Features of nephrology care in Ukraine during martial law

Abstract

Background. All the research data available in the world literature on this problem are mostly unpublished and relate to the provision of hemodialysis care in Syria, Afghanistan and Serbia during military conflicts, as well as extreme natural phenomena, for example, in Turkey, Japan and the USA. During this time, technical and information support and methods of treatment with pharmaceuticals have changed significantly. Therefore, new realities and extreme conditions of providing nephrology care in the conditions of martial law require new views and algorithms to preserve the life and health of patients with chronic kidney disease (CKD). The purpose: to present data on clinical observation and treatment of patients with CKD stage 1–5 D/T in Ukraine during martial law. The object of the study is CKD stage 1–5 D/T in patients in Ukraine during martial law. The subject of the research is the organization of providing nephrology care to patients with CKD stage 1–5 D/T in Ukraine during martial law. Materials and methods. The study is retro- and prospective; the primary documentation of patients who applied for nephrology care from February 24, 2022 to October 24, 2023 was examined. To study the obtained results, we used data available in open sources, which were subject to SWOT analysis and, if possible, statistical processing using online calculators. Results. According to the United Nations, the population of Ukraine during the military operations decreased by more than 6 million, of which at least 25 % were children. In addition, internal migration is documented, which objectively also negatively affected the ability to provide qualified nephrology care. Regarding the provision of medical care, nephrology patients, who make up an ave­rage of 10 % of the population, form a fairly significant group. The most available statistics during the martial law in Ukraine are on patients receiving renal replacement therapy. In the first 6 months from the beginning of hostilities, emigration in the form of refugees to the European Union amounted to 602 patients receiving dialysis, more than 400 remained in the territories temporarily not controlled by Ukraine. However, from the entire pre-war registry, we still do not have reliable information about more than 1,000 patients who received renal replacement therapy. During the military operations, we proposed to distinguish 4 zones, which differ in their characteristics in terms of the possibilities of providing nephrology care. Conclusions. With the beginning of martial law in Ukraine, primary difficulties arose in the provision of nephrology care. The results of the study showed that these difficulties are related to the unpreparedness of specialized medical care for current challenges and to solve issues that arise in wartime, and are due to a shortage of personnel, medicines and consumables. However, martial law gave impetus to the development of new solutions that proved to be quite successful in improving the provision of nephrology care.