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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.
Highlights
Austere renal replacement therapy (RRT) describes the provision of renal replacement therapy in any setting in which traditional, first-world therapies and resources are limited, incapacitated, or nonexistent
In this paper we briefly review the epidemiology and outcomes of patients with dialysis-requiring acute kidney injury (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
Crush syndrome with resultant myoglobulinuria and AKI due to acute tubular necrosis (ATN) is not the only type of renal failure requiring RRT seen under austere circumstances, it has received the most attention
Summary
Austere renal replacement therapy (RRT) describes the provision of renal replacement therapy in any setting in which traditional, first-world therapies and resources are limited, incapacitated, or nonexistent. If austere environment RRT is to be successful, the provider must identify the components that are lacking and attempt to offer reasonably safe and effective substitutes for them if they cannot be controlled or repaired. This requires flexibility, the ability to triage, and a thorough understanding of the engineering and physiologic principals of RRT. A important group is patients with ESRD receiving chronic dialysis Many such patients are likely to be encountered where chronic dialysis units have been incapacitated or resources are otherwise severely limited due to unanticipated disaster events. It is important to remember that an “austere” RRT situation may exist where there are only a few patients to manage, and no “disaster” has occurred, but RRT provision is limited by logistical and equipment considerations alone
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