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Sahutoglu T, Danis R, Pembegul I, Ozturk I, Huzmeli C, Tugcu M, Oguz EG, Bora F, Islam M, Ayar Y, Yilmaz Z, Tanburoglu DB, Genc F, Bindal ME, Tuglular S, Kazancioglu R. Resilience and challenges of peritoneal dialysis survivors in the aftermath of the 2023 Kahramanmaraş earthquake. Ther Apher Dial 2024; 28:648-656. [PMID: 38647140 DOI: 10.1111/1744-9987.14130] [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: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Peritoneal dialysis (PD) remains understudied in disaster nephrology. This retrospective multicenter study explores the experiences of PD survivors following the February 6, 2023, Kahramanmaraş Earthquake. METHODS Adult PD patients from 11 affected cities were analyzed to assess challenges faced during and postearthquake, alongside clinical outcomes. RESULTS Among 101 participants (median age: 45 years, median PD duration: 24 months), 57 were female, with 79 on continuous ambulatory PD. Challenges included power outages and water shortages, with primary shelter in kin's houses (33%) and homes (28%). Twelve patients experienced PD program delays, and three lacked assistance postdisaster. Sixteen patients changed PD modalities, with seven experiencing postearthquake peritonitis. Clinical parameters remained stable, except for a slight decrease in hemoglobin levels. CONCLUSION Despite challenges, PD survivors exhibited resilience, highlighting the importance of addressing peritonitis and unusual pathogens in disaster preparedness initiatives.
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Affiliation(s)
- Tuncay Sahutoglu
- Department of Nephrology, Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Ramazan Danis
- Department of Nephrology, Diyarbakır Gazi Yaşargil Education Research Hospital, Diyarbakir, Turkey
| | - Irem Pembegul
- Department of Nephrology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Ilyas Ozturk
- Department of Nephrology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Can Huzmeli
- Department of Nephrology, Hatay Education and Research Hospital, Hatay, Turkey
| | - Murat Tugcu
- Division of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, Etlik City Hospital, Health Sciences University, Ankara, Turkey
| | - Feyza Bora
- Department of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mahmud Islam
- Department of Nephrology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yavuz Ayar
- Nephrology Department, Bursa City Health Application Research Center, Bursa Faculty of Medicine, University of Health Sciences, Bursa, Turkey
| | - Zulfikar Yilmaz
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | | | - Fatih Genc
- Department of Nephrology, Faculty of Medicine, Elazig University, Elazig, Turkey
| | - Mehmet Emin Bindal
- Department of Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Serhan Tuglular
- Division of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Rumeyza Kazancioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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2
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Sever MŞ, Vanholder R, Lameire N. Disaster preparedness for people with kidney disease and kidney healthcare providers. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00176. [PMID: 39046087 DOI: 10.1097/mnh.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
PURPOSE OF REVIEW Man-made and natural disasters become more frequent and provoke significant morbidity and mortality, particularly among vulnerable people such as patients with underlying kidney diseases. This review summarizes strategies to minimize the risks associated with mass disasters among kidney healthcare providers and patients affected by kidney disease. RECENT FINDINGS Considering patients, in advance displacement or evacuation are the only options to avoid harmful consequences of predictable disasters such as hurricanes. Following unpredictable catastrophes, one can only rely upon educational initiatives for disaster risk mitigation. Preparatory initiatives before disasters such as training courses should target minimizing hazards in order to decrease morbidity and mortality by effective interventions during and early after disasters. Retrospective evaluation of previous interventions is essential to identify adverse consequences of disaster-related health risks and to assess the efficacy of the medical response. However, preparations and subsequent responses are always open for ameliorations, even in well developed countries that are aware of disaster risks, and even after predictable disasters. SUMMARY Adverse consequences of disasters in patients with kidney diseases and kidney healthcare providers can be mitigated by predisaster preparedness and by applying action plans and pragmatic interventions during and after disasters. Preparing clear, practical and concise recommendations and algorithms in various languages is mandatory.
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Affiliation(s)
- Mehmet Şükrü Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels
- Nephrology Section, Department of Internal Medicine and, Paediatrics
| | - Norbert Lameire
- Renal Division, Department of Medicine, University Hospital Ghent, Ghent, Belgium
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Sekkarie M, Murad L, Alasfar S. Assessment of the response to kidney patients' needs in disaster-stricken Syria. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00171. [PMID: 38900090 DOI: 10.1097/mnh.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW The major fighting activities in the Syrian conflict have subsided, but the country continues to deal with significant political, economic, and psychosocial consequences that gravely impact the healthcare system, including the care of patients with kidney disease. The purpose of this manuscript is to review some of the problems faced by kidney patients in postconflict Syria and their available and proposed remedies. RECENT FINDINGS Many challenges, such as unfair, poorly planned, and poorly organized distribution of resources, suboptimal quality-monitoring infrastructure, psychosocial barriers, and workforce shortages, impede the delivery of quality care and negatively impact outcomes. The negative impact of these problems is not uniform and tends to affect certain areas more than others because of geopolitical factors imposed by the conflict. SUMMARY After prolonged conflicts, healthcare resources remain limited for prolonged periods, leading to inadequate care, poor outcomes, and worsening inequities. Involvement of the international community and expatriate nephrologists is essential to guide care delivery and improve outcomes. The lessons learned from the Syrian conflict apply to many limited resources and disaster situations.
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Affiliation(s)
- Mohamed Sekkarie
- Nephrology and Hypertension Associates, Bluefield, West Virginia
| | - Lina Murad
- Metropolitan Access Center, Washington DC
| | - Sami Alasfar
- Division of Nephrology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
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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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5
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Cohen-Hagai K, Goldman S, Wald R, Frajewicki V, Chernin G, Iaina NL, Beckerman P, Antebi A, Haviv YS, Benchetrit S, Rozen-Zvi B. Delivering Dialysis during Wartime: The Israeli Experience. KIDNEY360 2024; 5:615-617. [PMID: 38317277 PMCID: PMC11093536 DOI: 10.34067/kid.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Goldman
- Department of Nephrology and Hypertension, Rabin Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Victor Frajewicki
- Department of Nephrology and Hypertension, Carmel Medical Center and Rappaport Faculty of Medicine, Haifa, Israel
| | - Gil Chernin
- Department of Nephrology and Hypertension, Kaplan Medical Center and Hebrew University School of Medicine, Rehovot, Israel
| | - Nomy Levin Iaina
- Department of Nephrology and Hypertension, Barzilai Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Pazit Beckerman
- Department of Nephrology and Hypertension, Sheba Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yosef S. Haviv
- Department of Nephrology and Hypertension, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Ivanov D. Nephrology Care in Ukraine: Almost 2 Years of Wartime Experience. KIDNEY360 2024; 5:266-270. [PMID: 38247041 PMCID: PMC10914190 DOI: 10.34067/kid.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Dmytro Ivanov
- Department of Nephrology and Extracorporal Technologies, Bogomolets Medical University, Kyiv, Ukraine
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7
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Antonyuk OY. Patient-centered approach to the management of acute kidney injury in the Covid-19 outcomes. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:778-783. [PMID: 38865637 DOI: 10.36740/wlek202404125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Aim: To identify patients at risk of AKI with severe COVID-19 and to guide management strategies according to national and global scientific data for improving kidney-related outcomes. PATIENTS AND METHODS Materials and Methods: We conducted retrospective study case-control analysing cases of hospitalisation patients with COVID-19 with or without AKI during hospital stay. RESULTS Results: In the study, we found that there was a positive correlation between AKI and respiratory insufficiency (0,513 - moderate, p<0,0001), moderate in the case of AKI grade 2 (0.301, <0,001) and mild in the case of AKI grade 1 and 3 correspondingly (0.252, p<0,01; 0.277, <0,001). Lethality (in-hospital death rate) correlated with respiratory insufficiency and AKI (0.733, 0,617; p<0,0001). We found that age had a reverse correlation with AKI and RI (younger patients were more likely to have a higher prevalence of AKI and RI, p<0,001). It was noticed that AKI correlated with the minimal albumin level (-0,35, p=0,016), minimal lymphocyte count (-0.377, p<0,0001), IL-6 (0.201, p=0,035), ferritin (0.34, p <0,0001), maximal CRP (0.439, p<0,0001). There was a mild correlation between Padua Score and AKI (0,232, p<0,01) and PLRI (0,172, p=0,05). CONCLUSION Conclusions: Early assessment of renal dysfunction could be used as a marker of severe outcomes of COVID-19, especially in the case of comorbidities such as metabolic disorders and cardiovascular events. We suggest using the Padua score, assessment of personal lethality risk index (PLRI), and rise of serum creatinine as additional tools for assessment criteria for hospitalisation.
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Affiliation(s)
- Olena Ya Antonyuk
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE; NATIONAL MILITARY MEDICAL CLINICAL CENTRE "MAIN MILITARY CLINICAL HOSPITAL", KYIV, UKRAINE; UNIVERSAL CLINIC "OBERIG" KYIV, UKRAINE
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8
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Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, Sawhney S, Scholes-Robertson N, Stengel B, Tannor EK, Tesar V, van der Tol A, Luyckx VA. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19:694-708. [PMID: 37580571 DOI: 10.1038/s41581-023-00745-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
- Association Renaloo, Paris, France
| | - Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK
| | - Priya Pais
- Department of Paediatric Nephrology, St John's Medical College, Bengaluru, India
| | - Tanjala S Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Arjan van der Tol
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valérie A 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 Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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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: 0] [Impact Index Per Article: 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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10
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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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11
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Tuğlular S, Luyckx V, Vanholder R, Skoberne A, Wiecek A, Nistor İ, Pawlowicz-Szlarska E, Shroff R, Ivanov D, Eckardt KU, Noruisiene E, Gallego D, Loboda O, Sever MS. Lessons learned during the war in Ukraine: a report from the Renal Disaster Relief Task Force of the ERA. Nephrol Dial Transplant 2023; 38:1960-1968. [PMID: 36931903 DOI: 10.1093/ndt/gfad053] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Indexed: 03/19/2023] Open
Abstract
People living with kidney disease are among the most vulnerable at times of natural or man-made disasters. In addition to their unpredictable course, armed conflicts impose a major threat given the disruption of infrastructure, sanitation and access to food, water and medical care. The ongoing war in Ukraine has once more demonstrated the importance of preparedness, organization, coordination and solidarity during disasters. People living with kidney disease face serious challenges given their dependence on life-sustaining treatment, irrespective of whether they remain in the war zone or are displaced internally or externally. This especially affects those requiring kidney replacement therapy, dialysis or transplantation, but also patients with other kidney diseases and the medical staff who care for them. Soon after the war started, the European Renal Association assigned a Renal Disaster Relief Task Force dedicated to support the people living with kidney disease and the nephrology community in Ukraine. This report summarizes the major challenges faced, actions taken and lessons learned by this task force. We anticipate that the experience will help to increase preparedness and mitigate the devastating effects of armed conflicts on the kidney community in the future and propose to establish an international collaboration to extend this effort to other parts of the world facing similar challenges.
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Affiliation(s)
- Serhan Tuğlular
- Department of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - 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
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Andrej Skoberne
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - İonut 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
| | - Ewa Pawlowicz-Szlarska
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - Dmytro Ivanov
- Department of Nephrology and RRT Shupyk, National Health Care University, Kyiv, Ukraine
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Edita Noruisiene
- European Kidney Health Alliance, Brussels, Belgium
- European Dialysis and Transplant Nurses Association-European Renal Care Association, Lithuania
| | - Daniel Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Olena Loboda
- Scientific Collaborator of Department of Efferent Technologies, Institute of Nephrology of NAMS of Ukraine, Kyiv, Ukraine
| | - Mehmet S Sever
- Department of Nephrology, School of Medicine, Istanbul University, Istanbul, Turkey
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Berhe E, Tesfay B, Teka H. The despair of patients with kidney diseases in third-world wars: the case of Ethiopia's crisis. Nephrol Dial Transplant 2023; 38:2092-2095. [PMID: 37188648 DOI: 10.1093/ndt/gfad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- Ephrem Berhe
- Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Tigray, Ethiopia
- Department of Internal Medicine, Head of Nephrology Unit, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Bisrat Tesfay
- Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Hale Teka
- Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Tigray, Ethiopia
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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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Daga A, Bjornstad EC, McCarthy F, Bonilla-Felix M. World Kidney Day 2023: preparing for the unexpected, supporting the vulnerable! Pediatr Nephrol 2023; 38:1697-1699. [PMID: 36941486 PMCID: PMC10027260 DOI: 10.1007/s00467-023-05945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Ankana Daga
- Division of Nephrology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Erica C Bjornstad
- Division of Nephrology, Department of Pediatrics, Children's of Alabama, University of Alabama Birmingham, Birmingham, AL, USA
| | | | - Melvin Bonilla-Felix
- Department of Pediatrics, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, 00936-5067, Puerto Rico
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Sever L, Pehlivan G, Canpolat N, Saygılı S, Ağbaş A, Demirgan E, Oh J, Levtchenko E, Ivanov DD, Shroff R. Management of pediatric dialysis and kidney transplant patients after natural or man-made disasters. Pediatr Nephrol 2023; 38:315-325. [PMID: 36194369 PMCID: PMC9529603 DOI: 10.1007/s00467-022-05734-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 01/10/2023]
Abstract
Pediatric patients on kidney replacement therapy (KRT) are among the most vulnerable during large-scale disasters, either natural or man-made. Hemodialysis (HD) treatments may be impossible because of structural damage and/or shortage of medical supplies, clean water, electricity, and healthcare professionals. Lack of peritoneal dialysis (PD) solutions and increased risk of infectious/non-infectious complications may make PD therapy challenging. Non-availability of immunosuppressants and increased risk of infections may result in graft loss and deaths of kidney transplant recipients. Measures to mitigate these risks must be considered before, during, and after the disaster including training of staff and patients/caregivers to cope with medical and logistic problems. Soon after a disaster, if the possibility of performing HD or PD is uncertain, patients should be directed to other centers, or the duration and/or number of HD sessions or the PD prescription adapted. In kidney transplant recipients, switching among immunosuppressants should be considered in case of non-availability of the medications. Post-disaster interventions target treating neglected physical and mental problems and also improving social challenges. All problems experienced by pediatric KRT patients living in the affected area are applicable to displaced patients who may also face extra risks during their travel and also at their destination. The need for additional local, national, and international help and support of non-governmental organizations must be anticipated and sought in a timely manner.
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Affiliation(s)
- Lale Sever
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Gülseren Pehlivan
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seha Saygılı
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayşe Ağbaş
- Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ebru Demirgan
- Department of Pediatric Nephrology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Jun Oh
- Department of Pediatric Nephrology, Medical Center University Hamburg/Eppendorf, Hamburg, Germany
| | | | - Dymtro D. Ivanov
- Department of Nephrology and Renal Replacement Therapy, Shupyk National Health Care University, Kiev, Ukraine
| | - Rukshana Shroff
- UCL Great Ormond Street Hospital and Institute of Child Health, Renal Unit, London, UK
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