End-stage renal disease patients who receive dialysis in advance of natural disasters are significantly less likely to need an emergency department visit or hospitalization in the week following the disaster and less likely to die within 30 days after the disaster, according to a U.S. Department of Health and Human Services study published in the American Journal of Kidney Diseases.
The study found that New York and New Jersey patients who received early dialysis prior to Hurricane Sandy had 20% lower odds of visiting the emergency department, and 21% lower odds of a hospitalization in the week of the storm, and 28% lower odds of death 30 days after the storm.
HHS Office of the Assistant Secretary for Preparedness and Response conducted the study in collaboration with the Centers for Medicare & Medicaid Services using Medicare fee-for-service data for 13,836 patients who received dialysis across the State of New Jersey and New York City, the areas most impacted by Hurricane Sandy. The data was provided in a way that protected personally identifiable information and individual patient privacy.
“Every disaster holds the potential to impact health and often disproportionately affect people who are medically vulnerable, including people who require dialysis,” said Dr. Nicole Lurie, HHS assistant secretary for preparedness and response and one of the study’s authors. “This study provides the first evidence that receiving early dialysis in advance of potential disasters helps protect health and saves lives for dialysis patients and suggests that early dialysis should become a standard practice and protective measure.”
Researchers sought to determine if early dialysis reduced the odds of a dialysis patient having an adverse outcome that included an emergency department visit or hospitalization in the week of the storm and death 30 days after the storm. Before Hurricane Sandy made landfall, 60% of ESRD patients received early treatment in 70% of the facilities in the impacted area.
“This study is part of a growing movement in the research community to provide scientific evidence to help patients, doctors, and community officials make decisions about how best to safeguard health from the impacts of disasters,” Lurie said. “The study also affirms the importance of dialysis facilities being fully prepared for disasters.”
The authors recommended that dialysis facilities conduct disaster drills to test emergency and communications plans and assess the staff’s ability to coordinate early dialysis in advance of an emergency. Drills also help determine their patients’ ability to understand, implement and arrive for treatment and identify potential gaps in facility and patient personal preparedness.
Preparing dialysis patients for disasters
Patients must understand how to request early dialysis and how to use emergency renal diet options to manage treatment delays. They also need to know how to seek care at pre-identified alternate dialysis facilities, which requires patients to be prepared to bring copies of their dialysis treatment plan and a list of their current medications when seeking treatment at an alternative facility or, as a last resort, in a hospital emergency department.