Clinical characteristics and treatment of adult dialysis patients fromukraine displaced to other european countries after the russian invasion

Abstract Background and Aims The Russian invasion on Ukraine, which started on 24th February 2022 led to migration of millions of people, including some of the about 10,000 adult dialysis patients. A Renal Disaster Relief Task Force (RDRTF) established by the European Renal Association, is dedicated to support the people living with kidney disease and to the nephrology community in Ukraine, working together with WHO, NGOs and industry. Besides these activities, the RDRTF conducted a survey to understand distribution and management of Ukrainian refugees requiring dialysis displaced to other European countries. The study aim was to characterize these patients and evaluate treatment modality and care they received after displacement. Method A cross-sectional online survey on status of displaced dialysis patients, clinical data and care they received after migration was sent to all national nephrology societies across Europe with a request to disseminate it to all dialysis centers in their countries. Data were collected between May and August 2022. Fresenius Medical Care (FMC) shared a set of aggregated data without direct center participation. Results Data on 602 patients (290 collected through the survey and 312 from FMC), who were dialyzed in 24 countries was gathered. Most patients were dialyzed in Poland (45.0%), followed by Slovakia (18.1%), Czech Republic (7.8%), Romania (6.3%), Germany (4.7%) and Hungary (3.5%). Mean time between last dialysis session and the first session in the reporting center was 3.1±1.6 days. For 28.1% of patients this time interval ranged from 4 to 12 days. Mean age was 48.1±13.4 years, and 43.5% of patients were females. The most common primary cause of kidney failure in the study group was glomerulonephritis or autoimmune diseases (29.5%), diabetic nephropathy constituted 12.7%. Before patients left Ukraine, 95.7% had been on hemodialysis, 2.5% on continuous ambulatory peritoneal dialysis (PD) and 1.8% on automated PD. Since leaving Ukraine, 33.8% of patients were hospitalized upon arrival at the reporting center. The most common causes of hospitalization were: anemia (18.6%), COVID-19 pneumonia (4.7%), non-COVID pneumonia (4.7%), overhydration (4.7%) and Perm-Cath implantation (4.7%), followed by exacerbation of heart failure, peripheral artery occlusive disease and arteriovenous fistula surgery. In terms of pharmacotherapy provided in the reporting dialysis units, 50.3% of patients received erythropoiesis stimulating agents and 36.9% received intravenous iron supplementation. 35.0%, 21.9% and 3.3% received phosphate binders, vitamin D analogues and cinacalcet, respectively. 29 patients (11.4%) were waitlisted for kidney transplantation (KTx) in Ukraine before displacement. Of these, 15 also qualified for KTx in the receiving country. A further 33 individuals who had not been listed for KTx in Ukraine, started the KTx recipient work-up under the care of the reporting center. Overall, 43 patients (17.4%) received psychological support – for 29 provided by the reporting dialysis units and for 14 patients outside the center. Conclusion Under 10% of dialysis patients fled Ukraine since the start of the Russian-Ukrainian war. Almost 30% of them remained without dialysis for 4 days or longer. Clinical status upon arrival often necessitated hospitalization. Our data indicate, that the treatment at receiving centers conformed with standard of care. Monitoring the situation of dialysis patients during armed conflicts may help in creating informed policies that allow for prompt and targeted interventions to respond to special needs of this vulnerable population.