ASN Positions

ASN-ERA-ISN Joint Statement on the Sudan Crisis

Friday, May 19, 2023

The Task Force is working with Direct Relief to deliver aid to Sudan. Donate

"Kidney Health for All: Preparing for the unexpected, protecting the vulnerable" is the call to action from World Kidney Day 2023. Many countries around the world are being affected by natural disasters or armed conflicts. Most recently, the armed conflict in Sudan has once again propelled forward the need to always keep vulnerable populations in mind as they face the effects of such major disruptive events.

Together, the American Society of Nephrology (ASN), the European Renal Association (ERA), and the International Society of Nephrology (ISN) express grave concern for the health and safety of all people, including those with kidney diseases, kidney failure requiring dialysis, and kidney transplants in Sudan affected by the armed conflict.

An estimated 8000 people in Sudan depend on dialysis to live. The stock of dialysis supplies within the country is running very low and needs to be replenished as soon as possible. Furthermore, some dialysis units are damaged while others are affected by disruptions in water and electric supplies. The major difficulties are procurement and delivery of supplies in war zones.

The global kidney community, including ASN, ERA, and ISN, thanks the many organizations and companies that are continuing to provide kidney care in war zones, donating medicines, supplies, and equipment as well as supporting nephrologists and other healthcare professionals in very challenging circumstances. ASN, ERA, and ISN urge other organizations, companies, and the governments of the world to do more for the people with kidney diseases in Sudan, its neighbors, and other war-torn or disaster-ravaged countries.

Millions of people with healthy kidneys are also at risk of acute kidney injury due to crush injuries occurring as a result of earthquakes, bombings, and other unfortunate realities of war. People with acute kidney injury often require hospitalization and immediate dialysis to survive. If they do not receive this care as soon as possible, they might die from a treatable cause.

Dialysis requires a safe space for treatment, intact electricity and water supplies, and medical staff to administer facility-based treatments. People with kidney failure who receive dialysis require these life-sustaining treatments several times a week. Any interruption of this schedule endangers their lives. Even if they miss one or two treatments, these patients could experience life-threatening complications or sudden death.

In addition, thousands of people living in affected zones worldwide have had kidney transplants and require daily treatment with immunosuppressive medicines. If they fail to take these medicines, people with kidney transplants risk rejection by their transplanted kidneys, loss of these kidneys, and life-threatening illness. There are 4,000 patients living with functioning grafts in Sudan, who are in danger of not being able to access their immunosuppressive medications.

Of particular concern is the wellbeing and health of children living with kidney diseases. In addition to the risks and burden of dialysis that all patients face, children on dialysis are considered a highly vulnerable group because of their increased risk of infections, malnutrition and psychological distress. Infections can cause severe hemodynamic instability and very rapidly lead to septic shock in young and malnourished children. These risks are amplified at times of strife mandating careful preventative measures and immediate medical attention for early detection and treatment. Also, children are dependent on parents or caregivers who themselves may be expriencing stressors or unable to help them, struggling to find care or medications or witnessing the horrors of war.

When people with kidney failure flee from dangerous areas, they must immediately be accommodated in dialysis facilities that are functioning and safe from the ravages of a disaster or war. Governments and other stakeholders must help them overcome these major challenges, even as their needs shift and change each day in emergency situations.

A dedicated Task Force has been formed by the ISN-Renal Disaster Preparedness Working Group, with participation from ERA and ASN, to reach out to the kidney community in Sudan and coordinate support.

As non-political medical specialty societies, ASN, ERA, and ISN call for an end to all armed conflicts. We also stand in solidarity with the world's nephrologists and other healthcare professionals to support and care for all people living with kidney disease.

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