Features of nephrology care in Ukraine during martial law

D. Ivanov, Isa Shadoglan Ogli Jabbarli, I. Zavalna, L.D. Denova
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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 All the research data available in the world literature on this problem are mostly unpublished and relate to the provision of hemodialysis care in Syria, Afghanistan and Serbia during military conflicts, as well as extreme natural phenomena, for example,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.
戒严期间乌克兰肾科护理的特点
背景。世界文献中关于这一问题的所有研究数据大多未公开发表,涉及军事冲突期间在叙利亚、阿富汗和塞尔维亚提供的血液透析护理,以及极端自然现象,例如在土耳其、日本和美国。在此期间,技术和信息支持以及药物治疗方法都发生了重大变化。因此,在戒严条件下提供肾脏病护理的新现实和极端条件需要新的观点和算法,以保护慢性肾脏病(CKD)患者的生命和健康。目的:介绍乌克兰戒严期间对 CKD 1-5 期 D/T 患者的临床观察和治疗数据。研究对象是戒严期间乌克兰的 CKD 1-5 期 D/T 患者。研究主题是戒严期间乌克兰为 CKD 1-5 期 D/T 患者提供肾科护理的组织情况。材料和方法。该研究具有追溯性和前瞻性;对 2022 年 2 月 24 日至 2023 年 10 月 24 日期间申请肾科护理的患者的主要文件进行了审查。为了研究获得的结果,我们使用了公开来源的数据,并对这些数据进行了 SWOT 分析,如有可能,还使用在线计算器进行了统计处理。研究结果据联合国统计,军事行动期间乌克兰人口减少了 600 多万,其中至少 25%是儿童。此外,国内移民也有记录在案,这客观上也对提供合格肾科医疗服务的能力产生了负面影响。在提供医疗服务方面,肾病患者平均占总人口的 10%,是一个相当重要的群体。在乌克兰戒严期间,关于接受肾脏替代治疗的病人的统计数据最多。在敌对行动开始后的头 6 个月中,以难民形式移居欧盟的透析患者达 602 人,400 多人留在了暂时不受乌克兰控制的领土上。然而,在整个战前登记册中,我们仍然没有关于 1 000 多名接受肾脏替代治疗的病人的可靠信息。在军事行动期间,我们建议划分出 4 个区域,这 4 个区域在提供肾病治疗的可能性方面各具特色。结论乌克兰开始戒严后,在提供肾病治疗方面出现了主要困难。研究结果表明,这些困难与专科医疗未做好应对当前挑战和解决战时出现的问题的准备有关,也与人员、药品和消耗品短缺有关。然而,戒严令推动了新解决方案的制定,事实证明,这些解决方案在改善肾脏病护理服务方面取得了相当大的成功。
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