End-Stage Kidney Disease in Areas of Armed Conflicts: Challenges and Solutions

Mohamed Sekkarie; Lina Murad; Akram Al-Makki; Fahd Al-Saghir; Oussama Rifai; Majd Isreb

doi:10.1016/j.semnephrol.2020.06.003

End-Stage Kidney Disease in Areas of Armed Conflicts: Challenges and Solutions

Semin Nephrol. 2020 Jul;40(4):354-362. doi: 10.1016/j.semnephrol.2020.06.003.

Authors

Mohamed Sekkarie¹, Lina Murad², Akram Al-Makki³, Fahd Al-Saghir⁴, Oussama Rifai⁵, Majd Isreb⁶

Affiliations

¹ Nephrology and Hypertension Associates, Bluefield, WV; The Syrian National Kidney Foundation, Bloomfield Hills, MI; Address reprint requests to Mohamed Sekkarie, MD, MPH, Nephrology and Hypertension Associates, PLLC, 188 Brookwood Dr, Charlottesville, VA 22902.. Electronic address: msekkarie@gmail.com.
² Metropolitan Access Center, Washington, DC.
³ The Syrian National Kidney Foundation, Bloomfield Hills, MI; Nephrology, Indiana University of Health-Arnett, Lafayette, IN.
⁴ The Syrian National Kidney Foundation, Bloomfield Hills, MI; Michigan Kidney Consultants, Pontiac, MI.
⁵ The Syrian National Kidney Foundation, Bloomfield Hills, MI; The Virtual Nephrologist, Lynn Haven, FL.
⁶ The Syrian National Kidney Foundation, Bloomfield Hills, MI; Internal Medicine/Nephrology, PeaceHealth Medical Group Nephrology, Washington State University Elson S Floyd College of Medicine, Vancouver, WA.

PMID: 32800286
DOI: 10.1016/j.semnephrol.2020.06.003

Abstract

Violent and protracted conflicts are disastrous to civilian populations and their health care systems. The complex requirements of caring for end-stage kidney disease (ESKD) dialysis patients in such contexts pose unique challenges. Dialysis is procedurally complex and resource-intensive. Delivering ESKD care in man-made conflict settings presents added challenges beyond what is required in natural disasters and resource-limited situations. In this article, we review the medical literature on, and document experience with, managing dialysis ESKD patients in conflict zones. We discuss the impact of war on patient outcomes, dialysis system infrastructure, operational funding, and risks to providers and organizations. This article provides recommendations to health care providers, educators, and policymakers on how to mitigate associated challenges.

Keywords: Conflict nephrology; Syrian war; dialysis; disasters; limited resources.

Publication types

Review

MeSH terms

Armed Conflicts
Delivery of Health Care
Humans
Kidney Failure, Chronic* / therapy
Renal Dialysis