Dialysis Care and Death Following Hurricane Sandy

Kelman, Jeffrey A.; Finne, Kristen; Bogdanov, Alina; Worrall, Chris; Margolis, Gregg S.; Rising, Kristin L.; MaCurdy, Thomas; Lurie, Nicole

doi:10.1053/j.ajkd.2014.07.005

Cited by 56 publications

(77 citation statements)

References 16 publications

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“…Kelman et al (12) recently published data on the adverse outcomes of the storm using the Centers for Medicare and Medicaid Services (CMS) claims data for patients on dialysis in the State of New Jersey and the five New York City boroughs (Brooklyn, Manhattan, Queens, Staten Island, and the Bronx). Among 13,264 patients with ESRD, Kelman et al (12) found increased emergency room (ER) visits and hospitalizations as well as an increased 30-day mortality rate compared with a similarly sized comparison group.…”

Section: Introductionmentioning

confidence: 99%

Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy

Murakami

Siktel

Lucido

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Patients with ESRD on dialysis live in a complex sociomedical situation and are dependent on technology and infrastructure, such as transportation, electricity, and water, to sustain their lives. Interruptions of this infrastructure by natural disasters can result in devastating outcomes.Design, setting, participants, & measurements Between November of 2013 and April of 2014, a cross-sectional survey was conducted of patients who received maintenance hemodialysis before and after the landfall of Hurricane Sandy on October 29, 2012 in lower Manhattan, New York. The primary outcome was the number of missed dialysis sessions after the storm. Dialysis-specific and general disaster preparedness were assessed using checklists prepared by the National Kidney Foundation and US Homeland Security, respectively. ResultsIn total, 598 patients were approached, and 357 (59.7%) patients completed the survey. Participants were 60.2% men and 30.0% black, with a median age of 60 years old; 94 (26.3%) participants missed dialysis (median of two sessions [quartile 1 to quartile 3 =1-3]), and 236 (66.1%) participants received dialysis at nonregular dialysis unit(s): 209 (58.5%) at affiliated dialysis unit(s) and 27 (7.6%) at emergency rooms. The percentages of participants who carried their insurance information and detailed medication list were 75.9% and 44.3%, respectively. Enhancement of the dialysis emergency packet after the hurricane was associated with a significantly higher cache of medical records at home at follow-up survey (P,0.001, Fisher's exact test). Multivariate Poisson regression analysis showed that dialysis-specific preparedness (incidence rate ratio, 0.91; 95% confidence interval, 0.87 to 0.98), other racial ethnicity (incidence rate ratio, 0.34; 95% confidence interval, 0.20 to 0.57), dialysis treatment in affiliated units (incidence rate ratio, 0.69; 95% confidence interval, 0.51 to 0.94), and older age (incidence rate ratio, 0.98; 95% confidence interval, 0.97 to 0.99) were associated with a significantly lower incidence rate ratio of missed dialysis.Conclusions There is still room to improve the preparedness for natural disasters of patients with ESRD. Provideror facility-oriented enhancement of awareness of the disease and preparedness should be a priority.

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Section: Introductionmentioning

confidence: 99%

Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy

Murakami

Siktel

Lucido

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Although the death toll for adult dialysis patients is not known yet, it is known that at least 1 patient died because was not able to get to the treatment center. Experience with Hurricane Sandy in 2012 showed increases in emergency room visits, hospitalizations, and 30-day mortality in the dialysis population as a direct result of the hurricane [7].…”

Section: Access To Dialysismentioning

confidence: 99%

Disaster Management in a Nephrology Service: Lessons Learned from Hurricane Maria

Bonilla–Félix

Suárez-Rivera²

2018

Blood Purif

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Background: Puerto Rico suffered a major humanitarian crisis after Hurricane Maria. We describe our experience with patients with renal disease in an academic medical center. Summary: A comprehensive emergency response plan should be developed, shared and discussed with the team and the patients prior to the hurricane. The needs of the staff should not be ignored to ensure their ability to participate as responders. Physical damage to facilities, lack of basic services, shortage of disposable products, and the inability to get to treatment centers are the most common threats. Preemptive dialysis can avoid serious complications. A contingency plan to move patients to another center should be prearranged in case the unit is rendered nonfunctional after the storm. Patients must receive preventive education about fluid and dietary restrictions and the possible use of potassium binding drugs if they cannot reach a dialysis unit. A list of alternative drugs that could be used if patients are not able to fill their medications is required. The Internet and social media proved to be an invaluable communication tool. A registry of patients with updated contact information, as well as contact information for relatives and a physical address where an emergency rescue team can be dispatched is essential. Water safety should be reinforced. Key Message: Our experience showed us that preparing for the worst is not enough. Advanced planning of a streamlined response is the best tactic to decrease harm.

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“…In this issue of CJASN, Murakami et al (7) address factors associated with missed dialysis treatments. Two other recent papers from Lurie and colleagues (8,9) have addressed the role of early dialysis (defined as extra dialysis sessions) in reducing adverse outcomes. Taken together, these papers provide new data on factors associated with missed dialysis treatment and evidence supporting aggressive efforts to provide additional dialysis treatments before predictable disasters.…”

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confidence: 99%

“…Kelman et al (8) reviewed Medicare claims data for states affected by Hurricane Sandy during October of 2012 (study group) and compared these with two control groups: the dialysis population in states unaffected by the storm (comparison group 1) and the affected area population 1 year earlier (October of 2011; comparison group 2). The study included 15,212 patients in 221 dialysis units, and these individuals were older, more often nonwhite, and dually eligible for Medicare and Medicaid (a marker for lower income) compared with comparison group 1, whereas demographics were similar in comparison group 2.…”

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confidence: 99%

“…Kelman et al (8) reported that 59% of patients received early dialysis in dialysis facilities on Saturday, Sunday, or Monday of the storm week. Despite these high rates of early dialysis, rates of emergency department visits were significantly higher in the study group (4.1%) compared with both control groups (2.6% and 1.7% for comparison groups 1 and 2, respectively), and rates of dialysis during an emergency room visit were much higher in the study group (23% versus 9.3% and 6.3% for comparison groups 1 and 2, respectively).…”

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confidence: 99%

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