Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy

Abstract

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.

Results: In 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. Provider- or facility-oriented enhancement of awareness of the disease and preparedness should be a priority.

Keywords: ESRD; dialysis; epidemiology and outcomes.

Figure 1.

Outline of the survey. Of a potential 820 slots calculated from chair and shift numbers, 598 participants were selected and approached as a convenience sample. *Participants younger than 18 years of age or unable to comprehend the informed consent process (including history of dementia) were excluded from this convenience sample in advance.

Figure 2.

Natural disaster preparedness. (A) Dialysis-specific disaster preparedness on the basis of the 13-item checklist of the National Kidney Foundation. The dark gray and light gray bars refer to the percentages before and after the storm, respectively. The percentage of those with knowledge of other dialysis centers increased from 58.2% to 65.8%. The percentage of those who had their medical records at home increased from 52.7% to 64.1%. (B) General disaster preparedness on the basis of the 15-item checklist of the Department of Homeland Security; 54.3% of participants fulfilled 13–15 items. In contrast, 5.9% of participants did not have any recommended items prepared.

Figure 3.

Dialysis emergency packet distribution and disaster preparedness. The percentages of participants who had knowledge of other dialysis centers with or without the dialysis emergency packet (67.3% and 64%, respectively). Similarly, 81.1% and 43.5% of participants had medical records at home with or without intervention, respectively. With the dialysis emergency packet distribution, the cache of medical records at home was significantly higher (P<0.001, Fisher’s exact test).