The Kidney Community's Role in Natural Disasters and Climate Change

View Full Size

Photo by Ed Kashi. A father and son pose in the cane fields of Chichigalpa, Nicaragua, on January 6, 2013. Both men experience chronic kidney disease.

Citation: Kidney News 16, 4

• Download Figure
• Download figure as PowerPoint slide

Despite recent advances in efforts to mitigate climate change, greenhouse gas emissions continue to rise (1). Climate change has led to the increased frequency and severity of extreme weather events, which pose a major challenge for patients who are dependent on dialysis. Dialysis requires stable electricity, water, and transportation systems. When natural disasters disrupt these systems, access to dialysis—our patients’ lifeline—is threatened. Therefore, the kidney health care community must address climate change and natural disaster management.

Hurricane Katrina, which struck the Gulf Coast in 2005, was a pivotal event for dialysis disaster mitigation efforts. Hurricane Katrina resulted in the closure of nearly 100 dialysis units and laid bare many challenges in dialyzing evacuees (2). In response, the Kidney Community Emergency Response was established to help dialysis facilities and patients treated with dialysis to respond to natural disasters with tools such as dialysis hotlines, emergency kidney diets, and disaster response guidance (3). In the face of further natural disasters, we have continued to learn how to best support our patients, such as identifying survival benefits of early dialysis during Hurricane Sandy (4) and navigating insurance challenges amidst patient displacement during Hurricane Maria (5).

Hurricanes are not the only climate change-related risk that our patients who are dependent on dialysis face. Extreme heat events and air pollution from wildfires, both of which we encountered on an unprecedented scale last year, are associated with increased mortality among patients receiving dialysis (6, 7). Even beyond catastrophic events, adverse weather such as snow, rain, and wind have been linked to missed dialysis sessions (8).

The kidney community must address climate change and its associated natural disasters, but implementing impactful solutions is challenging. I suggest three approaches:

1. Apply evidence-based, guideline-directed care to prevent or delay the need for kidney replacement therapies. This will reduce the number of patients who require dialysis amidst natural disasters and cut dialysis-related climate emissions (9).

2. Prepare our patients for dialysis disruptions with tools such as the 3-day emergency kidney diet and evacuation planning (3).

3. Advocate for the broadscale transition to carbon-free energy sources to slow climate change.

ASN has been a leader in this effort. In April 2022, the society released its “Statement on Climate Change,” urging professionals in the nephrology sector to address climate change with specific, actionable steps to support patients with kidney diseases in the face of climate change, reduce the environmental impact of kidney care, and advocate for climate change mitigation policies (10). ASN has also launched the Emergency Partnership Initiative to work with people with kidney diseases, dialysis companies, hospital systems, and disaster relief agencies in North America and the Caribbean to prepare for natural disasters and to locate needed resources during and after major events. Likewise, nephrology organizations around the world are leading efforts to mitigate the discipline's environmental damage with programs such as the International Society of Nephrology's Global Environmental Evolution in Nephrology and Kidney Care (GREEN-K) initiative (11) and the European Renal Association's Sustainable Nephrology Task Force (12).

While we are fortunate to have professional organizations that prioritize addressing climate change and kidney diseases, it is in our hands to take up their call and ensure that plans lead to action. Natural disasters are occurring with increased ferocity in the era of climate change and threaten the lives of our most vulnerable patients. For their sake, we must continue to push for climate action.