Dialysis Patients: Ready for Disasters?

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Most dialysis patients are not prepared to effectively handle man-made or natural disasters, finds a study appearing in the October Clinical Journal of the American Society of Nephrology. The findings held even for patients receiving relevant educational materials from dialysis centers.

“A dialysis patient is reliant on frequent visits to a dialysis facility to maintain his or her health, and when this cannot be achieved due to lack of clean water, lack of electricity, impassable roadways, etc., severe medical complications leading to significant morbidity and mortality can occur quite quickly,” said medical student Mark Foster of the University of North Carolina School of Medicine, who led the study. “This research is important because it sheds light on this lack of preparation and can serve as a stimulus to enact measures to ensure better preparation for future disasters.”

Mitigating the effects of disaster on dialysis patients will require local, regional, and national leadership. Because disaster preparedness was not related to level of education, literacy, socioeconomic status, or age, it is clear that the lack of preparation is a systemic problem that will require coordinated efforts from dialysis facilities, large dialysis organizations, and national foundations, the authors said.

“If these findings are representative of the dialysis community at large, and they may well be, the dialysis community needs to develop and validate innovative educational approaches that will improve disaster preparedness for our patients,” said Jeffrey Kopp, MD, of the Kidney Community Emergency Response Coalition (KCERC) and the National Institute of Diabetes and Digestive and Kidney Diseases.

Other experts agree. “The educational materials have been disseminated, but perhaps we need to explore what are the other barriers to preparedness, including financial and motivational,” said Richard Zoraster, MD, medical director of the National Hospital Preparedness Program at the Los Angeles County Emergency Medical Services Agency.

Disasters and dialysis

Patients on dialysis depend on technology to keep them alive, and they must take certain steps to avoid becoming seriously sick or dying in the face of a disaster such as the recent tornadoes in the Midwest or the earthquake in Japan. Several years ago, the KCERC developed a disaster response plan that addresses the particular needs of dialysis patients and includes implementation and dissemination of best practices at the state, local, and individual level (http://www.ncbi.nlm.nih.gov/pubmed/17699500). The KCERC and the National Kidney Foundation have provided information to both dialysis clinics and patients regarding the necessary steps for disaster preparedness.

“KCERC and large dialysis organizations have done a very good job by educating dialysis patients about what to do in the case of a disaster,” said Didier Portilla, MD, a member of the American Society of Nephrology’s Disaster Relief Task Force and a professor at the University of Arkansas College of Medicine.

Disaster scenarios fall along two lines of response. Often, people must evacuate their homes and seek shelter in other locations. Dialysis patients should know where alternative dialysis clinics are, have medications on hand, and carry medical documentation of their kidney condition. Other events such as severe snowstorms require people to stay in their homes. When this happens, dialysis patients should be careful how much they drink, have a stockpile of appropriate foods and medications, and notify local police, fire, electric, water, and emergency services.

Dialysis patients’ preparedness

To assess how well dialysis centers and their patients are prepared for disasters, Foster and his colleagues—including Jane Brice, MD, Maria Ferris, MD, PhD, and others—surveyed 311 end stage kidney disease patients who received care at six different regional dialysis centers in central North Carolina between June and August 2009. They also interviewed dialysis administrators to ascertain their centers’ disaster preparedness activities.

The researchers asked questions regarding demographics, general disaster preparedness using Homeland Security recommended item lists, dialysis specific preparation for an individual to shelter in place, and preparatory steps for a forced evacuation. The cross-sectional analysis revealed that all dialysis centers had a disaster preparedness program in place, but most patients were not well-prepared for a disaster. Only 43 percent of patients knew of alternative dialysis centers. Only 42 percent had adequate medical records at home that they could take with them on short notice. Only 40 percent had discussed the possibility of staying with a friend or relative during a disaster, and only 15 percent had a medical bracelet or necklace they could wear if they were forced to leave their homes. Also, while individuals should maintain personal stores of potassium exchange resins along with instructions for use to mitigate hyperkalemia, only 13 percent of patients had any knowledge of the medication, and only 6 percent had the medication in their homes.

“These results were found to be independent of age, gender, race, education, household income, and literacy level, indicating that all sorts of people were unprepared no matter what their socioeconomic status,” Foster said.

Preparedness was slightly better when patients were asked about their plans for disasters that would force them to stay in their homes, the researchers found. Fifty-seven percent knew what diet they should follow during a disaster, and 63 percent had a two-week supply of extra medications.

Home peritoneal dialysis patients were significantly more likely to be prepared for a disaster than hemodialysis patients. All 27 home peritoneal dialysis patients studied knew how to order extra supplies. Still, only 40 percent had an extra supply of antibiotics, only 38 percent had notified the local power company of their health condition, and 20 percent had notified the local water company.

“This is an excellent and timely paper pointing out the vulnerability of dialysis patients who experience a natural disaster,” said Allen Nissenson, MD, chief medical officer of DaVita Inc. “With experts now stating that climate change will drive an increase in extreme weather throughout the country, it is essential that patients and providers understand the risks and the key role of education and preparation to minimize the impact on patient health.”

Ways to Improve

The findings about dialysis patients’ disaster preparedness may apply to other patients as well, said study author Mark Foster. “With the recent string of natural disasters, including the recent tornadoes of the spring of 2011, the earthquake in Japan, Hurricane Katrina in 2005, and many others, it is quite relevant for all folks, especially those who are living with chronic illnesses who require frequent monitoring and intervention to maintain their health.”

October-November 2011 (Vol. 3, Number 10 & 11)