Management of pediatric dialysis and kidney transplant patients after natural or man-made disasters

Abstract

Pediatric patients on kidney replacement therapy (KRT) are among the most vulnerable during large-scale disasters, either natural or man-made. Hemodialysis (HD) treatments may be impossible because of structural damage and/or shortage of medical supplies, clean water, electricity, and healthcare professionals. Lack of peritoneal dialysis (PD) solutions and increased risk of infectious/non-infectious complications may make PD therapy challenging. Non-availability of immunosuppressants and increased risk of infections may result in graft loss and deaths of kidney transplant recipients. Measures to mitigate these risks must be considered before, during, and after the disaster including training of staff and patients/caregivers to cope with medical and logistic problems. Soon after a disaster, if the possibility of performing HD or PD is uncertain, patients should be directed to other centers, or the duration and/or number of HD sessions or the PD prescription adapted. In kidney transplant recipients, switching among immunosuppressants should be considered in case of non-availability of the medications. Post-disaster interventions target treating neglected physical and mental problems and also improving social challenges. All problems experienced by pediatric KRT patients living in the affected area are applicable to displaced patients who may also face extra risks during their travel and also at their destination. The need for additional local, national, and international help and support of non-governmental organizations must be anticipated and sought in a timely manner.

Keywords: Children; Dialysis; Kidney replacement therapy; Kidney transplant; Man-made disasters; Natural disasters; Nephrology.

Fig. 1

Preparedness towards disasters, response after a disaster, and post-disaster interventions targeting optimal response in pediatric nephrology centers and pediatric patients/their caregivers. In disaster-prone countries/regions, preparedness is vital to decrease extent of post-disaster chaos and disorganization. Following a catastrophe, response includes coordination, mitigation, and action plans, all of which are mandatory to save as many lives as possible; internal help from other regions of the country and external help from other countries may be very useful if disasters cannot be coped with locally. Response is far from being ideal even in well-developed countries that are faced with frequent disasters; therefore, post-disaster interventions may be useful for improvement in disaster response in future events