Sean Pickthorn, MD @SeanPickthorn
Dr Sean Pickthorn is currently first-year nephrology fellow at the University of Minnesota. His interests include hypertension, diabetic kidney disease, and AKI.
Sabine Karam, MD @SabineKaram6
Dr Sabine Karam is currently an Assistant Professor of Medicine in the division of Nephrology and Hypertension at the University of Minnesota. She is also the deputy chair of the Young Nephrologists Committee of the Internal Society of Nephrology (ISN) and a member of the 2021 cohort of the Emerging Leaders Program of the ISN. Her clinical and research interests include Onco-Nephrology, Hypertension and Peritoneal dialysis.
World Kidney Day, established in 2006, is an initiative to raise awareness about the health burden of kidney disease. The theme for World Kidney Day 2023 is “Kidney Health for All”.
Over the past few years, the world has experienced a rollercoaster of emotions as it has been shaken by major disruptive events and unprecedented crises. Examples include the Covid-19 pandemic and the war in the Ukraine which has instigated the largest refugee crisis in Europe since World War II. This has contributed to the acceleration of major economic crises in several countries around the world such as Lebanon and Sri-Lanka, among others. Most recently, the earthquake in Turkey and Syria, besides putting an end to more than 50,000 lives, has affected over 10 million people and displaced 2.2 million. Unexpected disasters and crises can shake healthcare systems and cause incredible harm to all patients. Patients with chronic conditions are often disproportionately affected, most notably the 850 million patients with kidney disease as of 2020.
This World Kidney Day, it is more important than ever to take a moment to reflect on the impact of these events on the global kidney population. It takes a village to arrange the care and support that our kidney patients need on a routine basis. This is especially true for those patients requiring kidney replacement therapy (KRT). In times of disruption, patients in low resource settings are the most vulnerable.
Within the last few weeks, the war in Ukraine has surpassed one year of duration. An emotional perspective by Stepanova et al describes the multiple challenges faced by the kidney community. With several areas receiving active bombardment, numerous health facilities (including dialysis centers) and medical warehouses stocking PD supplies have been heavily damaged, interrupting medical care to patients that often lack reliable humanitarian corridors for evacuation. The perspective describes one KRT patient who was able to escape to a neighboring country, while 49 out of the 50 patients in his dialysis center passed away. The report also acknowledges the heroic efforts deployed by local and international health communities, with numerous dialysis centers deployed in areas that were less frequently under attack to provide free hemodialysis services, and courageous nephrologists and staff remaining in their clinics—sometimes moving dialysis equipment into basements—to continue treating their patients.
In their most recent update, the World Health Organization (WHO) reports that 7.9 million people have been displaced from their homes due to this conflict, with many of them seeking refuge in neighboring countries. While access to KRT in most European countries is a universal right for citizens, the access for refugees is less straightforward and is highly dependent on their legal status and whether tor not hey are registered. In addition, the financial burden of dialysis remains a concern in many hosting countries.
In the aftermath of the recent earthquake in Turkey and Syria, countless people are surviving in homeless camps with poor access to care while the country seeks to rebuild. In this case as well, not only were homes destroyed but also clinics and healthcare centers, jeopardizing access to adequate management of acute kidney injury (AKI) following crush injury and rhabdomyolysis in patients being trapped under the debris of collapsed buildings. Buckled and impassable roads don’t make it any easier for medical organizations trying to provide relief. Moreover, in the case of Syria, the country had already been struggling with a chronic conflict since 2011, leading not only to massive population migration and healthcare infrastructure destruction but also to a dramatic reduction in the nephrology workforce.
The WHO has been at the forefront of emergency preparedness and response. They aim to contribute nearly 85 million USD in supplies and assistance to help manage the catastrophic damage. Despite their assistance in initiating the rebuilding process, it will be several years before there is any semblance of what life was like prior to the disaster.
Preparedness is the key to best assist our kidney population in times of disaster. For instance, a Lancet commission has estimated that readiness in the case of the Covid-19 pandemic could have avoided around 200,000 deaths in the United States in 2020 alone.
For this year’s World Kidney Day, we aim more than ever to raise awareness of the importance of achieving sustainable global kidney health for the most vulnerable, and under all circumstances. This can only be attained through the elaboration and implementation of meticulously planned emergency preparedness plans. A recent publication from the World Kidney Day Joint Steering Committee has addressed this with the intent to target populations across all levels of wealth and resources through a map of 11 points that provide guidance for adequate governance and leadership, effective planning, vigorous community engagement, accurate risk analysis, careful surveillance and monitoring, extensive practice and experience, resource optimization, workforce capacity building, timely communication, and prompt learning and evaluation in times of unexpected crises and disasters. Additional details to consider in a kidney specific population are also provided.
Finally, we would like to recognize all of the individuals that have worked tirelessly to provide undisrupted care to patients affected by disasters, often at the expense of their own safety. This is especially true for those who help arrange care for patients who require a dialysis modality (approximately 4 million patients worldwide). The personnel who continue to make this happen deserve our utmost appreciation.
– Post prepared by Sean Pickthorn and Sabine Karam.