1
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Alasfar S, Koubar SH, Gautam SC, Jaar BG. Kidney Care in Times of Crises: A Review. Am J Kidney Dis 2024:S0272-6386(24)00789-3. [PMID: 38851445 DOI: 10.1053/j.ajkd.2024.03.030] [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: 08/20/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 06/10/2024]
Abstract
The global burden of kidney disease is increasing, paralleled by a rising number of natural and man-made crises. During these tumultuous times, accessing vital health care resources becomes challenging, posing significant risks to individuals, particularly those with kidney disease. This review delves into the impact of crises on kidney disease, with a particular focus on acute kidney injury (AKI), kidney failure, and kidney transplant. Patients experiencing crush injuries leading to AKI may encounter delayed diagnosis due to the chaotic nature of disasters and limited availability of resources. In chronic crises such as conflicts, patients with kidney failure are particularly affected, and deviations from dialysis standards are unfortunately common, impacting morbidity and mortality rates. Additionally, crises also disrupt access to kidney transplants, potentially compromising transplant outcomes. This review underscores the critical importance of preparedness measures and proactive management for kidney disease in crisis settings. Collaborative efforts among government bodies, rescue teams, health care providers, humanitarian agencies, and nongovernmental organizations are imperative to ensure equitable and reasonable care for kidney disease patients during times of crises, with the aim of saving lives and improving outcomes.
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Affiliation(s)
- Sami Alasfar
- Department of Medicine, Division of Nephrology, Mayo Clinic, Phoenix, Arizona
| | - Sahar H Koubar
- Department of Medicine, Division of Nephrology, University of Minnesota, Minneapolis, Minnesota
| | - Samir C Gautam
- Department of Medicine, Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Bernard G Jaar
- Department of Medicine, Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
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2
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Konozy EHE. Sudan's healthcare crisis: The struggle of kidney patients amidst conflict. Health Sci Rep 2024; 7:e1980. [PMID: 38486685 PMCID: PMC10937813 DOI: 10.1002/hsr2.1980] [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: 11/07/2023] [Revised: 01/27/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
Background and Aim Conflicts, akin to other crises, disrupt lives and healthcare infrastructure, disproportionately affecting vulnerable individuals. The ongoing Sudanese conflict, initiated on April 15, 2023, between the Sudanese Armed Forces (SAF) and the Rapid Support Force (RSF), triggers significant population displacement, healthcare facility closures, and a scarcity of medical resources. Amid the intense conflict in Khartoum, reports of deceased individuals in the streets heighten concerns about public health, emphasizing the gravity of the situation. This crisis compounds the challenges faced by Sudan's already fragile healthcare system, impacting over 5 million displaced individuals, including those reliant on life-saving hemodialysis sessions. This commentary aims to illuminate the challenges confronting kidney dialysis patients in war-torn Sudan, emphasizing the impact on the Al-Goled hemodialysis center. Methodology This commentary relies on reports from the American Society of Nephrology (ASN), European Renal Association (ERA), and The International Society of Nephrology (ISN), along with recent journal articles discussing the consequences of ongoing conflicts. Personal observations in Al-Goled contribute to the insights, and data from the Al-Goled hemodialysis center in Sudan illuminate the struggles faced by kidney dialysis patients during the conflict, presented as a case study. Results Kidney dialysis patients, crucial for regular hemodialysis sessions, confront severe challenges due to the overwhelming conflict. With an estimated 8000 kidney failure patients in Sudan, disruptions in healthcare services, targeted attacks on medical staff, and a shortage of resources exacerbate their plight. The Al-Goled hemodialysis center, initially designed for 30 daily sessions, experiences a surge in demand, accommodating 85 patients daily-an alarming 183% increase. Limited resources, machine malfunctions, and a shortage of medications contribute to the loss of 13 patients' lives. Conclusions The conflict in Sudan disproportionately impacts kidney dialysis patients, causing disruptions in essential healthcare services. The surge in demand at the Al-Goled center underscores the broader impact on healthcare institutions nationwide. Local efforts to source medical supplies face bureaucratic hurdles and complex exportation procedures, impeding support for kidney patients. Patients, once receiving 3 weekly sessions, now struggle to secure even one, jeopardizing their well-being. Urgent international intervention is needed to cease the conflict and ensure the safety of healthcare facilities, especially for vulnerable populations like kidney dialysis patients.
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Affiliation(s)
- Emadeldin Hassan E. Konozy
- Department of BiotechnologyAfrica City of Technology (ACT)KhartoumSudan
- Pharmaceutical Research and Development Centre, Faculty of PharmacyKarary UniversityOmdurmanSudan
- Biomedical and Clinical Research CentreCape Coast UniversityCape CoastGhana
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3
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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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4
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Pawłowicz-Szlarska E, Vanholder R, Sever MS, Tuğlular S, Luyckx V, Eckardt KU, Gallego D, Ivanov D, Nistor I, Shroff R, Škoberne A, Stuard S, Gellert R, Noruišiene E, Sekkarie M, Wiecek A. Distribution, preparedness and management of Ukrainian adult refugees on dialysis-an international survey by the Renal Disaster Relief Task Force of the European Renal Association. Nephrol Dial Transplant 2023; 38:2407-2415. [PMID: 37326036 PMCID: PMC10539197 DOI: 10.1093/ndt/gfad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Due to the Russian-Ukrainian war, some of the about 10 000 adults requiring dialysis in Ukraine fled their country to continue dialysis abroad. To better understand the needs of conflict-affected dialysis patients, the Renal Disaster Relief Task Force of the European Renal Association conducted a survey on distribution, preparedness and management of adults requiring dialysis who were displaced due to the war. METHODS A cross-sectional online survey was sent via National Nephrology Societies across Europe and disseminated to their dialysis centers. Fresenius Medical Care shared a set of aggregated data. RESULTS Data were received on 602 patients dialyzed in 24 countries. Most patients were dialyzed in Poland (45.0%), followed by Slovakia (18.1%), Czech Republic (7.8%) and Romania (6.3%). The interval between last dialysis and the first in the reporting center was 3.1 ± 1.6 days, but was ≥4 days in 28.1% of patients. Mean age was 48.1 ± 13.4 years, 43.5% were females. Medical records were carried by 63.9% of patients, 63.3% carried a list of medications, 60.4% carried the medications themselves and 44.0% carried their dialysis prescription, with 26.1% carrying all of these items and 16.1% carrying none. Upon presentation outside Ukraine, 33.9% of patients needed hospitalization. Dialysis therapy was not continued in the reporting center by 28.2% of patients until the end of the observation period. CONCLUSIONS We received information about approximately 6% of Ukrainian dialysis patients, who had fled their country by the end of August 2022. A substantial proportion were temporarily underdialyzed, carried incomplete medical information and needed hospitalization. The results of our survey may help to inform policies and targeted interventions to respond to the special needs of this vulnerable population during wars and other disasters in the future.
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Affiliation(s)
- Ewa Pawłowicz-Szlarska
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Łódź, Łódź, Poland
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
- European Kidney Health Alliance, Brussels, Belgium
| | - Mehmet S Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Serhan Tuğlular
- Department of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Valerie Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Africa, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Dmytro Ivanov
- Department of Nephrology and RRT, Bogomolets National Medical University, Kyiv, Ukraine
| | - Ionut Nistor
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
- Department of Nephrology, Dr C. I. Parhon University Hospital, Iasi, Romania
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - Andrej Škoberne
- Department of Nephrology, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Stefano Stuard
- Global Medical Office, Fresenius Medical Care, Bad Homburg, Germany
| | - Ryszard Gellert
- Department of Nephrology and Internal Medicine, Centre for Postgraduate Medical Education, Warsaw, Poland
| | - Edita Noruišiene
- European Kidney Health Alliance, Brussels, Belgium
- European Dialysis and Transplant Nurses Association – European Renal Care Association, Hergiswil, Switzerland
| | | | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
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5
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Piccoli GB, Hmida MB. KRT, instructions for (green) use. J Nephrol 2023; 36:1729-1730. [PMID: 37725278 DOI: 10.1007/s40620-023-01776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Affiliation(s)
| | - Mohamed Ben Hmida
- Department of Nephrology, Hédi Chaker University Hospital, 3029, Sfax, Tunisia
- Faculty of Medicine, Research Laboratory of Renal Pathology LR19ES11, University of Sfax, 3029, Sfax, Tunisia
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6
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Małyszko J, Macech M, Kępska-Dzilińska M, Nazarewski S. Renal Replacement Therapy in Poland and Lifesaving Treatment for Ukrainian Refugees: Coping With the Humanitarian Crisis. Transplantation 2023; 107:1643-1645. [PMID: 37476862 DOI: 10.1097/tp.0000000000004543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
- Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Michał Macech
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Sławomir Nazarewski
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
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7
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Hsiao LL, Shah KM, Liew A, Abdellatif D, Balducci A, Haris Á, Kumaraswami LA, Liakopoulos V, Lui SF, Ulasi I, Langham RG. Kidney health for all: preparedness for the unexpected in supporting the vulnerable. Kidney Int 2023; 103:436-443. [PMID: 36822747 DOI: 10.1016/j.kint.2022.12.013] [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: 11/04/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 02/23/2023]
Abstract
As the rate of natural disasters and other devastating events caused by human activities increases, the burden on the health and well-being of those affected by kidney disease has been immeasurable. Health system preparedness, which involves creating a resilient system that is able to deal with the health needs of the entire community during times of unexpected disruptions to usual care, has become globally important. In the wake of the COVID-19 pandemic, there is a heightened awareness of the amplification of negative effects on the renal community. Paradoxically, the complex medical needs of those who have kidney diseases are not met by systems handling crises, often compounded by an acute increase in burden via new patients as a result of the crisis itself. Disruptions in kidney care as a result of unexpected events are becoming more prevalent and likely to increase in the years to come. It is therefore only appropriate that the theme for this year's World Kidney Day will focus on Kidney Health for All: preparedness for the unexpected in supporting the vulnerable.
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Affiliation(s)
- Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Kavya M Shah
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrian Liew
- Department of Renal Medicine, Mount Elizabeth Novena Hospital, Singapore
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | | | - Ágnes Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Latha A Kumaraswami
- Tamilnad Kidney Research (TANKER) Foundation, The International Federation of Kidney Foundations-World Kidney Alliance (IFKF-WKA), Chennai, India
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Siu-Fai Lui
- International Federation of Kidney Foundations-World Kidney Alliance, Hong Kong, China; The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Robyn G Langham
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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8
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Karam S, Gunasekara VN, Abou Jaoudeh P, Wijewickrama E. Preparing for the Unexpected, Supporting the Vulnerable-A Perspective From Lebanon and Sri Lanka. Kidney Int Rep 2023; 8:383-387. [PMID: 36938072 PMCID: PMC10014372 DOI: 10.1016/j.ekir.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota, USA
- Correspondence: Sabine Karam, Division of Nephrology and Hypertension, 717 Delaware Street SE Suite 353B, Minneapolis, Minnesota 55414, USA.
| | | | | | - Eranga Wijewickrama
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- National Hospital of Sri Lanka, Colombo, Sri Lanka
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9
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Sever MS, Vanholder R, Luyckx V, Eckardt KU, Kolesnyk M, Wiecek A, Pawlowicz-Szlarska E, Gallego D, Shroff R, Škoberne A, Nistor I, Sekkarie M, Ivanov D, Noruišiene E, Tuglular S. Armed conflicts and kidney patients: a consensus statement from the Renal Disaster Relief Task Force of the ERA. Nephrol Dial Transplant 2023; 38:56-65. [PMID: 35998320 DOI: 10.1093/ndt/gfac247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Indexed: 01/26/2023] Open
Abstract
During conflicts, people with kidney disease, either those remaining in the affected zones or those who are displaced, may be exposed to additional threats because of medical and logistical challenges. Acute kidney injury developing on the battlefield, in field hospitals or in higher-level hospital settings is characterized by poor outcomes. People with chronic kidney disease may experience treatment interruptions, contributing to worsening kidney function. Patients living on dialysis or with a functioning graft may experience limitations of dialysis possibilities or availability of immunosuppressive medications, increasing the risk of severe complications including death. When patients must flee, these threats are compounded by unhealthy and insecure conditions both during displacement and/or at their destination. Measures to attenuate these risks may only be partially effective. Local preparedness for overall and medical/kidney-related disaster response is essential. Due to limitations in supply, adjustments in dialysis frequency or dose, switching between hemodialysis and peritoneal dialysis and changes in immunosuppressive regimens may be required. Telemedicine (if possible) may be useful to support inexperienced local physicians in managing medical and logistical challenges. Limited treatment possibilities during warfare may necessitate referral of patients to distant higher-level hospitals, once urgent care has been initiated. Preparation for disasters should occur ahead of time. Inclusion of disaster nephrology in medical and nursing curricula and training of patients, families and others on self-care and medical practice in austere settings may enhance awareness and preparedness, support best practices adapted to the demanding circumstances and prepare non-professionals to lend support.
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Affiliation(s)
- Mehmet S Sever
- Istanbul University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium; Nephrology Section, Department of Internal Medicine and, Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valerie Luyckx
- Department of Nephrology, University Children's Hospital, 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
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mykola Kolesnyk
- SI Institute of Nephrology of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Ewa Pawlowicz-Szlarska
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland
| | - Daniel Gallego
- European Kidney Health Alliance, Brussels, Belgium; European Kidney Patient Federation, Wien, Austria
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - Andrej Škoberne
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Ionut Nistor
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania; Department of Nephrology, Dr C I Parhon University Hospital, Iasi, Romania
| | | | - Dmytro Ivanov
- Department of Nephrology and RRT Shupyk, National Health Care University, Kyiv, Ukraine
| | - Edita Noruišiene
- European Kidney Health Alliance, Brussels, Belgium; European Dialysis and Transplant Nurses Association - European Renal Care Association
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
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Vanholder R, Conway PT, Gallego D, Scheres E, Wieringa F. The European Kidney Health Alliance (EKHA) and the Decade of the KidneyTM. Nephrol Dial Transplant 2022; 38:1113-1122. [PMID: 35790139 DOI: 10.1093/ndt/gfac211] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
The European Kidney Health Alliance (EKHA) is an advocacy organization that defends the case of the kidney patients and the nephrological community at the level of the European Union (EU), and from there, top to bottom, also at the national level of the EU member states and the EU-associated countries. The Decade of the KidneyTM is a global initiative launched by the American Association of Kidney Patients (AAKP) to create greater awareness and organize patient demands for long overdue innovation in kidney care. This article describes the medical and patient burden of kidney disease, the history of EKHA, its major activities and tools for policy action and the need for innovation. We then describe the Decade of the KidneyTM initiative, the rationale why EKHA joined this activity to emanate parallel action at the European side, the novel professionalized structure of EKHA, and its immediate targets. The final aim is to align all major stakeholders for an action plan on kidney disease comparable to Europe's successful Beating Cancer Plan, with the additional intent that the EKHA model is applied also by the respective national kidney-related societies to create a broad mobilization at all levels. The ultimate aims are that the EU considers chronic kidney disease (CKD) as a major health and health-economic problem, to consequently have CKD included as a key health research target by the European Commission, and to improve quality of life and outcomes for all kidney patients.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance (EKHA), Brussels, Belgium.,Nephrology Section, Department of Internal Medicine and Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Paul T Conway
- Policy and Global Affairs, American Association of Kidney Patients (AAKP), Washington, DC, US
| | - Daniel Gallego
- European Kidney Patient's Federation (EKPF), Vienna, Austria
| | - Eveline Scheres
- European Kidney Health Alliance (EKHA), Brussels, Belgium.,Buiten de Lijnen, Utrecht, The Netherlands
| | - Fokko Wieringa
- Department of Nephrology and Hypertension, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.,Department of Autonomous Therapeutics, Imec, Eindhoven, The Netherlands
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Kolesnyk M, Dudar I, Stepanova N, Novakivskyy V, Honchar Y, Krasyuk E, Shifris I, Zograbian R, Velychko M, Loboda O, Fomina S. Recommendations of the Ukrainian Renal Disaster Relief Committee of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists regarding medical care to kidney disease patients during the war. UKRAINIAN JOURNAL OF NEPHROLOGY AND DIALYSIS 2022:3-12. [DOI: 10.31450/ukrjnd.3(75).2022.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Abstract. The occurrence of an emergency situation (ES) forced international (ISN, EDTA/ERA) and national (Turkey) nephrological associations to establish the Renal Disaster Relief Task Force, which is primarily concerned with the treatment of patients with acute kidney injury and end-stage renal disease requiring dialysis. The war started by the RF is putting the Ukrainian state, Ukrainian society, and the healthcare system in the catastrophic ES. Under these circumstances, all nephrological patients became one of the most vulnerable categories of patients.
To provide immediate support in solving problems within the Ukrainian Association of Nephrologists and Kidney Transplant Specialists (UAN&KTS), the Ukrainian Renal Disaster Relief Committee (URDRC) has been established. One of the most important tasks was to form a group of experts to develop recommendations for specialized medical care for kidney patients in wartime.
According to the experts, the key person for this type of medical care is the leading nephrologist in the region or city. He/she establishes a local Renal Disaster Relief Committee (LRDRC) and decides through horizontal (with other LRDRC) or vertical (with UAN &KTS) collaboration, using available communication tools, on the problems that arise; the most appropriate tool is the Viber platform "Nephrology. Dialysis. Transplantation". In this way, a network without administrative subordination and a non-hierarchical functional system was created, which, on the one hand, functions according to similar working principles, but, on the other hand, may differ in terms of LRDRC composition, communication methods, and more.
The LRDRC divides all patients into three groups and provides work preparation measures before, during and after the cancellation of ES.
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12
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Martin DE, Fadhil RAS, Więcek A. Ethical Aspects of Kidney Donation and Transplantation for Migrants. Semin Nephrol 2022; 42:151271. [PMID: 36577643 DOI: 10.1016/j.semnephrol.2022.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Migrants represent a large and diverse population globally that includes international refugees, stateless persons, expatriate workers, and more. Many migrants face significant barriers in accessing health care, especially scarce and costly resources such as dialysis and kidney transplantation. Improving equity of access to these kidney replacement therapies for migrant populations may present a range of complex ethical dilemmas, particularly in the setting of crises and when considering the use of residency status and citizenship as eligibility criteria for access to treatment. In this article, we discuss ethical obligations to provide kidney care for migrants, the implications of the self-sufficiency concept with regard to access to deceased donation and transplantation, factors that may influence evaluation of the risks and benefits of transplantation for migrants with insecure access to care, and the vulnerability of migrants to organ trafficking. We also present a set of general recommendations to assist in preventing and managing ethical dilemmas when making decisions about policy or practice regarding kidney care for migrants.
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Affiliation(s)
| | - Riadh A S Fadhil
- Qatar Organ Donation Center, Hamad Medical Corporation, Doha, Qatar; Weill Cornell College of Medicine - Doha, Qatar
| | - Andrzej Więcek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
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Kumar BN, James R, Hargreaves S, Bozorgmehr K, Mosca D, Hosseinalipour SM, AlDeen KN, Tatsi C, Mussa R, Veizis A, Kállayová D, Blanchet K, Machado RS, Orcutt M, Severoni S. Meeting the health needs of displaced people fleeing Ukraine: Drawing on existing technical guidance and evidence. THE LANCET REGIONAL HEALTH. EUROPE 2022; 17:100403. [PMID: 35721694 PMCID: PMC9198835 DOI: 10.1016/j.lanepe.2022.100403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The invasion of Ukraine has unleashed a humanitarian crisis and the impact is devastating for millions displaced in Ukraine and for those fleeing the country. Receiving countries in Europe are reeling with shock and disbelief and trying at the same time to grapple with the reality of providing for a large, unplanned, unprecedented number of refugees mainly women and children on the move. Several calls for actions, comments and statements express outrage, the risks, and the impending consequences to life and health. There is a need to constantly assess the situation on the ground, identify priorities for health and provide guidance regarding how these needs could be addressed. Therefore, the Lancet Migration European Regional Hub conducted rapid interviews with key informants to identify these needs, and in collaboration with the World Health Organization Health and Migration Programme, summarized how these could be addressed. This viewpoint provides a summary of the situation in receiving countries and the technical guidance required that could be useful for providing assistance in the current refugee crisis.
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Affiliation(s)
- Bernadette N. Kumar
- Norwegian Institute of Public Health, Norway
- Lancet Migration European Regional Hub, Switzerland
| | - Rosemary James
- Lancet Migration European Regional Hub, Switzerland
- Geneva Centre of Humanitarian Studies, Geneva, Switzerland
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of General Practice and Health Services Research, Section for Health Equity Studies and Migration, University Hospital Heidelberg, Heidelberg, Germany
| | - Davide Mosca
- Realizing Health SDGs for Migrants, Displaced and Communities, Switzerland
| | | | | | | | - Reem Mussa
- Humanitarian Affairs Adviser, Forced Migration, Médecins Sans Frontières, Operational Centre of Brussels, Brussels, Belgium
| | | | | | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Geneva, Switzerland
| | - Rita Sá Machado
- Health and Migration Programme, Office of the Deputy Director-General, World Health Organization, Geneva, Switzerland
| | - Miriam Orcutt
- Health and Migration Programme, Office of the Deputy Director-General, World Health Organization, Geneva, Switzerland
| | - Santino Severoni
- Health and Migration Programme, Office of the Deputy Director-General, World Health Organization, Geneva, Switzerland
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Stepanova N, Kolesnyk M, Mithani Z, Alkofair B, Shakour R, Petrova A, Novakivskyy V, Hymes J, Brzosko S, Giullian J, Espinel Z, Shultz J. Life-Saving Care for Patients with End-Stage Kidney Disease during the War in Ukraine 2022. Clin J Am Soc Nephrol 2022; 17:1079-1081. [PMID: 35537755 PMCID: PMC9269632 DOI: 10.2215/cjn.04720422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Natalia Stepanova
- N Stepanova, Head of Nephrology and Dialysis Department, SI Institute of Nephrology of the National Academy of Medical Sciences of Ukraine, Kiiv, Ukraine
| | - Mykola Kolesnyk
- M Kolesnyk, Director, SI Institute of Nephrology of the National Academy of Medical Sciences of Ukraine, Kiiv, Ukraine
| | - Zain Mithani
- Z Mithani, Assistant Professor of Medicine, University of Miami Katz Family Division of Nephrology and Hypertension, Miami, United States
| | - Baneen Alkofair
- B Alkofair, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, United States
| | - Rebecca Shakour
- R Shakour, University of Miami Miller School of Medicine, Miami, United States
| | - Anna Petrova
- A Petrova, Nephrologist, Department of Internal Medicine, ISN Young Nephrologists Committee, Bogomolets National Medical University, Kiiv, Ukraine
| | | | - Jeffrey Hymes
- J Hymes, Global Head of Clinical Affairs, Chief Medical Officer, Care Delivery Chair, Pharmacy & Therapeutics Committee EVP, Fresenius Medical Care North America, Waltham, United States
| | - Szymon Brzosko
- S Brzosko, Chief Medical Officer, DaVita Poland, Wroclaw, Poland
| | - Jeff Giullian
- J Giullian, Chief Medical Officer, DaVita Inc, Denver, United States
| | - Zelde Espinel
- Z Espinel, Psycho-oncologist, Sylvester Comprehensive Cancer Center, Miami, United States
| | - James Shultz
- J Shultz, Director, P3H: Protect & Promote Population Health in Complex Crises, Miami, United States
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15
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The disasters of war. On kidney patients in the Ukrainian-Russian war. J Nephrol 2022; 35:375-376. [PMID: 35254641 PMCID: PMC8900475 DOI: 10.1007/s40620-022-01300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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