{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:39:22Z","timestamp":1786372762175,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.0000000900","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:00:15Z","timestamp":1764957615000},"page":"1088-1098","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Conservative Kidney Management in the Middle East and North Africa"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4510-8010","authenticated-orcid":false,"given":"Akram","family":"Al-Makki","sequence":"first","affiliation":[{"name":"Indiana University Health Arnett, Lafayette, Indiana"},{"name":"Indiana University School of Medicine-WL, West Lafayette, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4154-0911","authenticated-orcid":false,"given":"David","family":"Gunderman","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine-WL, West Lafayette, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7066-8135","authenticated-orcid":false,"given":"Valerie","family":"Luyckx","sequence":"additional","affiliation":[{"name":"University Children's Hospital, University of Zurich, Zurich, Switzerland"},{"name":"Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"},{"name":"Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taha","family":"Hatab","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6996-2775","authenticated-orcid":false,"given":"Imed","family":"Helal","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0315-522X","authenticated-orcid":false,"given":"Mayssaa","family":"Hoteit","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Bridgeport Hospital\/Yale New Haven Health, Bridgeport, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9739-2164","authenticated-orcid":false,"given":"Rana","family":"Yamout","sequence":"additional","affiliation":[{"name":"Division of Palliative care, Medicine Department, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5538-6068","authenticated-orcid":false,"given":"Ala","family":"Ali","sequence":"additional","affiliation":[{"name":"Medical Department, Nephrology and Renal Transplantation Center, Baghdad, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3413-4472","authenticated-orcid":false,"given":"Abdulhafid","family":"Shebani","sequence":"additional","affiliation":[{"name":"Nephrology Department, Tripoli University Hospital, Tripoli, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najib","family":"AbuOsba","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Yemen, Sanaa, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2847-588X","authenticated-orcid":false,"given":"Mohamed H.","family":"Sayegh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6087-6383","authenticated-orcid":false,"given":"Krishna","family":"Allam","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1943-9377","authenticated-orcid":false,"given":"Sahar H.","family":"Koubar","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"issue":"10111","key":"B1-20260618","doi-asserted-by":"crossref","first-page":"2516","DOI":"10.1016\/S0140-6736(17)30741-9","article-title":"Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet-American University of Beirut Commission on Syria","volume":"390","author":"Fouad","year":"2017","journal-title":"Lancet."},{"issue":"5","key":"B2-20260618","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1053\/j.ajkd.2024.03.030","article-title":"Kidney care in times of crises: a review","volume":"84","author":"Alasfar","year":"2024","journal-title":"Am J Kidney 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Nephrol."},{"issue":"2","key":"B26-20260618","doi-asserted-by":"crossref","first-page":"334","DOI":"10.21037\/apm-23-407","article-title":"Pain management and the use of opioids in adults with kidney failure receiving conservative kidney management","volume":"13","author":"Davison","year":"2024","journal-title":"Ann Palliat Med."},{"issue":"1","key":"B27-20260618","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1200\/JCO.2015.62.1615","article-title":"Provision of palliative care in Low- and middle-income countries: overcoming obstacles for effective treatment delivery","volume":"34","author":"Hannon","year":"2016","journal-title":"J Clin Oncol."},{"issue":"3","key":"B28-20260618","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.ekir.2023.12.006","article-title":"Providing hemodialysis in unstable areas: an assessment and framework for effective care","volume":"9","author":"Alasfar","year":"2024","journal-title":"Kidney Int Rep."}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000900","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:37:03Z","timestamp":1786369023000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000900"}},"subtitle":["A Comparative Study of Conflict and Nonconflict Settings"],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.0000000900","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]}}}