Škoberne Andrej
Department of Nephrology, Division of Internal Medicine, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia.
Curr Opin Nephrol Hypertens. 2025 Nov 1;34(6):521-526. doi: 10.1097/MNH.0000000000001107. Epub 2025 Jul 14.
Patients with kidney disease, especially patients with kidney failure, are disproportionately affected in settings of active conflict, as they rely on near constant medical care for survival. Recent increases in violent conflicts are endangering increasing numbers of patients, requiring immediate attention, a revision of current knowledge and constructive actions.
Recent violent conflicts have revealed the profound vulnerability of patients with chronic kidney disease (CKD). In war-torn regions such as Ethiopia, Sudan, Gaza, and Ukraine, availability of essential services has been disrupted. Patients with CKD often lose access to antihypertensive and antidiabetic medications. Dialysis-dependent patients face high mortality when centres are damaged, or supply chains are cut. In Sudan, over 65% of patients on haemodialysis developed complications due to missed treatments. Sources from the wars in Bosnia, Ethiopia, and Gaza have reported mortality rates of patients with kidney failure reaching close to 50% or even exceeding it. In contrast, reports from Ukraine have shown that with intact infrastructure and sustained international support, dialysis services can be maintained and even expanded. These experiences underline the critical role of logistics, preparation, and humanitarian coordination in sustaining kidney care during conflict.
Conflicts severely compromise kidney care by disrupting continuity of treatment, dialysis infrastructure, and supply chains. Outcomes vary widely depending on external support and blockade status. Preventable deaths among dialysis patients are common in besieged regions. Preparedness, coordination, and open supply lines are essential to mitigate humanitarian catastrophe among vulnerable kidney patients.
综述目的：肾病患者，尤其是肾衰竭患者，在冲突活跃地区受到的影响尤为严重，因为他们的生存依赖于近乎持续的医疗护理。近期暴力冲突的增加正危及越来越多的患者，这需要立即关注、对现有知识进行修订并采取建设性行动。
最新发现：近期的暴力冲突揭示了慢性肾病（CKD）患者的极度脆弱性。在埃塞俄比亚、苏丹、加沙和乌克兰等饱受战争蹂躏的地区，基本服务的供应已被打乱。CKD患者常常无法获得抗高血压和抗糖尿病药物。依赖透析的患者在透析中心受损或供应链中断时面临高死亡率。在苏丹，超过65%的血液透析患者因错过治疗而出现并发症。来自波斯尼亚、埃塞俄比亚和加沙战争的消息来源报告称，肾衰竭患者的死亡率接近50%甚至超过这一数字。相比之下，来自乌克兰的报告显示，在基础设施完好且有持续国际支持的情况下，透析服务可以维持甚至扩大。这些经历突显了后勤、准备工作和人道主义协调在冲突期间维持肾脏护理方面的关键作用。
总结：冲突通过破坏治疗的连续性、透析基础设施和供应链，严重损害了肾脏护理。结果因外部支持和封锁状况而有很大差异。在被围困地区，透析患者中可预防的死亡很常见。做好准备、进行协调和保持开放的供应线对于减轻弱势肾病患者的人道主义灾难至关重要。
