BMC nephrology · 2026
Clinical complications and psychological distress of patients requiring dialysis during the Sudan conflict in Al-Qadarif State: a cross-sectional study.
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Salih Mowafag H, Qassim Maha, Mahmoud Anfal, Mutawali Gawahir, Ali Ladin, Shabat Lana, Mohamedahmed Lina, Seedahmed Monzer, Abdalla Eslam S, Mohamed Rayan, AdamSabi Yosra, Mohammed Omer A, Taha Saida, Alhassan Alrumaisa, Mohammadat Doaa
Аннотация
BACKGROUND: End-stage kidney disease (ESKD) is a growing global health problem with marked disparities in access to kidney replacement therapy, particularly in low- and middle-income countries. Armed conflict disrupts health services and supply chains-leading to missed dialysis sessions, medication shortages, and increased mental-health burden among people requiring dialysis. Our objective was to assess the association between the ongoing conflict in Sudan and dialysis-related clinical complications and psychological distress among patients attending a haemodialysis centre in Al-Qadarif State.
METHODS: This is a cross-sectional study using a convenience sample of haemodialysis patients attending centres in Al-Qadarif. We collected sociodemographic and clinical data (displacement status, dialysis frequency/duration, comorbidities, self-reported dialysis interruptions), medication access, and a single-item measure of emotional impact. Anxiety was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. The association with binary clinical outcomes (complication/no complication) was estimated using multivariable logistic regression. The association with the GAD-7 score was estimated using multivariable linear regression.
RESULTS: Forced relocation and treatment disruption were common among displaced patients (94.8%). Nearly three-quarters of participants reported ≥ 1 medical complication and 84% reported negative effects on emotional well-being. Comorbidity was independently associated with higher odds of dialysis-related complications (adjusted OR 2.53, 95% CI 1.16-5.51, p = 0.019); age, interruption frequency, and interruption duration were not significantly associated with complications in this sample. Low-frequency dialysis was common (70% received two sessions/week; 26% received one session/week). Self-reported psychological distress was associated with age ≥ 40 (OR 3.59, p = 0.032) and difficulty obtaining medications (OR 2.41, p = 0.033). GAD-7 scores clustered in the minimal-mild range; lower anxiety scores were observed in men (B = - 1.13, p = 0.027) and married participants (B = - 1.77, p = 0.023); comorbidity was also associated with GAD-7 in adjusted models (B = 1.239, p = 0.032).
CONCLUSIONS: In this cross-sectional sample in a conflict setting, haemodialysis patients experienced a high prevalence of displacement, treatment disruption, and psychosocial burden. Comorbidity and medication access were salient correlates of clinical complications and distress. Given the observational design, causal inferences cannot be drawn; prospective and interventional studies are needed to evaluate mitigation strategies to preserve dialysis continuity and address mental-health needs during crises.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: This is a cross-sectional study using a convenience sample of haemodialysis patients attending centres in Al-Qadarif. We collected sociodemographic and clinical data (displacement status, dialysis frequency/duration, comorbidities, self-reported dialysis interruptions), medication access, and a single-item measure of emotional impact. Anxiety was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. The association with binary clinical outcomes (complication/no complication) was estimated using multivariable logistic regression. The association with the GAD-7 score was estimated using multivariable linear regression.
RESULTS: Forced relocation and treatment disruption were common among displaced patients (94.8%). Nearly three-quarters of participants reported ≥ 1 medical complication and 84% reported negative effects on emotional well-being. Comorbidity was independently associated with higher odds of dialysis-related complications (adjusted OR 2.53, 95% CI 1.16-5.51, p = 0.019); age, interruption frequency, and interruption duration were not significantly associated with complications in this sample. Low-frequency dialysis was common (70% received two sessions/week; 26% received one session/week). Self-reported psychological distress was associated with age ≥ 40 (OR 3.59, p = 0.032) and difficulty obtaining medications (OR 2.41, p = 0.033). GAD-7 scores clustered in the minimal-mild range; lower anxiety scores were observed in men (B = - 1.13, p = 0.027) and married participants (B = - 1.77, p = 0.023); comorbidity was also associated with GAD-7 in adjusted models (B = 1.239, p = 0.032).
CONCLUSIONS: In this cross-sectional sample in a conflict setting, haemodialysis patients experienced a high prevalence of displacement, treatment disruption, and psychosocial burden. Comorbidity and medication access were salient correlates of clinical complications and distress. Given the observational design, causal inferences cannot be drawn; prospective and interventional studies are needed to evaluate mitigation strategies to preserve dialysis continuity and address mental-health needs during crises.
CLINICAL TRIAL NUMBER: Not applicable.