Grandstand. One of the consequences of the war is the immediate vital danger of patients requiring regular essential care. According to the European Registry of Patients with Chronic Kidney Disease (CKD) Requiring Kidney Transplant or Dialysis to Live, more than 10,000 people are treated in Ukraine, of which about 1,500 by transplant, just under 8,000 by hemodialysis, and less than 1,000 by peritoneal dialysis.
Before the war, Ukraine was one of the European countries with the lowest number of people treated by these techniques, testifying to the difficulties of access to care: the number of new patients compared to the population was four times lower in Ukraine than in France, resulting in barely 10,000 patients treated in Ukraine compared to more than 90,000 in France. The situation of people requiring a kidney function replacement technique was therefore already precarious.
heavy care
These difficulties become major with the war, and this for the three techniques, of which it seems useful to detail the modalities. Hemodialysis is generally performed three times four hours a week, mainly in hospitals or clinics, so patients have to be able to move back and forth, or stay put. Uninterrupted electricity is needed for the dialysis machines, clean water in very large quantities (from 500 to 1,000 liters per session and per patient), consumable materials for carrying out extracorporeal circulation and purification of the blood, and of course highly qualified medical and paramedical staff, the rule in France being at least one nurse for four patients. In addition to hemodialysis, patients must take many vital drugs, some of which are very expensive such as erythropoietin which corrects anemia, and they must carry out biological analyzes at least monthly.
The technique of peritoneal dialysis is done at home by autonomous patients. It requires clean premises and perfect hygiene. The purification of the blood is carried out by infusing, through a fixed catheter, liquid of suitable composition into the abdominal cavity, with several “infusion, stasis, drainage” sequences each day. Thus, it takes for a person about 10 kilos of liquids and consumables every day to ensure a correct purification.
When life depends on hemodialysis or peritoneal dialysis, the cessation of treatment is followed by death within five to ten days in general.
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