RESUMO
BACKGROUND: Conflicts can lead to significant disruption in the care of endstage kidney disease (ESKD) patients. The purpose of this paper is to review the available literature on the care of ESKD patients in times of armed conflict and make recommendations for action. METHOD: A review of all PubMed-published reports between 1965 and 2015 about the care of ESKD patients at the time of conflict. We excluded articles that reported on acute kidney injury and natural disasters. RESULTS: We found a total of 12 reports on dialysis care and/or kidney transplant care from five armed conflicts and resulting refugee crises. These conflicts led to significant shortage of staff and resources and caused several obstacles in providing adequate dialysis to ESKD patients. In one study, the mortality rate of patients on automated peritoneal dialysis was as high as 95%. The kidney transplantation rate decreased in all but one of the reports about kidney transplant care and patients had difficulties securing their immunosuppressive medications. CONCLUSIONS: ESKD patients, especially dialysis patients, comprise a severely vulnerable population during conflicts. Their care can be disrupted and altered leading to a substantial increase in their mortality rate. Efforts to improve their care during conflicts are needed.
Assuntos
Conflitos Armados , Atenção à Saúde , Falência Renal Crônica/terapia , Transplante de Rim , Diálise Renal , Feminino , Política de Saúde , Humanos , Transplante de Rim/efeitos adversos , Populações VulneráveisAssuntos
Injúria Renal Aguda/terapia , Hemofiltração/instrumentação , Unidades Móveis de Saúde , Injúria Renal Aguda/etiologia , Adulto , Conflitos Armados , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Hemorragia Pós-Parto/terapia , Gravidez , Síria , Tortura , Ferimentos por Arma de Fogo/complicaçõesRESUMO
We describe ethical issues arising in the allocation of civilian medical resources during armed conflict. Three features are significant in the context of allocating scarce resources in armed conflicts: the distinction between continuous and binary medical resources; the risks of armed conflict itself, and the impact of cultural differences on cases of armed conflict. We use these factors to elicit a modified principle for allocating medical resources during armed conflict, using hemodialysis for patients with end-stage renal disease as a case study.
RESUMO
Forced migration is on the rise, mainly from the Middle East to western countries, resulting in unprecedented moral, political, and economic challenges for both refugees and host communities. Recent research showed that refugees represent around 1.5% of the dialysis population in several European and Middle Eastern countries surveyed. Despite the fact that refugees represent a small percentage of all dialysis patients in these countries, adequate care for this population is challenging. There are cultural differences between refugee patients with end-stage renal disease hailing from the Middle East, who are predominantly Muslims, and people from the western host countries. These differences may present a major obstacle in ensuring adequate patient care. In this study, we identify several of these issues that we believe western renal providers should be aware of.