Kidney Patient Care in Disasters

Kopp, Jeffrey B.; Ball, Lynda; Cohen, Andrew J.; Kenney, Robert J.; Lempert, Kenneth D.; Miller, Paul E.; Muntner, Paul; Qureshi, Nauman; Yelton, Sarah A.

doi:10.2215/cjn.03481006

Cited by 81 publications

(82 citation statements)

References 13 publications

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“…Although infrequent, natural disasters, such as hurricanes, tornados, or earthquakes, readily disrupt this infrastructure and can result in devastating outcomes (1)(2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy

Murakami

Siktel

Lucido

et al. 2015

Clinical Journal of the American Society of Nephrology

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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. ResultsIn 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. Provideror facility-oriented enhancement of awareness of the disease and preparedness should be a priority.

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“…Although infrequent, natural disasters, such as hurricanes, tornados, or earthquakes, readily disrupt this infrastructure and can result in devastating outcomes (1)(2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy

Murakami

Siktel

Lucido

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Man-made and natural disasters are frequent precipitants of infrastructure interruptions, as evidenced by Hurricane Katrina in 2005, which caused 94 Gulf Coast dialysis centers to close for at least 1 week. Of 5849 affected dialysis patients, 148 died within a month after the storm (2). Dialysis-dependent patients typically make detailed arrangements in advance of traveling away from their home dialysis units.…”

Section: Introductionmentioning

confidence: 99%

Personal Disaster Preparedness of Dialysis Patients in North Carolina

Foster¹,

Brice²,

Shofer³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Dialysis patients are among the most vulnerable patients during a disaster because they are sensitive to a lapse in treatment. Although thorough preparation could mitigate disaster effects, we hypothesized that dialysis patients' personal and medical disaster preparedness was inadequate.Design, setting, participants, & measurements This prevalence study surveyed mentally competent adults requiring care at six regional dialysis centers. We asked questions regarding demographics, general disaster preparedness utilizing Homeland Security recommended item lists, dialysis-specific preparation for an individual to shelter in place, and preparatory steps for a forced evacuation. To determine if preparedness differed by demographic variables (gender, race, age, and education) chi-squared tests were used.Results Four hundred forty-two patients were approached, and 311 (70%) completed the survey. Participants were 54% male, 60% black, average age was 58 (Ϯ 15) years, and although 79% completed high school, 50% of our sample had marginal or low health literacy. Although all units had a disaster preparedness program in place, the general disaster preparedness of most participants was poor. Age, gender, race, education, literacy, and socioeconomic status did not affect general disaster preparedness. However, home peritoneal dialysis patients were significantly more likely to be prepared for a disaster compared with hemodialysis patients. No other significant associations were noted. ConclusionsIrrespective of sociodemographic characteristics, most subjects were unprepared for a disaster. Dialysis patients were poorly prepared to shelter in place or to evacuate in the face of a disaster. Education regarding personal and dialysis-specific disaster preparedness is warranted.

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“…SPS has an important role in the treatment of acute hyperkalemia under austere conditions after a natural or manmade disaster (21,22). It may be used for trauma-associated hyperkalemia and as prophylaxis in dialysis-dependent patients who are not able to get to a dialysis unit (21,23).…”

mentioning

confidence: 99%

“…It may be used for trauma-associated hyperkalemia and as prophylaxis in dialysis-dependent patients who are not able to get to a dialysis unit (21,23). We prescribed oral SPS/sorbitol for this indication during the recent mid-Atlantic blizzard.…”

mentioning

confidence: 99%

Damned If You Do, Damned If You Don't

Watson

Abbott

Yuan

2010

Clinical Journal of the American Society of Nephrology

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Sodium polystyrene sulfonate (SPS) potassium binding resins increase colonic potassium excretion and are approved by the U.S. Food and Drug Administration (FDA) for the treatment of hyperkalemia. In 2009, the FDA recommended that sorbitol, a cathartic often given with SPS to prevent obstipation, not be added to SPS powder because of associated colonic necrosis. A premixed oral suspension of SPS in 33% sorbitol was not included in this warning. SPS resins increase stool potassium excretion in normokalemic subjects, but proportionately more potassium is excreted due to cathartics when the two are combined. In hyperkalemic patients, oral SPS mixed in water significantly decreases serum potassium within 24 hours. SPS/sorbitol-associated colonic necrosis is most commonly seen in patients who have received enemas in the setting of recent abdominal surgery, bowel injury, or intestinal dysfunction. It is a rare event, on the order of 0.2 to 0.3%, almost exclusively present in patients at risk. The agent most likely associated with colonic necrosis is 70% sorbitol, and animal data support that etiology. There is very little data to suggest that oral SPS given with 33% sorbitol (in the premixed form) or SPS powder in water orally or as an enema causes colonic necrosis. SPS ion-exchange resins are the only agents, other than dialysis and diuretics, available to increase potassium excretion in hyperkalemia, and when used appropriately, they appear to be clinically effective and reasonably safe.

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Kidney Patient Care in Disasters

Cited by 81 publications

References 13 publications

Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy

Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy

Personal Disaster Preparedness of Dialysis Patients in North Carolina

Damned If You Do, Damned If You Don't

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