Abstract：
During conflicts, people with kidney disease, either those remaining in the affected zones or those who are displaced, may be exposed to additional threats because of medical and logistical challenges. Acute kidney injury developing on the battlefield, in field hospitals or in higher-level hospital settings is characterized by poor outcomes. People with chronic kidney disease may experience treatment interruptions, contributing to worsening kidney function. Patients living on dialysis or with a functioning graft may experience limitations of dialysis possibilities or availability of immunosuppressive medications, increasing the risk of severe complications including death. When patients must flee, these threats are compounded by unhealthy and insecure conditions both during displacement and/or at their destination. Measures to attenuate these risks may only be partially effective. Local preparedness for overall and medical/kidney-related disaster response is essential. Due to limitations in supply, adjustments in dialysis frequency or dose, switching between hemodialysis and peritoneal dialysis and changes in immunosuppressive regimens may be required. Telemedicine (if possible) may be useful to support inexperienced local physicians in managing medical and logistical challenges. Limited treatment possibilities during warfare may necessitate referral of patients to distant higher-level hospitals, once urgent care has been initiated. Preparation for disasters should occur ahead of time. Inclusion of disaster nephrology in medical and nursing curricula and training of patients, families and others on self-care and medical practice in austere settings may enhance awareness and preparedness, support best practices adapted to the demanding circumstances and prepare non-professionals to lend support.
摘要：
在冲突期间,患有肾脏疾病的人，无论是留在受影响地区的人还是流离失所的人，由于医疗和后勤挑战，可能会面临额外的威胁。急性肾损伤在战场上发展，在野战医院或更高级别的医院环境中,预后较差.患有慢性肾病的人可能会经历治疗中断，导致肾功能恶化。透析或有功能移植物的患者可能会受到透析可能性或免疫抑制药物可用性的限制。增加包括死亡在内的严重并发症的风险。当病人必须逃离时，流离失所和/或目的地期间的不健康和不安全状况加剧了这些威胁。减轻这些风险的措施可能只是部分有效。为整体和与医疗/肾脏有关的灾难响应做好本地准备至关重要。由于供应的限制，透析频率或剂量的调整，可能需要在血液透析和腹膜透析之间切换,并改变免疫抑制方案.远程医疗（如果可能的话）可能有助于支持缺乏经验的当地医生管理医疗和后勤挑战。战争期间治疗的可能性有限，可能需要将患者转诊到遥远的高级医院，一旦紧急护理开始。灾难的准备应该提前发生。将灾难肾脏病学纳入医疗和护理课程以及对患者的培训，家庭和其他人在严峻的环境中进行自我保健和医疗实践可以提高认识和准备，支持适应苛刻环境的最佳实践，并准备非专业人员提供支持。
