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      Disaster preparedness for earthquakes in hemodialysis units in Gyeongju and Pohang, South Korea

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          Abstract

          In 2016 and 2017, there were earthquakes greater than 5.0 in magnitude on the Korean Peninsula, which has previously been considered an earthquake-free zone. Patients with chronic kidney disease are particularly vulnerable to earthquakes, as the term “renal disaster” suggests. In the event of a major earthquake, patients on hemodialysis face the risk of losing maintenance dialysis due to infrastructure disruption. In this review, we share the experience of an earthquake in Pohang that posed a serious risk to patients on hemodialysis. We review the disaster response system in Japan and propose a disaster preparedness plan with respect to hemodialysis. Korean nephrologists and staff in dialysis facilities should be trained in emergency response to mitigate risk from natural disasters. Dialysis staff should be familiar with the action plan for natural disaster events that disrupt hemodialysis, such as outages and water treatment system failures caused by earthquakes. Patients on hemodialysis also need to be educated about disaster preparedness. In the event of a disaster situation that results in dialysis failure, patients need to know what to do. At the local and national government level, long-term preparations should be made to handle renal disaster and patient safety logistics. Moreover, Korean nephrologists should also be prepared to manage cardiovascular disease and diabetes in disaster situations. Further evaluation and management of social and national disaster preparedness of hemodialysis units to earthquakes in Korea are needed.

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          Management of crush-related injuries after disasters.

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            Current characteristics of dialysis therapy in Korea: 2016 registry data focusing on diabetic patients

            Diabetic nephropathy is the most frequent cause of end-stage renal disease worldwide. Dialysis patients with diabetes mellitus (DM) have more complications and shorter survival duration than non-DM dialysis patients, requiring more clinical attention and difficult management. The registry committee of the Korean Society of Nephrology has collected data about dialysis therapy in Korea through an on-line registry program and analyzed the characteristics of patients. A survey of dialysis patients in 2016 showed that 50.2% of new dialysis patients had DM nephropathy as the cause of end-stage renal disease. The proportion of patients receiving hemodialysis (HD) for more than 5 years was 38% in DM patients and 51% in non-DM patients. The mean pulse pressure in DM HD patients was 71.5 mmHg, compared with 62.6 mmHg in non-DM patients. The proportion of DM patients with native vessel arteriovenous fistula as vascular access for HD was lower than that of non-DM patients (73% vs. 78%). Mean serum creatinine of DM and non-DM dialysis patients was 8.4 mg/dL and 9.5 mg/dL respectively. As vascular access of the DM HD patients was poor, the dialysis adequacy of DM patients was slightly lower than that of non-DM patients. The 5-year survival rate for DM HD patients was 53.9%, which was much lower than that of chronic glomerulonephritis patients (78.2%). The proportion of patients with a full-time job was 17% for DM patients and 28% for non-DM patients.
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              Medical complications associated with earthquakes.

              Major earthquakes are some of the most devastating natural disasters. The epidemiology of earthquake-related injuries and mortality is unique for these disasters. Because earthquakes frequently affect populous urban areas with poor structural standards, they often result in high death rates and mass casualties with many traumatic injuries. These injuries are highly mechanical and often multisystem, requiring intensive curative medical and surgical care at a time when the local and regional medical response capacities have been at least partly disrupted. Many patients surviving blunt and penetrating trauma and crush injuries have subsequent complications that lead to additional morbidity and mortality. Here, we review and summarise earthquake-induced injuries and medical complications affecting major organ systems. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Kidney Res Clin Pract
                Kidney Res Clin Pract
                Kidney Research and Clinical Practice
                Korean Society of Nephrology
                2211-9132
                2211-9140
                March 2019
                18 February 2019
                : 38
                : 1
                : 15-24
                Affiliations
                [1 ]Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
                [2 ]Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
                [3 ]Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
                [4 ]Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
                [5 ]Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
                [6 ]Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
                [7 ]Division of Nephrology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
                Author notes
                Correspondence: Yon Su Kim, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail: yonsukim@ 123456snu.ac.kr , ORCID: https://orcid.org/0000-0003-3091-2388

                Edited by Jung Eun Lee, Sungkyunkwan University, Seoul, Korea

                Article
                krcp-38-015
                10.23876/j.krcp.18.0058
                6481979
                30776874
                3fe57d5e-ca12-45d5-b88c-3a7338cf99ff
                Copyright © 2019 by The Korean Society of Nephrology

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 June 2018
                : 29 October 2018
                : 01 November 2018
                Categories
                Special Article

                disasters,earthquakes,renal dialysis,south korea
                disasters, earthquakes, renal dialysis, south korea

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