The impact of Iraqi occupation on end-stage renal disease patients in Kuwait, 1990-1991.

This paper describes the impact of Iraqi invasion and occupation on 196 end-stage renal failure (ESRD) patients maintained on dialysis treatment in Kuwait. Seventeen patients were abroad on holidays at the time of invasion, 77 fled the country for safety, and the rest (102) remained in Kuwait. Nearly half of those patients who remained in Kuwait died during the period of occupation. The mortality rate was as high as 95% in the intermittent cycler peritoneal dialysis (IPD) patients and 41% in haemodialysis patients compared to only 12.7% for those who left the country for treatment. Failure to reach dialysis centres, sepsis, myocardial infarction, and cerebral haemorrhage were the major causes of death. Shortage of skilled nurses was the major detrimental factor which necessitated major policy changes in the treatment programme. Those were (1) restriction of haemodialysis treatment hours and (2) discontinuation of IPD and transfer of patients to continuous ambulatory peritoneal dialysis (CAPD). The incidence of new ESRD Kuwaiti patients entering dialysis programme during the occupation period and soon afterwards was only 37 per million Kuwaiti population compared to 60 per million in the previous years.