Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 20;9(3):580-588.
doi: 10.1016/j.ekir.2023.12.006. eCollection 2024 Mar.

Providing Hemodialysis in Unstable Areas: An Assessment and Framework for Effective Care

Sami Alasfar  1 , Hani Alashavi  2 , Khaled Hajj Nasan  3 , Abd Aljabbar Haj Mousa  4 , Camila Polinori  5 , Valerie Luyckx  6   7   8 , Mohamed Sekkarie  9 , Saleh Kaysi  10 , Lina Murad  11   12 , Gilbert M Burnham  13
Affiliations

Providing Hemodialysis in Unstable Areas: An Assessment and Framework for Effective Care

Sami Alasfar et al. Kidney Int Rep. .

Abstract

Introduction: Providing hemodialysis to patients with kidney failure (KF) in conflict-affected areas poses a significant challenge. Achieving and sustaining reasonable quality hemodialysis operations in such regions necessitates a comprehensive approach.

Methods: In the conflict area of Northwest (NW) Syria, a 3-phase project was initiated to address the quality of hemodialysis operations. The assessment phase involved the examination of infection prevention and control (IPC) protocols, staff training, medical protocols, individualized hemodialysis prescriptions, and laboratory testing capabilities. The second phase involved activities toward capacity building and implementing an action plan based on feasibility and sustainability.

Results: The assessment phase revealed that only 7 of 14 centers had IPC protocols, and 8 centers provided IPC training for their staff. Furthermore, only 7 centers had medical protocols, and 5 used individualized hemodialysis prescriptions. Difficulties in testing for potassium was reported in 7 centers and the inability to perform hepatitis B and C serologies was reported in 3 centers. Only 2 centers adhered to machine and water treatment system maintenance guidelines, and 4 conducted daily water quality checks. Recommendations were formulated, and an action plan was developed for implementation in the second phase. The plan encompassed enhancements in IPC practices, medical protocols, record-keeping, laboratory testing, and equipment maintenance.

Conclusion: This project underscores that hemodialysis services in conflict-affected areas do not meet the standards for quality care. It emphasizes the necessity of implementing a comprehensive framework that engages relevant stakeholders in defining and upholding quality care, a model that should be extended to other protracted conflict-affected regions.

Keywords: conflict; hemodialysis; kidney failure; wars.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Geographic location and relative size of the hemodialysis centers in NW Syria.
Figure 2
Figure 2
Action plan for second phase including stakeholders and their roles. NGO, Non-governmental organization; WHO, World Health Organization.
Figure 3
Figure 3
Framework for assessment and improving dialysis services in areas affected by protracted armed conflict. NGO, Non-governmental organization
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Sekkarie M., Murad L., Al-Makki A., Al-Saghir F., Rifai O., Isreb M. End-stage kidney disease in areas of armed conflicts: challenges and solutions. Semin Nephrol. 2020;40:354–362. doi: 10.1016/j.semnephrol.2020.06.003. - DOI - PubMed
    1. Berhe E., Ross W., Teka H., Abraha H.E., Wall L. Dialysis service in the embattled Tigray region of Ethiopia: a call to action. Int J Nephrol. 2022;2022 doi: 10.1155/2022/8141548. - DOI - PMC - PubMed
    1. Alasfar S., Alashavi H., Nasan K.H., et al. Improving and maintaining quality of hemodialysis in areas affected by war: a call to action. Kidney Int. 2023;103:817–820. doi: 10.1016/j.kint.2023.02.004. - DOI - PubMed
    1. Alasfar S., Isreb M., Kaysi S., Hatahet K. Renal transplantation in areas of armed conflict. Semin Nephrol. 2020;40:386–392. doi: 10.1016/j.semnephrol.2020.06.006. - DOI - PubMed
    1. Berhe E., Paltiel O., Teka H., et al. Ethiopia’s Tigray dialysis service cut due to dwindling supplies amid war. Kidney Int Rep. 2022;7:1136–1137. doi: 10.1016/j.ekir.2022.02.024. - DOI - PMC - PubMed

LinkOut - more resources