The tragic situation unfolding in Ukraine as a result of the military invasion by Russia is a humanitarian disaster. Some cities and towns, particularly in the south and east of the country, have been devastated by the loss of many lives and the destruction of essential infrastructure, including healthcare provision. Well over four million refugees have now left Ukraine.
For patients with kidney disease, there are approximately 10,000 adults and 40 children requiring dialysis treatment in Ukraine. There are around 1,800 kidney transplant recipients. At the time of writing, 94 of 110 Ukraine dialysis units are still operating. Dialysis companies are managing to maintain supply lines to units and no shortages are being reported in the direct delivery of dialysis treatment. However, there are currently major shortages of vital medications, including immunosuppression drugs, heparin, ESA and iv iron. Patients with transplants and those requiring specialist treatments for kidney disease are having problems accessing vital medication.
To date, around 300 patients requiring dialysis have left Ukraine. Our understanding is that the vast majority of dialysis patients who remain in Ukraine want to stay in the country. Most of those who have left are now receiving dialysis treatment in neighbouring countries including Poland, Romania, and Slovenia. Ukrainian nationals are having their full health costs met as refugees in European Union countries through the European Union protection act.
A coordinated approach to supporting Ukrainian patients and their medical teams is essential. The European Renal Association has established a task force for assisting Ukraine, is in direct contact with the Ukrainian Society of Nephrology, Ukrainian Ministry for Health, and is working with multiple stakeholder organisations including the World Health Organisation and Medicine Sans Frontiers to provide support.
Information can be accessed through the European Renal Association (ERA) website.
The European Society for Paediatric Nephrology (ESPN) also have a website email link.
In the UK, the Department of Health and Social Care have asked NHS England to identify potential dialysis capacity for Ukraine refugees. This is being done through the regional renal networks in England. Renal services in the devolved nations are also identifying capacity. At the time of writing, we are only aware of two refugees requiring specialist renal care in the UK to date, these individuals are having their medical needs provided for. Thank you to those who have worked to enable this.
The ability to provide care in the UK for Ukrainian nationals with kidney disease is dependent on entry into the UK, which requires a visa issued through family connections or through the Ukraine at Home scheme. There are currently significant delays in issuing visas as evidenced by the number of applications versus the number of visas issued to date. It is unclear what proportion of those who have obtained visas are now in the country, and we do not know if, amongst the visa applicants who are yet to arrive, there are individuals requiring dialysis and/or other elements of specialist renal care.
The UKKA is taking the following actions to support Ukraine:
1. We have been in contact with the European Renal Association offering our assistance in any practical way that we can
2. We will support patient kidney charities in communicating to patients and the public with a clear understanding of the situation for patients with kidney disease in Ukraine and what actions are being taken.
3. Please let us know if we can support any individual or local initiatives in Ukraine through dissemination and coordination. Please email firstname.lastname@example.org using the email title Ukraine. The ERA have a dedicated email address at email@example.com.
4. We are working through the Association of Renal Industries with industry partners to provide advocacy for the provision of treatments where they are needed.
5. We will write to the home office highlighting the challenges for patients with kidney disease, asking if the application system can be tailored for the purpose.
Thank you to Albert Ong and Rukshana Shroff for their leadership in the ERA, to Liz Lightstone in the International Society of Nephrology, to Gill Manning for ensuring that we are linked with industry partners, and to all organisations and colleagues who are supporting the needs of individuals with kidney disease in Ukraine.