THE IMPACT OF WAR ON CKD DEVELOPMENT AND PROGRESSION: THE FIRST RESULTS OF “SAVE KIDNEYS STUDY” GRANTED BY CLINICAL RESEARCH PROGRAM OF THE ISN.

Introduction:

Chronic kidney disease (CKD) affects up to 10% of adults worldwide. Since 24 Feb 2022, at least 12 million people, equivalent to 27% of the Ukrainian population of 44.1 million, have fled their homes. However, according to the registry analysis across eight European countries, among 14,436 migrants who attended health clinics, only 1.5% were diagnosed with CKD. This low prevalence may mean that especially healthier people tend to leave the affected zones while the sicker and older individuals stay behind.

We have not had yet the significant information about the impact of war on CKD development and progression.

Therefore, the aim of the study is to estimate the impact of war on CKD development and progression among people living in war-affected region (Kharkiv, Ukraine).

Methods:

We have begun to study two independent cohorts, to date comprising a total of 150 patients with non-dialysis dependent CKD. Patients are divided onto two groups: diagnosis of CKD before 24 Feb 2022 (group 1), diagnosis of CKD after 24 Feb 2022 (group 2). Approximately number of patients, which are planned to include in the study are 300 people. The design of the study is presented in figure 1.

Patients are undergo a routine examination, which include physical examination; vital signs; urinary and blood tests; ECG; kidney ultrasound and other. All assessments and study procedures are specified in table 1. The primary outcome of this research is to evaluate the progression of CKD to end-stage kidney disease (ESKD) defined as either (a) a decline in eGFR by 50% or (b) progression to ESKD, defined as a need for dialysis or kidney transplant. Accordingly, the primary endpoint will be define as the change in eGFR (CKD-EPI) from baseline to Month 36.

Assessment of secondary outcomes includes: eGFR slope, time to ESKD and to first occurrence of the primary composite endpoint or cardiovascular (CV) death, frequency of all-cause hospitalization, blood pressure changes etc.

The studies were approved by local ethics committees and all participants have provided written informed consent.

Results:

Since the first patient was randomized in the study (26Dec 2023) we have examined 165 patients, among which 150 (90.9%) were included. The main age was 39.8 yo (IQR 19-80).  

At baseline, median eGFR among observed patients was 72.5 ml/min/1.73m2 in the first group and 73.6 ml/min/1.73m2 in the second group. Different CKD stages among groups is presented in Figure 2. As we can see from the Fig. 2, the most prevalent among two groups was CKD G1. Interestingly, the prevalence of CKD has increased from 24Feb 2022 till know on 30.77% (Figure 3).  

The following etiology of CKD was diagnosed among included patients: glomerulonephritis, tubule-interstitial nephritis, pyelonephritis, diabetic nephropathy, ADPKD with its prevalence 61.5%, 13.8%, 9.2%, 12.3%, 3% respectievly (Figure 4).

Baseline characteristics of observed patients are presented in table 2.

Conclusions:

This is the first results of our study, main aim of which is to investigate the impact of armed conflict on the development and progression of CKD in individuals residing in affected areas. The armed conflict in Ukraine is going on the third year. Compared with available data on the impact of natural disasters, the effects of armed conflicts on outcomes for kidney patients are very limited.    Approximately 700 million people are estimated to have CKD worldwide. According to the Global Burden of Disease (GBD) study, the global prevalence of CKD increased by 33% between 1990 and 2017. Our results demonstrate the increasing prevalence of CKD among people, living in war-affected region on 30.7% during 2 years. Taking all this results into consideration, with this project, we will be able to develop effective preventive measures for kidney function preservation during armed conflict. Ultimately, this study will provide valuable insights into the relationship between war and progression of CKD, with the potential to improve the health outcomes of individuals directly and indirectly affected by armed conflict.

I have potential conflict of interest to disclose.
My project is financed by grant of Clinical Research Program ISN

I did not use generative AI and AI-assisted technologies in the writing process.