, laboratory and clinical data of the patients were retrospectively analyzed. RESULTS Mean age of the patients was 10.3 ± 4.9 years (134 females and 131 males). The median time spent under the rubble was 20 h. Crush syndrome developed in 135 (50.9%). Patients with crush syndrome were older and had higher body weight, respectively (p = 0.014, p = 0.044). Acute kidney injury was present in 157 (59.2%) patients. Thirty-two patients (12.1%) received kidney replacement therapy (KRT). The risk factors for the development of AKI Stage 3 were crush syndrome, abdominal trauma, and age. CONCLUSION This disaster taught us the importance of establishing in advance a national emergency disaster plan. Older pediatric earthquake victims with multiple trauma and severe crush syndrome should be closely followed-up for development of AKI and, if necessary, started on dialysis. Timely access to medical care, early fluid resuscitation, and effective use of dialysis treatment are essential.
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Affiliation(s)
- Sevgin Taner
- Adana City Training and Research Hospital, Pediatric Nephrology, Adana, Turkey.
| | - Ulas Ozdemir
- Adana City Training and Research Hospital, Pediatrics, Adana, Turkey
| | - Tugba Kandemir Gulmez
- Adana City Training and Research Hospital, Pediatric Infectious Diseases, Adana, Turkey
| | - Sercin Güven
- Marmara University Faculty of Medicine, Pendik Training and Research Hospital, Pediatric Nephrology, Istanbul, Turkey
| | - Neslihan Cicek
- Marmara University Faculty of Medicine, Pendik Training and Research Hospital, Pediatric Nephrology, Istanbul, Turkey
| | - Emre Kelesoglu
- Istanbul Medeniyet University Faculty of Medicine, Pediatric Nephrology, Istanbul, Turkey
| | - Ilknur Arslan
- Adana City Training and Research Hospital, Pediatric Intensive Care, Adana, Turkey
| | - Umit Celik
- Adana City Training and Research Hospital, Pediatric Infectious Diseases, Adana, Turkey
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Bakkaloğlu SA, Delibaş A, Sürmeli Döven S, Taner S, Yavuz S, Erfidan G, Danacı Vatansever E, Aynacı F, Yilmaz K, Taşdemir M, Akacı O, Akıncı N, Güven S, Çiçek N, Dursun I, Keleşoğlu E, Sancaktar M, Alaygut D, Saygılı S, Yavaşcan Ö, Yılmaz A, Gülleroğlu K, Ertan P, Demir BK, Poyrazoğlu H, Pınarbaşı S, Gençler A, Baştuğ F, Günay N, Çeleğen K, Noyan A, Parmaksız G, Avcı B, Çaycı FŞ, Bayrakçı U, Özlü SG, Aksoy ÖY, Yel S, İnal GA, Köse S, Bayazıt AK, Atmış B, Sarıbaş E, Çağlı Ç, Tabel Y, Elmas AT, Zırhlı Selçuk Ş, Demircioğlu Kılıç B, Akbalık Kara M, Büyükçelik M, Balat A, Durucu Tiryaki B, Erdoğdu B, Aksu B, Mahmudova G, Dursun H, Candan C, Göknar N, Mutlubaş F, Çamlar SA, Başaran C, Akbulut BB, Düzova A, Gülhan B, Oruç Ç, Peru H, Alpay H, Türkkan ÖN, Gülmez R, Çelakıl M, Doğan K, Bilge I, Pehlivanoğlu C, Büyükkaragöz B, Leventoğlu E, Alpman N, Zeybek C, Tülpar S, Çiçek Gülşan RY, Kara A, Gürgöze MK, Akyol Önder EN, Özdemir Atikel Y, Pul S, Sönmez F, Yıldız G, Akman S, Elmacı M, Küçük N, Yüksel S, Kavaz A, Nalçacıoğlu H, Alparslan C, Dinçel N, Elhan AH, Sever L. Pediatric kidney care experience after the 2023 Türkiye earthquake. Nephrol Dial Transplant 2024; 39:1514-1522. [PMID: 38327222 DOI: 10.1093/ndt/gfae033] [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: 10/23/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. METHOD Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded. RESULTS A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of >120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% at 3000-4000 mL/m2 BSA and only 2% at >4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age >15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume <3000-4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. CONCLUSIONS These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.
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Affiliation(s)
- Sevcan A Bakkaloğlu
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Ali Delibaş
- Mersin University, Faculty of Medicine, Department of Pediatric Nephrology, Mersin, Türkiye
| | - Serra Sürmeli Döven
- Mersin University, Faculty of Medicine, Department of Pediatric Nephrology, Mersin, Türkiye
| | - Sevgin Taner
- Adana City Hospital, Pediatric Nephrology Unit, Adana, Türkiye
| | - Sevgi Yavuz
- Başakşehir Çam ve Sakura City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Gökçen Erfidan
- Diyarbakır Gazi Yaşargil Hospital, Pediatric Nephrology Unit, Diyarbakır, Türkiye
| | | | - Fatma Aynacı
- Mersin City Hospital, Pediatric Nephrology Unit, Mersin, Türkiye
| | - Kenan Yilmaz
- Şanlıurfa Training Hospital, Pediatric Nephrology Unit, Şanlıurfa, Türkiye
| | - Mehmet Taşdemir
- İstinye University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Okan Akacı
- Bursa Yüksek İhtisas Hospital, Pediatric Nephrology Unit, Bursa, Türkiye
| | | | - Serçin Güven
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Neslihan Çiçek
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Ismail Dursun
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Emre Keleşoğlu
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | | | - Demet Alaygut
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Seha Saygılı
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Önder Yavaşcan
- İstanbul Medipol University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Alev Yılmaz
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Kaan Gülleroğlu
- Başkent University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Pelin Ertan
- Manisa Celal Bayar University, Faculty of Medicine, Department of Pediatric Nephrology, Manisa, Türkiye
| | - Belde Kasap Demir
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Hakan Poyrazoğlu
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Seda Pınarbaşı
- Diyarbakır Children's Hospital, Pediatric Nephrology Unit, Diyarbakır, Türkiye
| | - Aylin Gençler
- Harran University, Faculty of Medicine, Department of Pediatric Nephrology, Şanlıurfa, Türkiye
| | - Funda Baştuğ
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Neslihan Günay
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Kübra Çeleğen
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Aytül Noyan
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Gönül Parmaksız
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Begüm Avcı
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | | | - Umut Bayrakçı
- Bilkent City Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | - Sare Gülfem Özlü
- Bilkent City Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | | | - Sibel Yel
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Güldane Aylin İnal
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Seçil Köse
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Aysun Karabay Bayazıt
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Bahriye Atmış
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Emel Sarıbaş
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Çağla Çağlı
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Yılmaz Tabel
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | - Ahmet Taner Elmas
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | - Şenay Zırhlı Selçuk
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | | | - Mehtap Akbalık Kara
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Mithat Büyükçelik
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Ayşe Balat
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Betül Durucu Tiryaki
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Bilge Erdoğdu
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Bağdagül Aksu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Günay Mahmudova
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Hasan Dursun
- SBÜ Prof. Dr Cemil Taşçıoğlu City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Cengiz Candan
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Nilüfer Göknar
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Fatma Mutlubaş
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Seçil Arslansoyu Çamlar
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Cemaliye Başaran
- İzmir Tepecik Hospital, Pediatric Nephrology Unit, İzmir, Türkiye
| | - Burcu Bulum Akbulut
- Acıbadem University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Ali Düzova
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Bora Gülhan
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Çiğdem Oruç
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Harun Peru
- Selçuk University, Faculty of Medicine, Department of Pediatric Nephrology, Konya, Türkiye
| | - Harika Alpay
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Özde Nisa Türkkan
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Rüveyda Gülmez
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Mehtap Çelakıl
- Sakarya University, Faculty of Medicine, Department of Pediatric Nephrology, Sakarya, Türkiye
| | - Kenan Doğan
- Kocaeli University, Faculty of Medicine, Department of Pediatric Nephrology, Kocaeli, Türkiye
| | - Ilmay Bilge
- Koç University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Cemile Pehlivanoğlu
- Koç University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Bahar Büyükkaragöz
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Emre Leventoğlu
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Nuray Alpman
- Gülhane Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | - Cengiz Zeybek
- SBÜ Gülhane Hospital, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Sebahat Tülpar
- Bakırköy Dr Sadi Konuk Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | | | - Aslıhan Kara
- Fırat University, Faculty of Medicine, Department of Pediatric Nephrology, Elazığ, Türkiye
| | - Metin Kaya Gürgöze
- Fırat University, Faculty of Medicine, Department of Pediatric Nephrology, Elazığ, Türkiye
| | | | | | - Serim Pul
- Ümraniye Training and Research Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Ferah Sönmez
- Bezm-i Alem University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Gizem Yıldız
- Dokuz Eylül University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Sema Akman
- Akdeniz University, Faculty of Medicine, Department of Pediatric Nephrology, Antalya, Türkiye
| | - Midhat Elmacı
- Karamanoğlu Mehmetbey University, Faculty of Medicine, Department of Pediatric Nephrology, Karaman, Türkiye
| | - Nuran Küçük
- Kartal Dr Lütfi Kırdar City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Selçuk Yüksel
- Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Pediatric Nephrology, Çanakkale, Türkiye
| | - Aslı Kavaz
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Nephrology, Eskişehir, Türkiye
| | - Hülya Nalçacıoğlu
- Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Nephrology, Samsun, Türkiye
| | - Caner Alparslan
- İzmir Demokrasi University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Nida Dinçel
- SBÜ İzmir Dr Behçet Uz Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Atilla H Elhan
- Ankara University, School of Medicine Department of Biostatistics, Ankara, Türkiye
| | - Lale Sever
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
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Smith N, Donaldson M, Mitton C, Lee E. Communication in disasters to support families with children with medical complexity and special healthcare needs: a rapid scoping review. Front Public Health 2024; 12:1229738. [PMID: 38544735 PMCID: PMC10967951 DOI: 10.3389/fpubh.2024.1229738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/13/2024] [Indexed: 04/24/2024] Open
Abstract
Disasters can disrupt normal healthcare processes, with serious effects on children who depend upon regular access to the health care system. Children with medical complexity (CMC) are especially at risk. These children have chronic medical conditions, and may depend on medical technology, like feeding tubes. Without clear, evidence-based processes to connect with healthcare teams, families may struggle to access the services and supports they need during disasters. There is limited research about this topic, which has been pushed forward in importance as a result of the COVID-19 pandemic. The authors therefore conducted a rapid scoping review on this topic, with the intention to inform policy processes. Both the peer-reviewed and gray literatures on disaster, CMC, and communication were searched in summer 2020 and spring 2021. Twenty six relevant articles were identified, from which four main themes were extracted: 1. Cooperative and collaborative planning. 2. Proactive outreach, engagement, and response. 3. Use of existing social networks to connect with families. 4. Return to usual routines. Based on this review, good practices appear to involve including families, professionals, other stakeholders, and children themselves in pre-disaster planning; service providers using proactive outreach at the outset of a crisis event; working with existing peer and neighborhood networks for support; employing multiple and two-way communication channels, including social media, to connect with families; re-establishing care processes as soon as possible, which may include virtual connections; addressing mental health issues as well as physical functioning; and prioritizing the resumption of daily routines. Above all, a well-established and ongoing relationship among children, their caregivers, and healthcare teams could reduce disruptions when disaster strikes.
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Affiliation(s)
- Neale Smith
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Meghan Donaldson
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Esther Lee
- Complex Care Program, British Columbia Children’s Hospital, Vancouver, BC, Canada
- Canuck Place Children’s Hospice, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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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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Kopp JB, Lempert K, Finne K. Disaster preparedness for patients with kidney disease. Nat Rev Nephrol 2023; 19:147-148. [PMID: 36747083 DOI: 10.1038/s41581-023-00678-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Kenneth Lempert
- Division of Nephrology, Wayne State University, Detroit, MI, USA
| | - Kristen Finne
- Empower Program, Department of Health and Human Services, Washington, DC, USA
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Sever MS, Vanholder R, Oniscu G, Abramowicz D, Van Biesen W, Maggiore U, Watschinger B, Mariat C, Buturovic-Ponikvar J, Crespo M, Mjoen G, Heering P, Peruzzi L, Gandolfini I, Hellemans R, Hilbrands L. Kidney transplantation during mass disasters - from COVID-19 to other catastrophes A Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA. Nephrol Dial Transplant 2023; 38:300–308. [PMID: 36066915 PMCID: PMC9923698 DOI: 10.1093/ndt/gfac251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Indexed: 07/23/2023] Open
Abstract
Mass disasters are characterized by a disparity between health care demand and supply, which hampers complex therapies like kidney transplantation. Considering scarcity of publications on previous disasters, we reviewed transplantation practice during the recent COVID-19 pandemic, and dwelled upon this experience for guiding transplantation strategies in the future pandemic and non-pandemic catastrophes. We strongly suggest continuing transplantation programs during mass disasters, if medical and logistic operational circumstances are appropriate. Postponing transplantations from living donors and referral of urgent cases to safe regions or hospitals are justified. Specific preventative measures in anticipated disasters (such as vaccination programs during pandemics or evacuation in case of hurricanes or wars) may be useful to minimize risks. Immunosuppressive therapies should consider stratifying risk status and avoiding heavy immune suppression in patients with a low probability of therapeutic success. Discharging patients at the earliest convenience is justified during pandemics, whereas delaying discharge is reasonable in other disasters, if infrastructural damage results in unhygienic living environments for the patients. In the outpatient setting, telemedicine is a useful approach to reduce the patient load to hospitals, to minimize the risk of nosocomial transmission in pandemics and the need for transport in destructive disasters. If it comes down to save as many lives as possible, some ethical principles may vary in function of disaster circumstances, but elementary ethical rules are non-negotiable. Patient education is essential to minimize disaster-related complications and to allow for an efficient use of health care resources.
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Affiliation(s)
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium; Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | | | | | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Umberto Maggiore
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation rénale, Centre Hospitalier Universitaire de Saint Etienne, Hôpital NORD, Université de Lyon, Université Jean Monnet, Saint Etienne, France
| | | | - Marta Crespo
- Hospital del Mar, Department of Nephrology, Barcelona, Spain
| | - Geir Mjoen
- Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Peter Heering
- Klinik für Nephrologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen, Solingen, Germany
| | | | | | - Rachel Hellemans
- Department of Nephrology and Hypertension, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Luuk Hilbrands
- Radboud university medical center, Department of Nephrology, Nijmegen, The Netherlands
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Sever L, Pehlivan G, Canpolat N, Saygılı S, Ağbaş A, Demirgan E, Oh J, Levtchenko E, Ivanov DD, Shroff R. Management of pediatric dialysis and kidney transplant patients after natural or man-made disasters. Pediatr Nephrol 2023; 38:315-325. [PMID: 36194369 PMCID: PMC9529603 DOI: 10.1007/s00467-022-05734-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 01/10/2023]
Abstract
Pediatric patients on kidney replacement therapy (KRT) are among the most vulnerable during large-scale disasters, either natural or man-made. Hemodialysis (HD) treatments may be impossible because of structural damage and/or shortage of medical supplies, clean water, electricity, and healthcare professionals. Lack of peritoneal dialysis (PD) solutions and increased risk of infectious/non-infectious complications may make PD therapy challenging. Non-availability of immunosuppressants and increased risk of infections may result in graft loss and deaths of kidney transplant recipients. Measures to mitigate these risks must be considered before, during, and after the disaster including training of staff and patients/caregivers to cope with medical and logistic problems. Soon after a disaster, if the possibility of performing HD or PD is uncertain, patients should be directed to other centers, or the duration and/or number of HD sessions or the PD prescription adapted. In kidney transplant recipients, switching among immunosuppressants should be considered in case of non-availability of the medications. Post-disaster interventions target treating neglected physical and mental problems and also improving social challenges. All problems experienced by pediatric KRT patients living in the affected area are applicable to displaced patients who may also face extra risks during their travel and also at their destination. The need for additional local, national, and international help and support of non-governmental organizations must be anticipated and sought in a timely manner.
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Affiliation(s)
- Lale Sever
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Gülseren Pehlivan
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seha Saygılı
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayşe Ağbaş
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ebru Demirgan
- Department of Pediatric Nephrology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Jun Oh
- Department of Pediatric Nephrology, Medical Center University Hamburg/Eppendorf, Hamburg, Germany
| | | | - Dymtro D Ivanov
- Department of Nephrology and Renal Replacement Therapy, Shupyk National Health Care University, Kiev, Ukraine
| | - Rukshana Shroff
- UCL Great Ormond Street Hospital and Institute of Child Health, Renal Unit, London, UK
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Maternik M, Andrunevych R, Drożdż D, Czauderna P, Grenda R, Tkaczyk M. Transition and management of Ukrainian war refugee children on kidney replacement therapy. Pediatr Nephrol 2023; 38:311-314. [PMID: 36066772 DOI: 10.1007/s00467-022-05726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Michal Maternik
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdańsk, Poland.
| | - Roman Andrunevych
- Department of Pediatric Nephrology, West Ukrainian Specialized Children's Medical Center, Lviv, Ukraine
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Pediatric Institute, Jagiellonian University Medical College, Kracow, Poland
| | - Piotr Czauderna
- Department of Pediatric Surgery and Urology, Medical University of Gdansk, Gdansk, Poland
| | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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Jacob H, Marlais M. Safeguarding children and young people requiring kidney replacement therapy: challenges and potential opportunities. Pediatr Nephrol 2022; 37:1007-1015. [PMID: 34247294 DOI: 10.1007/s00467-021-05133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 10/20/2022]
Abstract
Kidney replacement therapy (KRT) makes considerable physical and psychological demands on children, young people and their families. The impact can be wide-ranging, affecting education, employment, mental health, finances and relationships for both child and caregiver. It is vitally important for those working with these families to recognise the psychosocial challenges they face and to know the range of interventions available. This article explores the psychosocial impact of KRT, considering opportunities to minimise risk and optimise outcomes for children, young people and their families.
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Affiliation(s)
- Hannah Jacob
- Department of Nephrology, Great Ormond Street Hospital, London, UK.
| | - Matko Marlais
- Department of Nephrology, Great Ormond Street Hospital, London, UK
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Kidney disease profile and encountered problems during follow-up in Syrian refugee children: a multicenter retrospective study. Pediatr Nephrol 2022; 37:393-402. [PMID: 34331573 DOI: 10.1007/s00467-021-05046-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children are one of the most vulnerable groups in conflict zones, especially those with chronic diseases. This study aimed to investigate kidney disease profiles and problems during follow-up in a population of Syrian refugee children residing in Turkey. METHODS Syrian refugee children aged between 0 and 18 years were included in the study. Demographic data, diagnosis, particular interventions due to nephrological problems, and problems encountered during follow-up were obtained from all participating pediatric nephrology centers. RESULTS Data from 633 children from 22 pediatric nephrology centers were included. Mean age of the children was 94.8 ± 61.7 months and 375 were male (59%). 57.7% had parental consanguinity and 23.3% had a close relative(s) with kidney disease. The most common kidney diseases were congenital anomalies of the kidney and urinary tract (CAKUT) (31.0%), glomerular disease (19.9%), chronic kidney disease (CKD) (14.8%), and urolithiasis (10.7%). Frequent reasons for CAKUT were nonobstructive hydronephrosis (23.0%), vesico-ureteral reflux (18.4%), and neurogenic bladder (15.8%). The most common etiology of glomerular diseases was nephrotic syndrome (69%). Ninety-four children had CKD, and 58 children were on chronic dialysis. Six children had kidney transplantation. Surgical intervention was performed on 111 patients. The language barrier, lack of medical records, and frequent disruptions in periodic follow-ups were the main problems noted. CONCLUSIONS CAKUT, glomerular disease, and CKD were highly prevalent in Syrian refugee children. Knowing the frequency of chronic diseases and the problems encountered in refugees would facilitate better treatment options and preventive measures.
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Sever MS, Ortiz A, Maggiore U, Bac-García E, Vanholder R. Mass Disasters and Burnout in Nephrology Personnel: From Earthquakes and Hurricanes to COVID-19 Pandemic. Clin J Am Soc Nephrol 2021; 16:829-837. [PMID: 33414153 PMCID: PMC8259469 DOI: 10.2215/cjn.08400520] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to work-related stress) is already a frequent part of routine nephrology practice and, not surprisingly, is even more common during mass disasters due to increased workload and specific conditions, in addition to individual factors. Avoiding burnout is essential to prevent psychologic and somatic health problems in personnel as well as malpractice, understaffing, and inadequate health care delivery, all of which increase the health care burden of disasters. Burnout may be prevented by predisaster organizational measures, which include developing an overarching plan and optimizing health care infrastructure, and ad hoc disaster-specific measures that encompass both organizational and individual measures. Organizational measures include increasing safety, decreasing workload and fear of malpractice, optimizing medical staffing and material supplies, motivating personnel, providing mental health support, and enabling flexibility in working circumstances. Individual measures include training on coping with stress and problematic conditions, minimizing the stigma of emotional distress, and maintaining physical health. If these measures fall short, asking for external help is mandatory to avoid an inefficient disaster health care response. Minimizing burnout by applying these measures will improve health care provision, thus saving as many lives as possible.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy,UO Nefrologia, Azienda-Ospedaliero Universitaria di Parma, Parma, Italy
| | - Enrique Bac-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain,Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium,European Kidney Health Alliance, Brussels, Belgium
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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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Distribution and management of the pediatric refugee population with renal replacement: A German pediatric cohort. Pediatr Nephrol 2021; 36:271-277. [PMID: 31897711 DOI: 10.1007/s00467-019-04374-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
With migration rising, the pediatric nephrology community is faced with challenges concerning the management of end-stage kidney disease (ESKD) in the pediatric refugee population. Data on the care of the pediatric refugee cohort on renal replacement therapy (RRT) is not available. A survey conducted by us in 2018 showed that the group of refugee children arriving to Germany during the years 2015-2017 accounts for approximately 20% of the total pediatric dialysis population in Germany. Provision of (medical) care for these children and their families is often hampered by psychosocial problems, cultural differences, language barriers, and administrative issues. Treating centers need to provide additional human as well as financial and logistic resources. In this educational review, we raise awareness and discuss possible challenges occurring in the treatment of refugee children with ESKD.
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Abstract
Armed conflicts continue to occur in some regions of the globe, mostly in developing countries. These man-made disasters affect all segments of the population; however, some groups are more vulnerable and suffer more seriously from the unfavorable consequences of such conflicts. Among these, the pediatric population deserves special attention because they cannot protect themselves, and hence carry a higher threat of injuries and probability of death during conflicts. In addition, children who do survive the disaster are more prone to exploitation. Pediatric victims, including those who sustain acute kidney injury or those suffering from chronic kidney disease before armed conflicts, face higher risks of morbidity and mortality as a result of treatment problems, specifically limited dialysis options. Displaced children, forced to flee their homes as a result of armed conflicts, are also at risk for various health problems because they may not find ideal circumstances for disease treatment. Making preparations in anticipation of armed conflicts, such as disaster-relief scenarios and action plans, may be useful to decrease the death toll in these children, who are dependent on their caregivers for survival. Adopting principles of disaster nephrology may contribute to improved survival chances of pediatric kidney patients in chaotic circumstances.
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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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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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