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Planning Tool Prepares Kidney Patients for the Next Disaster

More Intense Floods, Fires and Hurricanes Driven by Climate Change Threaten Access to Dialysis

By Allison Eatough ’97

patient getting dialysis

Climate change-related hazards can block access to dialysis in multiple ways, including extreme storms knocking out power, damaging treatment facilities or making roads impassable. That prompted a School of Public Health professor to help create a preparedness tool for patients.

Illustration by Shutterstock

With nature’s events more frequently edging into natural disasters caused by climate change, patients with chronic kidney disease who require regular dialysis increasingly struggle to stay connected to this lifesaving service.

The deepening threat drove Professor Amir Sapkota, chair of the Department of Epidemiology and Biostatistics at the University of Maryland, to co-create a preparedness framework that provides a timeline and steps to protect patients as early as 90 days before a disaster strikes.

“If there’s an extreme weather event that wipes out electricity, for normal people, it may mean simple inconvenience,” Sapkota said. “But for people that need dialysis, it may mean the difference between life and death. Our traditional approach of simply reacting to these extreme events is not enough. We need a proactive approach so we can anticipate these extreme events, prepare for them, and effectively respond to them when the time comes.”

Chronic kidney disease affects more than 850 million people worldwide. In the United States, the most commonly administered form of therapy for affected individuals is thrice-weekly hemodialysis treatment. Climate-change related hazards can block access in multiple ways, including:

  • Increasing intensity of hurricanes damages electrical grids, leading to power outages that can interrupt dialysis services at home and in clinics.
  • Extreme weather-related high winds, storm surges and flooding can damage treatment facilities and render roads impassable.
  • Drought-related wildfires are significant sources of air pollution that disproportionately impact individuals with chronic kidney disease.
  • People undergoing hemodialysis are particularly vulnerable to extreme heat events as they cannot increase their fluid intake to stay hydrated the way healthy people do.

The preparedness framework, forthcoming in the March 9 issue of Nature Reviews Nephrology, is based around the “Ready-Set-Go” concept and provides time-period specific action items to help dialysis patients, clinics and the larger kidney community prepare for climate change.

Sapkota said he and co-creator Peter Kotanko, research director at the Renal Research Institute, plan to work with kidney communities and relevant stakeholders to implement these strategies to better prepare for climate change-driven extreme weather events.

The plan covers patients, clinics and the kidney-care community in general, providing clear and practical responses for a full range of disasters—with tips like what documents and contacts patients should always have on hand, how medical facilities can physically get ready, and how the broader community can more effectively secure necessary personnel for various needs, all keyed to a timeline starting months before the disaster.

While not all disasters are discernible on such long timeframes, the researchers say, there are tools available to help plan for extreme weather, among other possible catastrophes. For instance, the National Oceanic and Atmospheric Administration has seasonal and subseasonal forecast systems which release forecasts from a year to weeks in advance, Sapkota said.

“While they can’t predict a specific hurricane, they can predict the likelihood of this hurricane season being above or below normal,” he said. “Or if a drought is particularly bad right now, then we can start preparing for a wildfire season that may be worse than normal.”

Chart: Kidney care preparedness for natural disasters: Patient: Ready: 30-90 days before disaster: Carry patient ID card, Obtain insurance documents, Update phone numbers, Attend annual preparedness training. Set: 10-30 days before disaster: Obtain backup medication, Stock up on peritoneal dialysis supplies, Identify potential locations for evacuation. Go: 1-10 days before disaster: Identify backup clinics, Receive additional dialysis if needed, Notify immediate plan to clinic, Evacuate. Disaster response: 1-10 days after disaster: Notify clinic of location, Check KCER portal for facility status, Answer calls from clinic. Clinics: Ready: Issue patient ID cards, Conduct annual preparedness training, Obtain generators, Conduct contingency planning for staff shortages. Set: Test generators, ensure adequate fuel supply, Enhance capacity to accommodate additional dialysis. Go: Review and/or modify staff shortage contingency plan, Provide early dialvsis. Disaster response: Activate staff shortage contingency plan, Coordinate with KCER, Track and/or account for patients and staff, Facilitate patient treatment at backup facility. Kidney community: Ready: Develop sub-seasonal to seasonal KHT capacity, Generate long-range KHT forecasts informed by seasonal weather forecasts, Train volunteers. Set: Generate extended-range KHT forecasts using sub-seasonal weather forecasts, Coordinate plan with local and/or state agencies, Allocate resources. Go: Generate short-range KHT forecasts, Activate volunteers and evacuation plans, Establish separate hotlines for patients and clinicians. Disaster response: Manage hotlines
Courtesy of Amir Sapkota


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