Conservative Kidney Management in the Middle East and North Africa: A Comparative Study of Conflict and Nonconflict Settings

Conflicts severely disrupt care for patients with kidney failure, often limiting access to dialysis. In these challenging settings, conservative kidney management (CKM) emerges as a compassionate alternative focused on quality of life and symptom relief. This study explores how conflict conditions shape nephrologists' perceptions and implementation of CKM across the Middle East and North Africa (MENA) region. A web-based survey was distributed across 17 Arabic-speaking MENA countries over 3 months in 2022. Responses were divided into two groups according to the country's conflict status. Of the 334 nephrologist respondents, 66 were practicing in conflict zones and 268 in nonconflict zones. Conflict zone respondents were more likely to work part-time and less likely to be female. Dialysis in conflict zones was more likely funded by charitable sources (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.36 to 13.07). Compared with nonconflict zones, nephrologists in conflict areas reported significantly less access to palliative care (OR, 3.36; 95% CI, 1.3 to 8.68) and cited lack of CKM training and limited access to CKM programs as barriers to its implementation (OR, 2.59; 95% CI, 1.24 to 5.38 and OR, 3.42; 95% CI, 1.59 to 7.35; respectively). While overall awareness of CKM was similar, those in conflict zones expressed greater moral and religious discomfort with withholding dialysis. These findings underscore important ethical, operational, and access-related disparities in CKM delivery in conflict zones in the MENA region. Addressing these gaps through supportive ethical policies focusing on procedural and distributive justice, increased nephrologists' awareness and training, and enhanced efforts to strengthen palliative care services are essential tools for establishing CKM as a viable and ethical approach for patients in conflict-affected regions.