The impact of conflicts on patients with chronic kidney disease

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.