At least 372 people developed
crush syndrome after they were injured by the Great Hanshin-Awaji Earthquake. Of these, 23 were transferred to Osaka City General Hospital from the disaster area. The serum
creatinine kinase (CK) of each of the 23 patients exceeded 10,000 IU/L. Sixteen of these patients were treated with various methods of blood purification including
hemodialysis (HD),
plasma exchange (PE), and continuous
hemodiafiltration (CHDF). The effectiveness on each method of blood purification was evaluated in this study based on the clearance of
myoglobin and the length of time until recovery from
acute renal failure (ARF). None of the patients died, and none suffered from ARF longer than 2 months. The length of time required for blood purification was significantly correlated with the serum CK and
myoglobin levels on admission. The serum
myoglobin levels decreased linearly regardless of the method of blood purification used. Our findings showed that the severity of ARF that occurred in association with
crush injury was proportional to the amount of crushed muscle and that once ARF had developed, the clearance of
myoglobin was not affected by any of the blood purification methods tested including HD, PE, and CHDF. Therefore, the method of blood purification employed for
crush syndrome should be selected for its effectiveness in treating ARF, rather than the elimination of
myoglobin.