Even before the earthquake and subsequent aftershocks ripped through the island country of Haiti last week, a person with end-stage renal disease had little chance of surviving.

Few hospitals offer outpatient care, and treatment costs must be borne by patients. And, with very little preventive care because of the country's limited financial resources, the disease often goes undiagnosed.

The international outpouring of help offered to island residents needing dialysis care has been slowed not only by logistics, getting dialysis machines and medical supplies through the maze of checkpoints and the threat of looters, but by limited access to tests that can identify individuals who need dialysis treatment. Creatinine testing to measure renal function is in short supply.

"We should be at a peak with acute kidney injury," said Timothy Bunchman, a nephrologist representing the International Pediatric Nephrology Association, in an interview with NN&I. "And there is none ... there isn't any way to detect kidney injury because we don't have the means of measuring creatinine."

The test is particularly important in treating AKI that results from "crush" syndrome , a serious medical condition characterized by major shock and renal failure following a crushing injury to skeletal muscle. Cases commonly occur in catastrophes such as earthquakes or war, where victims have been trapped under fallen debris. Individuals can die from the built-up toxicity in the blood if not treated immediately.

Based on recent numbers, only nine patients in Port-au-Prince and nine patients in Santa Domingo, about an hour flight away, have been identified as having either chronic end-stage renal disease or acute kidney injury and are being treated.

Even with donations of creatinine tests (Fresenius Medical Care is sending over 500 test kits), Bunchman says border problems are holding up supplies. "Getting supplies into Port-au-Prince is a disaster, once you hit the border [into Haiti], it's hard to get it where it is needed."

Sending supplies by vehicle appears to be unsafe because of the threat of looting.

Bunchman participates in daily meetings at 2 pm EST organized by the Kidney Community Emergency Response Coalition. Various nephrology support groups are part of the daily call to assess the response and progress in caring for individuals with AKI or who need chronic dialysis care. At a teleconference meeting this week attended by several nephrology support groups it was revealed that:

• Several of the island's hospitals that offered acute dialysis care were destroyed or severely damaged; one nephrologist in Port-au-Prince was killed and another is alive but still remains out of contact.
• One nephrologist from Johns Hopkins Medical Center, who has family in Haiti, was expected to arrive this week to offer assistance.

Offering help

Numerous dialysis providers and suppliers have donated equipment and supplies to help the victims of the Haitian earthquake.

• Fresenius Medical Care loaded dialysis equipment and supplies onto the USNS Comfort, a floating medical treatment facility now offshore in Haiti with teams of doctors and nurses.
• The American Society of Nephrology has helped recruit 70 trained clinical volunteers and physicians to assist in providing emergency care on the ground.
• Amgen has donated $2 million toward relief efforts.
• Baxter Healthcare has donated $1 million.
• Gambro has donated dialysis machines and supplies.

Here is a list of needed supplies

• Antibiotics (Unasyn, cefazolin and gram negative coverage)
• Arterial and venous lines for dialysis
• Bicarbonate concentrate for hemodialysis
• Bloodline systems (tubing)
• Catheter with two lumens
• Catheters for peritoneal dialysis (both stiff and Tenckhoff)
• ClNa 0.9%
•  Dialysers and filters
• Dialysis solutions for peritoneal dialysis
• Disinfectants (Peracetic acid)
• Gauze
• Heparin

Health professionals wishing to go to Haiti, individuals, organizations, and companies wishing to make monetary contributions or to donate medical supplies or equipment, should register at the Center for International Disaster Information (CIDI) site.