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International Journal of Nephrology
Volume 2011, Article ID 748053, 9 pages
http://dx.doi.org/10.4061/2011/748053
Review Article

Renal Replacement Therapy in Austere Environments

1Nephrology Service, Department of Medicine, Walter Reed Army Medical Center, 6900 Georgia Avenue Northwest, Washington, DC 20012, USA
2Department of Nephrology, Center for Health Research, Geisinger Medical Center, MC 44-00, 100 North Academy Avenue, Danville, PA 17822, USA

Received 7 September 2010; Revised 8 February 2011; Accepted 22 February 2011

Academic Editor: Achim Jörres

Copyright © 2011 Christina M. Yuan and Robert M. Perkins. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.