Kidney health of refugee children: an ongoing challenge

Abstract

Aim: Its geographical proximity to Syria makes Turkey an important destination and transit country for refugees from various countries. The aim of this study is to determine the kidney and urological disease profile and to reveal the ongoing problems of refugee children who applied to a single center in Adana, home to a dense refugee population. To the best of our knowledge, this study is the largest single center experience with the refugee pediatric patient population in this field. Methods: Medical records of 614 refugee children admitted to the pediatric nephrology and urology departments between February 2020 and May 2022 evaluated retrospectively. A total of 530 patients were included in the study. Results: Median age of the 530 patients (301 male/229 female) was 72 months. The median follow-up time was 7 months (IQR 14 months). Congenital anomalies of the kidney and urinary tract with 181 patients (34.2%) is the most common diagnosis. The frequency of chronic kidney disease (CKD) of the patients was determined as 25% with 132 patients. 64 (12%) of the patients required surgical intervention. It was observed that 322 (61%) of the patients did not come to their regular follow-ups and delayed their follow-up. Conclusion: Irregular follow-up and delaying the treatment can lead to sad consequences in patients with CKD in the long term. We believe that regular patient follow-up will have a positive impact on the long-term follow-up results of the patients and on the health costs of the country hosting the refugee patient profile.

Keywords

• refugee
• children
• acute kidney disease
• chronic kidney disease

Mülteci çocukların renal sağlığı: süregelen bir zorluk

Abstract

Amaç: Suriye'ye olan coğrafi yakınlığı, Türkiye'yi çeşitli ülkelerden gelen mülteciler için önemli bir varış noktası ve geçiş ülkesi yapmaktadır. Bu çalışmanın amacı, yoğun bir mülteci nüfusuna ev sahipliği yapan Adana'da tek merkeze başvuran mülteci çocukların böbrek ve ürolojik hastalık profilini belirlemek ve devam eden sorunlarını ortaya koymaktır. Bildiğimiz kadarıyla bu çalışma, bu alanda mülteci pediatrik hasta popülasyonu ile ilgili en büyük tek merkezli deneyimdir. Gereç ve Yöntem: Şubat 2020 ve Mayıs 2022 tarihleri arasında pediatrik nefroloji ve üroloji bölümlerine başvuran 614 mülteci çocuğun tıbbi kayıtları retrospektif olarak değerlendirildi. Çalışmaya toplam 530 hasta dahil edildi. Bulgular: Beş yüz otuz hastanın (301 erkek/229 kız) ortanca yaşı 72 ay idi. Ortalama takip süresi 7 ay idi (IQR 14 ay). En sık görülen tanı yüz seksen bir hasta (%34,2) ile böbrek ve idrar yollarının konjenital anomalileri idi. Kronik böbrek hastalığı (KBH) sıklığı 132 hasta ile %25 olarak belirlendi. Hastaların 64'üne (%12) cerrahi girişim gerekti. Hastaların 322'sinin (%61) düzenli kontrollerine gelmediği ve takiplerini ertelediği görüldü. Sonuç: Düzensiz takip ve tedavinin geciktirilmesi uzun vadede KBH hastalarında üzücü sonuçlara yol açabilmektedir. Düzenli hasta takibinin, hastaların uzun dönem takip sonuçlarına ve mülteci hasta profilini barındıran ülkenin sağlık maliyetlerine olumlu etki edeceğine inanıyoruz.

Keywords

• mülteci
• çocuklar
• akut böbrek hastalığı
• kronik böbrek hastalığı

References

1. 1. Assi R, Özger-İlhan S, İlhan MN. Health needs and access to health care: the case of Syrian refugees in Turkey. Public Health. 2019;172:146-52.
2. 2. Fine S. Liaisons, labelling and laws: International Organization for Migration bordercratic interventions in Turkey. J Ethn Migr Stud. 2018;44:1743-55.
3. 3. Republic of Turkey. Ministry of Interior Directorate General of Migration Management.http://www.goc.gov.tr/icerik/migration-statistics_915_1024. [Accessed 17 September 2018].
4. 4. United Nations High Commissioner for Refugees (UNHCR). https ://www.unhcr.org/figures-at-a-glance.html. Accessed 21 March 2020.
5. 5. Karadağ ŞG, Sönmez HE, Demir F, Çakan M, Öztürk K, Tanatar A, Çakmak F, Sözeri B, Aktay Ayaz N. Rheumatic diseases in Syrian refugee children: a retrospective multicentric study in Turkey. Rheumatol Int. 2020;40(4):583-589.
6. 6. Sever L, Balat A. Renal Crisis in Children during Armed Conflict. Semin Nephrol 2020;40(4):408-420.
7. 7. Akbalik Kara M, Demircioglu Kilic B, Col N, Ozcelik AA, Buyukcelik M, Balat A. Kidney Disease Profile of Syrian Refugee Children. Iran J Kidney Dis 2017;11(2):109-114.
8. 8. Balat A, Kilic BD, Aksu B, Kara MA, Buyukcelik M, Agbas A, et al. Kidney disease profile and encountered problems during follow-up in Syrian refugee children: a multicenter retrospective study. Pediatr Nephrol. 2022 Feb;37(2):393-402.

9. 9. Al-Saegh RM, Assad LW. The spectrum of glomerular diseases as studied by immunofluorescence microscopy a single center study in Iraq. Arab J Nephrol Transplant 2013;6(3):161-7.
10. 10. North American Pediatric Kidney Trials and Collaborative Studies. NAPTRCS 2008 Annual Report. https://naprtcs.org/system/files/2008_Annual_CKD_Report.pdf [Accessed April 16, 2022]
11. 11. Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 2012;27(3):363-73. doi: 10.1007/s00467-011-1939-1.
12. 12. Mohammed Bassam A. Saeed. The Major Causes of Chronic Renal Insufficiency in Syrian Children: a One-Year, Single-Center Experience. Saudi J Kidney Dis Transplant. 2005;16(1):84-88
13. 13. Çelakıl M, Çoban Y. Etiologic-sociodemographic assessment and comparison of dialysis modalities in pediatric Syrian migrants with chronic kidney disease. J Bras Nefrol 2022;44(1):68-74.
14. 14. Bucak IH, Almis H, Benli S, Turgut M. An overview of the health status of Syrian refugee children in a tertiary hospital in Turkey. Avicenna J Med. 2017;7(3):110-114.
15. 15. Alberer M, Malinowski S, Sanftenberg L, Schelling J. Notifiable infectious diseases in refugees and asylum seekers: experience from a major reception center in Munich, Germany. Infection. 2018;46(3):375-383.
16. 16. Kerbl R, Grois N, Popow C, Somekh E, Ehrich J. Pediatric Healthcare for Refugee Minors in Europe: Steps for Better Insight and Appropriate Treatment. J Pediatr. 2018;197:323-324.
17. 17. Yucel H, Akcaboy M, Oztek-Celebi FZ, Polat E, Sari E, Acoglu EA, Oguz MM, Kesici S, Senel S. Analysis of Refugee Children Hospitalized in a Tertiary Pediatric Hospital. J Immigr Minor Health .2021; 23(1):11-18.
18. 18. Güngör A, Çatak AI, Çuhaci Çakir B, Öden Akman A, Karagöl C, Köksal T, et al. Evaluation of Syrian refugees who received inpatient treatment in a tertiary pediatric hospital in Turkey between January 2016 and August 2017. Int Health 2018;10(5):371-375.
19. 19. Sekkarie MA, Abdel-Rahman EM. Cultural Challenges in the Care of Refugees with End-Stage Renal Disease: What Western Nephrologists Should Know. Nephron. 2017;137(2):85-90.
20. 20. Lemke J, Schild R, Konrad M, Pape L, Oh J; Members of the German Society of Pediatric Nephrology (GPN). Distribution and managementof the pediatric refugee population with renal replacement: A German pediatric cohort. Pedaitr Nephrol. 2021; 36(2):271-277.