Death rates of kidney patients increased during Hurricane Sandy

Areas impacted by Hurricane Sandy in 2012 experienced hospital and dialysis facility disruptions, which led to increased emergency department visits, hospitalizations and a slight rise in the death rate of kidney patients in New York and New Jersey.

Kidney patients 'should know what to do when their facilities might close - patients should know where to go, and facilities should be able to provide a surge in early dialysis care.'

According to a new study published in the January issue of the National Kidney Foundation's American Journal of Kidney Diseases, work still needs to be completed to prepare hospitals for patient emergency in such circumstances. 

The report outlines recommendations to all hospitals and any patient with a chronic condition.

Researchers from the US Department of Health and Human Services' (HHS) Office of the Assistant Secretary for Preparedness and Response and the Centers for Medicare and Medicaid Services (CMS) conducted the study.

The results serve as a stark reminder that all patients and health care facilities need to have emergency plans in place well in advance of natural disaster - particularly for those chronic kidney patients in need of dialysis.

"The research showed clearly that delaying dialysis can have devastating health effects for patients with end-stage renal disease."

The good news is that the researchers saw a lot of patients receiving dialysis before the storm hit. That type of advance planning by patients and their facilities should become routine nationwide.

"Everyone involved should know what to do when their facilities might close - patients should know where to go, and facilities should be able to provide a surge in early dialysis care, so treatment is not delayed. At the end of the day, that helps people and their communities be more resilient."

Included in the study were CMS data from 13,264 patients from New Jersey and New York - the areas hit hardest by Sandy. These data were compared with patients in states unaffected by Sandy in the same period, and to those patients living in the Sandy-effected region a year previous to the hurricane.

The study 'underscores the importance of pre-disaster dialysis planning community-wide'

Findings from the study show that when compared to the comparison groups, emergency visits for patients in impacted areas during the storm:

• Increased to 4.1% - a higher rate than the 2.6% and 1.7% observed in the comparison groups
• 23% of the patients received dialysis treatment while at the hospital
• There was a small increase in mortality for end-stage renal disease
• Death rates rose to 1.83% in the 30 days following the hurricane compared with 1.47% and 1.6% in comparison groups.

Dialysis care was provided to a large number of patients before the emergency. Almost 70% of the dialysis facilities located in the study areas had provided early dialysis to 59% of dialysis patients on the Sunday before the storm struck.

Early treatment on this scale was attributed to the strong relationships that had been developed before the storm, enabling close collaboration and coordination among state and local health officials, kidney networks, Kidney Community Emergency Response Coalition (KCERC), and dialysis patients prior to, during and after Sandy.

Researchers reveal that the study underscores the importance of pre-disaster dialysis planning community-wide. About 40% of patients did not receive early dialysis, which means there is still plenty of room for dialysis patient and facility improvement.

The researchers hope these findings serve as a rallying cry not just for the dialysis community, but for all for people with any type of chronic health condition and their care providers to plan for emergencies.

The study highlighted what protective measures to implement prior to, during and after a disaster. In advance of an emergency, patients, providers and facilities should discuss emergency renal diet options and any supplies that should be on hand, in addition to the facility's protocol for obtaining early dialysis.

The authors of the study recommend that patients:

• Regularly update their facility and nephrologist on their emergency plan and caregiver contact list
• Request information from their facility on how to access care at an alternative facility if theirs closes
• Multiple transport options to travel to and from treatments
• Have a recent copy of their current dialysis treatment plan and hepatitis status and a list of medications.

Additionally facilities should ensure:

• Patients understand who to contact if their facility is unreachable.

Information provided by facilities should at minimum include contact details for their regional kidney network and KCERC's patient hotline, which is available at: www.kcercoalition.com.

The chief medical officer of the National Kidney Foundation, says:

"This is an important analysis of the impact of Hurricane Sandy in October 2012 on individuals treated with in-center hemodialysis that ultimately helps the dialysis community better anticipate what might go wrong, improve emergency plans for disaster scenarios, and more rapidly respond to protect the health of our patients during emergencies."

In conclusion, this study reflects another step forward to improve the education and training of patients and dialysis clinic staff, following the widely recognized poor response to hurricane Katrina in August 2005.

References:

Dialysis Care and Death Following Hurricane Sandy, Nicole Lurie, MD, MSPH et al., American Journal of Kidney Diseases, DOI: 10.1053/j.ajkd.2014.07.005, published online 23 August 2014, abstract.
National Kidney Foundation news release, accessed 8 January 2015