title: Care and outcomes of end-stage kidney disease patients in times of armed conflict: recommendations for action.
abstract: 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.
  
  
  METHODS
  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.
authors.forename: Majd A
authors.initials: MA
authors.lastname: Isreb
authors.forename: A Oussama
authors.initials: AO
authors.lastname: Rifai
authors.forename: Lina B
authors.initials: LB
authors.lastname: Murad
authors.forename: Akram
authors.initials: A
authors.lastname: Al-Makki
authors.forename: Fahd
authors.initials: F
authors.lastname: Al-Saghir
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Sekkarie
mesh_terms: D000068337:Armed Conflicts; D003695:Delivery of Health Care; D005260:Female; D006291:Health Policy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects; D006435:Renal Dialysis; D035862:Vulnerable Populations