View of kidney care in Ukraine months after the Russian invasion
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When Russia attacked Ukraine in February 2022, kidney care was among the wreckage.
Medicine supplies dwindled, staff shortages occurred and damaged infrastructure created obstacles to treatment. However, many of the estimated 10,000 patients on dialysis in Ukraine remained through the invasion, according to a paper published in Nature Reviews Nephrology, with slightly less than 600 patients with advanced chronic kidney disease fleeing the country between February and August 2022.
At Shupyk National Healthcare University of Ukraine in Kyiv, Dmytro D. Ivanov, MD, PhD, DSC, treated patients with advanced chronic kidney disease for renal replacement therapy throughout the early attacks. During this time, the largest children’s hospital in the city closed, leading to the evacuation of nearly all children with advanced CKD to Western Ukraine or abroad, according to Ivanov’s paper in Kidneys.
“The biggest problem was that up to 75% of our staff left the country and there was not enough medical staff to perform renal replacement therapy as well as everyday nephrology care,” Ivanov told Healio. “The second biggest problem was that there were not enough medicines for medical care, and then there was not enough food.”
When supplies were made available by the German Society of Nephrology, the Belgium Pediatric Nephrology Society, the European Society for Pediatric Nephrology (ESPN), local industrial companies and other organizations, Ivanov and his team mailed medicine to patients. According to Ivanov, bombings and rocket attacks led to broken infrastructure in the city, such as broken bridges along the river, that made it nearly impossible for some patients to receive care in person.
However, as Ivanov wrote in Kidneys, “Patients are at high risk regardless of whether they remain in affected areas or move elsewhere, putting themselves at risk in the absence of care, resulting in increased morbidity and mortality.”
International support
As the war continues, nephrologists in Ukraine continue to receive support from international organizations, such as the WHO and European Renal Association (ERA).
Immediately after Russia attacked Ukraine on Feb. 24, Serhan Tuglular, MD, a professor at Marmara University in Turkey and an ordinary council member of the ERA-European Dialysis and Transplant Association, said the ERA began to meet biweekly to discuss the conflict. By March, a renal disaster relief task force was formed with the intention of assisting nephrologists in Ukraine. As Ivanov reported, the most common needs included medicines, supplies for dialysis and equipment.
“We tried to contact pharmaceutical industry, and there were some donations, but that wasn't a sustainable solution,” Tuglular, the coordinator of the task force, told Healio. “So then, we started fundraising through an organization called Direct Relief.”
Medications such as tacrolimus were in high demand among the kidney transplant community, and at one point, the shortage threatened organ viability for nearly 1,500 transplant recipients, according to a paper published in Nature Reviews Nephrology. Cooperating with Direct Relief, Tuglular said the ERA was able to use funds to address the needs of kidney patients and staff without entering the conflict zone.
Additional organizations, like Baxter, utilized Direct Relief. Not only has the resource allowed Baxter to send funds to kidney patients, but also to Ukrainians with trauma and wounds.
“The war in the Ukraine has made health care for chronic patients particularly challenging, especially for kidney patients who are uniquely impacted by its potential disruption of their regular dialysis therapy,” Lee Ann Schuette, president of Baxter’s Renal Care business, told Healio. “Regardless, if they are still in the Ukraine or have sought refuge in another country, our teams are working tirelessly in support of Ukrainian kidney patients’ access to care during this difficult time.”
The ERA task force also conducted meetings to address specific clinical cases on which nephrologists in the Ukraine were working. Without the medical environment they were used to, nephrologists had difficulty with daily clinical needs, such as basic lab access. In these meetings, Tuglular said the group would provide support and collaborate on potential solutions.
“Now,” Ivanov said in an interview with Healio in September, “less people ask for these medicines because Ukraine’s needs were fulfilled by humanitarian organizations.”
Kidney care returns to 'normal'
According to Ivanov, the first 3 months of the war were the worst. However, international support and changes in conflict have helped kidney care return to a stable state.
“It is OK,” Ivanov said. “Only in regions where military activity exists are there problems for patients with kidney disease, but their normal care and procedures are OK. [...] Kidney transplants resumed. After the Russian militaries left the central part of Ukraine, everything became better. Around the fourth month of the war, it seemed to me that things looked like normal life during peaceful times. So now, there are problems in small regions bordered to the active military.”
As of September, at least 25% of Ivanov’s staff that fled Ukraine returned to work, and more than 65% of children with CKD have returned to the country for care. Kidney care has preserved despite the ongoing war.
“It is important to make a plan and be prepared for these disaster conditions,” Tugluar said. “The lesson that we take from this experience should be that we should increase our preparedness in the world, not only in Europe or in Ukraine, but in Africa, Asia, South America, everywhere ... Both for manmade and natural disasters. That's the only way to mitigate the outcomes.”
Current state of kidney care
After the destruction of the Crimean bridge, the intensity of rocket strikes increased many times over, Ivanov told Healio. “A number of infrastructure facilities, in particular power generating facilities, were damaged. In district hospitals, there are interruptions with electricity and the Internet,” Ivanov said. “Kyiv and cities with a million people are still coping with the situation. Nevertheless, in Kyiv, where more than a thousand dialysis patients are treated, uninterruptible power supplies have been purchased to ensure the continuity of the dialysis process.”
He shared that nephrologists are continuing “intensive contact” with Direct Relief to ensure medical and dialysis supplies. Anyone interested in supporting nephrologists, dialysis staff and patients with kidney disease in Ukraine are welcome to donate through this Direct Relief campaign.
References:
- Ever in pediatrics: World experts set agenda to improve care of acute kidney injury in kids. https://www.newswise.com/articles/first-ever-in-pediatrics-world-experts-set-agenda-to-improve-care-of-acute-kidney-injury-in-kids?sc=dwhr&xy=10007438/?ad2f=1&aid=779223. Published Sept. 28, 2022. Accessed Oct. 03, 2022.
- Ukraine relief. https://www.directrelief.org/emergency/ukraine-crisis/. Accessed Oct. 19, 2022.
- Consensus-based recommendations for acute kidney injury in children. https://www.bcm.edu/news/consensus-based-recommendations-for-acute-kidney-injury-in-children. Published Sept. 30, 2022. Accessed Oct. 03, 2022.
- Ivanov, D. et al. Nephrological care in the conditions of martial law in Ukraine. KIDNEYS. 2002; doi: 10.22141/2307-1257.11.3.2022.372
- Sever, L. et al. Management of pediatric dialysis and kidney transplant patients after natural or man-made disasters. Pediatr Nephrol. 2022; doi: 10.1007/s00467-022-05734-8.
- Sever, MS. et al. Armed conflicts and kidney patients: a consensus statement from the Renal Disaster Relief Task Force of the ERA. Nephrol Dial Transplant. 2022; doi: 10.1093/ndt/gfac247.
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