Multimorbid and stress-induced triggers of CKD progression and mortality during wartime: a retrospective cohort study

Armed conflict creates unique stressors for chronic disease management. Patients with chronic kidney disease (CKD) are particularly vulnerable to treatment interruptions, malnutrition, stress, and infection burden. Aim of the study. To identify war-related triggers of CKD progression, cluster patients by dominant risk factors, and evaluate their impact on outcomes. Materials and methods. We retrospectively analyzed 303 CKD stage 1–3 patients followed for 6 months (February 2022–September 2025). Clinical data, Charlson Comorbidity Index (CCI), Malnutrition-Inflammation Score (MIS), Perceived Stress Scale (PSS), and Infection Burden Index (IBI) were collected. Patients were stratified into four clusters based on dominant wartime-related triggers. Cox regression and ROC analysis assessed associations with outcomes. Results. Four clusters were identified: Cluster A (n=84): frequent treatment interruptions, high infection burden; Cluster B (n=76): malnutrition and anemia; Cluster C (n=95): high stress scores; Cluster D (n=48): combined triggers. During follow-up, mortality reached 14%, predominantly in Clusters A and B. Infection burden was the strongest predictor of mortality (HR 2.5, 95% CI 1.8–3.4). Malnutrition independently predicted hospitalization (HR 1.9, 95% CI 1.3–2.7). Stress cluster showed excess cardiovascular events (HR 1.6, 95% CI 1.1–2.3). Conclusions. CKD patients exposed to war-related disruptions face distinct, trigger-specific risks. Our cluster-based framework highlights infection control, nutritional support, and stress management as urgent targets for nephroprotection in humanitarian crises.