Organization of nephrological care for patients with terminal chronic kidney disease and concomitant SARS-CоV-2 infection under martial law: a retrospective study (2022–2024)

Abstract

Background. Patients with chronic kidney disease (CKD) are one of the most vulnerable populations during pandemics due to impaired immune response, frequent hospitalizations, and dependence on life-sustaining renal replacement the­rapy. SARS-CoV-2 may directly affect renal structures via ACE2 receptors expressed in proximal tubules and indirectly through systemic inflammation and hypercoagulability. In dialysis patients, COVID-19 is associated with increased risk of complications, erythropoietin resistance, and high mortality. Since the beginning of the armed conflict in Ukraine in 2022, nephrological care has been complicated by logistical disruptions, threats to patient and provider safety, population displacement, resource scarcity, and reduced access to essential care. Ukrainian sources report adaptive strategies such as mobile dialysis teams, patient relocation, and emergency care protocols. However, issues of treatment effectiveness and clinical outcomes in CKD 5D patients with COVID-19 during wartime require systemic analysis. The purpose was to analyze the course of COVID-19 and organizational aspects of nephrological care for patients with CKD 5D receiving maintenance hemodialysis under martial law conditions in Ukraine. Materials and methods. A retrospective single-center study included 31 CKD 5D patients with laboratory-confirmed SARS-CoV-2 infection receiving hemodialysis from 2022 to 2024. Data on clinical severity, mortality, changes in erythropoietin resistance, dialysis efficacy, vaccination status, and logistic challenges were assessed. Results. The mean patient age was 64.2 ± 10.8 years. Mild, moderate, and severe COVID-19 courses were observed in 61.3, 25.8, and 12.9 % of patients, respectively. Mortality reached 6.5 %. Severe cases were more frequent among unvaccinated patients. Erythropoietin resistance increased in 45 % of cases. No dialysis interruptions occurred despite logistical difficulties related to wartime conditions. Conclusions. The findings demonstrate the feasibility of maintaining effective nephrological care in crisis settings. Vaccination and adaptive medical logistics contributed to lower complication rates and provided the continuity of treatment.