Clinical complications and psychological distress of patients requiring dialysis during the Sudan conflict in Al-Qadarif State: a cross-sectional study

Abstract

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.