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The war has decreased the possibilities of nephrological care in Ukraine, but on the other hand, has given the possibility of developing innovative technologies for CKD treatment.
Demographic, statistical, analysis of indicators of nephrological care.
The population of Ukraine during the war was reduced by 5-8 million people, including children up to 30%. The register of patients with stage 5 CKD in 2022 included 10,534 patients; in 2022, 602 dialysis refugees (data from the Renal Disaster Relief Task Force of the ERA) received therapy in the EU, 8533 patients in Ukraine, over 400 in the territories, which is not under the Ukraine control. Thus, more than 1,050 people with CKD 5 are still not available for analysis. By the end of 2023, the registry had expanded to 10,748 patients, with an additional surplus of 2,111 RRT beds.
In 2022, 274 transplantations were performed, and in the first 9 months of 2023 - 272, most of them from a deceased donor. The increase was by 54% and 63.5%, in 2022 and 2023 respectively; in children it increased by 78%, mostly living related. Laparoscopic and robotic (DaVinci®️) donor nephrectomy, Cell-saver for significant bleeding, Kidney-assist were used. In all patients, HLA-typing and PRA are performed before transplantation, surveillance and immunosuppressants are supplied after surgery.
For people with CKD 5D, reducing the frequency of dialysis due to logistical reasons has been introduced, for some dialysis centers twice-weekly dialysis with increased flow, duration and extended dialysis with target Kt/V 1.4 achieved. For PD in 20% of cases electric batteries are used to ensure energy efficiency; the effectiveness of such procedures is similar to traditional ones.
For CKD 2-4 in cases of non-inherent glomerular diseases with proteinuria raised 0.75 g/l and above in adults and children, rituximab for 1.5 years duration in 3 double doses was used (under the CD 20 control) with daily tacrolimus, iRAAS, and in case of 6 months' fail – replacing rituximab with SGLT2i and pioglitazone. This ensured a total reduction of the risk of progression to CKD5DT (QxMD) over 2 years by 27%. During COVID-19, iACE were temporarily discontinued due to hypotension obtained in CKD.
A digital nephrobiopsy was initiated using immunohistochemical analysis, with the results obtained over 24 hours online.
The war has mobilized for the development of innovative approaches, which thanks to humanitarian relief demonstrate some positive results for CKD patients in Ukraine. The shortage of medicines and supplies is still making the situation challenging. Humanitarian and scientific encouragement from foreign colleagues, and the exchange of evidence at international forums are helping Ukrainian doctors.