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Jagodage HMH, Seib C, McGuire A, Bonner A. Once-per-week haemodialysis in a financial crisis: Predictors of interdialytic weight gain. J Ren Care 2024. [PMID: 38796744 DOI: 10.1111/jorc.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Several countries are experiencing challenges in maintaining standard haemodialysis services for people with kidney failure. OBJECTIVE This study aimed to investigate the health profile of people receiving haemodialysis and to identify factors associated with interdialytic weight gain. DESIGN A cross-sectional study. PARTICIPANTS A total of 166 adults with kidney failure and receiving haemodialysis for at least 3 months were included. MEASUREMENTS A structured chart audit form collected, demographic and haemodialysis treatment characteristics, recent biochemical and haematological results, and prescribed treatment regimens from clinical records. Data were analysed descriptively. Odds ratios (OR) were calculated to identify independent risk factors for interdialytic weight gain. RESULTS Mean age was 52 years (SD = 12.5), over half were male (60.2%, n = 100), and most were receiving 4 h of haemodialysis once per week (87.3%, n = 145). Approximately half (51.8%, n = 86) had an interdialytic weight gain >2%. Being female (OR = 3.39; 95% CI, 1.51-7.61), increased comorbidities (OR = 1.50; 95% CI, 1.22-1.84) and having BMI outside of the normal range (overweight/obese [OR = 8.49; 95% CI, 3.58-20.13] or underweight [OR = 4.61; 95% CI, 1.39-15.31]) were independent risk factors for increased interdialytic weight gain. CONCLUSION Most patients were receiving 4 h of haemodialysis once per week although only modest alterations in potassium, phosphate, and fluid status were observed. Understanding the patient profile and predictors of interdialytic weight gain will inform the development of self-management interventions to optimise clinician support.
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Affiliation(s)
- Hemamali M H Jagodage
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Charrlotte Seib
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Amanda McGuire
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Kidney Health Service, Metro North Health, Herston, Queensland, Australia
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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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3
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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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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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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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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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Gopolan T, Ornelas-Brauer CM, Barbar T, Mithani Z, Silberzweig J. Conflict Nephrology: War and Natural Disasters. KIDNEY360 2023; 4:405-408. [PMID: 36763799 PMCID: PMC10103227 DOI: 10.34067/kid.0000000000000071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/04/2023] [Indexed: 02/12/2023]
Abstract
Access to care for patients with ESKD is frequently disrupted after natural disasters, public health crises, and human conflict. Emergency preparation can mitigate the risk of harm and improve outcomes. Before Hurricane Katrina in 2005, the United States was unprepared to assist patients facing disaster. We evaluate responses to Hurricane Katrina which caused unprecedented damage to health and property in the Gulf Coast. As a result of the multitude of identified problems with the national, local, and kidney-specific responses to Katrina, new systems were created that mitigated loss after Hurricane Sandy in 2012. The improved disaster response system was no match for the coronavirus disease 2019 pandemic; real-time changes worsened the effect on highly vulnerable populations, including patients with ESKD. Similarly, preparation can only mitigate the difficulties faced by patients with ESKD living in a war zone. Government agencies need to provide tools and dialysis centers need to educate patients. Beginning with steps implemented in the aftermath of Hurricane Katrina and augmented after Hurricane Sandy, every patient with ESKD and those who care for them must begin emergency preparations before the need arises. Recognizing that it is not possible to prepare for every possible emergency, our health care systems must be ready to adapt to our ever-changing world. After reviewing the responses to previous events, we suggest steps that should be considered to improve preparations for our uncertain future.
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Affiliation(s)
- Tulasi Gopolan
- University of Texas Southwestern School of Medicine, Dallas, Texas
| | | | | | - Zain Mithani
- Division of Nephrology, Department of Medicine, Leonard Miller School of Medicine at the University of Miami, Miami, Florida
| | - Jeffrey Silberzweig
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
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8
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Meena P, Anandh U, Bajpai D. Kidney Health for Vulnerable: Challenges and Solutions. Indian J Nephrol 2023; 33:2-3. [PMID: 37197046 PMCID: PMC10185020 DOI: 10.4103/ijn.ijn_59_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Affiliation(s)
- Priti Meena
- Department of Nephrology, AIIMS, Bhubaneshwar, Odisha, India
| | - Urmila Anandh
- Department of Nephrology Amrita Hospitals, Faridabad, NCR, Haryana, India
| | - Divya Bajpai
- Department of Nephrology, King Edward (VII) Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
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9
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Sekkarie M, Al-Makki A, Kaysi S, Isreb M. Just responses of the kidney community in man-made crises. Kidney Int 2022; 102:1427. [PMID: 36411020 DOI: 10.1016/j.kint.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Mohamed Sekkarie
- Nephrology and Hypertension Associates, Bluefield, West Virginia, USA.
| | - Akram Al-Makki
- Nephrology, Indiana University of Health-Arnett, Lafayette, Indiana, USA; The Syrian National Kidney Foundation, Bloomfield Hills, Michigan, USA
| | - Saleh Kaysi
- University Hospital Brugmann UVC, Brussels, Belgium
| | - Majd Isreb
- The Syrian National Kidney Foundation, Bloomfield Hills, Michigan, USA; Peace Health Medical Group, Nephrology, Elson S Floyd College of Medicine, Washington State University, Vancouver, Washington, USA
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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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