End-stage kidney disease patients during the current Gaza war: challenges and outcomes of care.

Abstract

Background: This study aims to investigate the challenges and complications faced by End-Stage kidney Disease (ESKD) patients undergoing dialysis during the Gaza conflict.

Methods: A cross-sectional study was conducted on 105 ESKD patients undergoing dialysis. Data were collected through a customized, interviewer-administered questionnaire at a single center, Al Aqsa Hospital in central Gaza (from October to November 2024). Statistical analysis was performed using SPSS software.

Results: The mean age of participants was 49.9 years. 47.6% were male, resided in Deir Al Balah, lived in tents, and were displaced. Additionally, most patients faced difficulties accessing hospitals (70.5%), while 94.3% were unaffected by war-related injuries. Regarding dialysis, 73.3% of participants initially received three dialysis sessions per week, but this decreased to 68.6%. In terms of challenges, 81% reported damage to dialysis machines, 91.4% were affected by electricity cuts, 63.8% experienced gaps in dialysis due to displacement, and 33.3% cited a shortage of medical staff. With respect to diet and medications, 43.8% reported adherence, 54.3% faced difficulties obtaining their medications, 49.5% had lost their prior medical records, and 80% carried a list of their current medications. The most frequently reported complications included intradialytic hypotension (61.9%), hospitalization during dialysis (52.4%), and weight loss (70.5%). Our analysis revealed a statistically significant association between interruptions in dialysis therapy and hospitalization rates (p < 0.001). Additionally, displaced patients had a significantly higher loss of medical records compared to non-displaced patients (p = 0.014). A significant difference was also observed in dialysis session length changes in relation to hospitalization (p = 0.018). Logistic regression showed that patients with comorbidities were 2.5 times more likely to develop complications. However, this result wasn't statistically significant (p = 0.058).

Conclusion: This study highlights the challenges faced by ESKD patients during the Gaza conflict and their associated complications. International support is crucial to protecting ESKD patients in conflict zones. Telemedicine and patient education may help mitigate complications. Further studies are needed to improve the care of ESKD patients in conflict-affected areas.