Patients with end-stage renaldisease (ESRD) in the regions affectedby Hurricane Sandy in October 2012experienced higher rates of emergencydepartment (ED) visits and hospitalizationas well as a slightly higher 30-daymortality rate, according to a new study.
Using claims data from the Centersfor Medicare & Medicaid Services,researchers compared a study groupof ESRD patients in the areas mostaffected by the hurricane (New Jerseyand New York City) with 2 comparisongroups: (1) ESRD patients living instates unaffected by Sandy during thesame period; and (2) ESRD patientsliving in the Sandy-affected region ayear prior to Sandy (October 1, 2011through October 30, 2011).
Of 13,264 study group patients, 59%received early dialysis in 70% of theNew York City and New Jersey dialysisfacilities. The ED visit rate was 4.1% forthe study group compared with 2.6%and 1.7% of comparison groups 1 and2, respectively, the researchers reportedin the American Journal of KidneyDiseases (2015;65:109–115). The hospitalizationrate for the study group was4.5%, which was significantly higherthan the 3.2% and 3.8% rates for comparisongroups 1 and 2, respectively.
In addition, among patients who visitedthe ED, those in the study groupwere significantly more likely to receivedialysis there than those in comparisongroups 1 and 2 (23% vs. 9.3% and6.3%, respectively).
The 30-day mortality rate for thestudy group was significantly higherthan that of comparison group 1(1.47%) and slightly but not significantlyhigher than that of comparisongroup 2 (1.6%).
Early dialysis important
“Our findings support the feasibility ofusing early dialysis as a potential standardof care and protective measurewhen a hurricane or other ‘notice event’is anticipated to interrupt dialysis treatment,”the authors wrote.
“Emergencypreparedness and response depend ongood planning and strong day-to-daysystems. Many dialysis providers routinelyorganize early dialysis for patientsin advance of major holidays, suggestingthat systems are in place to providesuch care in advance of a major storm.”
The investigators stated that, froma preparedness perspective, “dialysisfacilities should consider having plansin place to provide early dialysis topatients in advance of predictable disasterssuch as hurricane and to ensuretheir ability to function in a disaster.”
In a statement prepared by the NationalKidney Foundation (NKF), which publishesthe American Journal of KidneyDiseases, corresponding author NicoleLurie, MD, Department of Health andHuman Services Assistant Secretaryfor Preparedness and Response, statedthat the research clearly showed thatdelaying dialysis can have devastatinghealth effects for patients with ESRD.
“The good news is that we saw a lot ofpatients receiving dialysis before thestorm hit. That type of advance planningby patients and their facilities shouldbecome routine nationwide,” she said.“Everyone involved should know whatto do when their facilities might close—patients should know where to go, andfacilities should be able to provide asurge in early dialysis care so treatmentis not delayed. At the end of the day, thathelps people and their communities bemore resilient.”
Room for improvement
Dr. Lurie pointed out that 40% ofpatients did not receive early dialysis,meaning “there is still plenty ofroom for dialysis patient and facilityimprovement. I hope these findingsserve as a rallying cry not just for thedialysis community, but for all people with any type of chronic healthcondition and their care providers toplan for emergencies.”
“This is an important analysis of theimpact of Hurricane Sandy in October2012 on individuals treated with in-centerhemodialysis that ultimatelyhelps the dialysis community betteranticipate what might go wrong,improve emergency plans for disasterscenarios, and more rapidly respondto protect the health of our patientsduring emergencies,” said JosephVassalotti, MD, NKF’s Chief MedicalOfficer. “The study reflects anotherstep forward to improve the educationand training of patients and dialysisclinic staff, following the widely recognizedpoor response to HurricaneKatrina in August 2005.”
Although the new study had a numberof strengths—such as the use ofMedicare data, which cover nearly allof the nation’s ESRD patients—it alsohad some limitations, including lackof access to sufficiently granular dataon sustained power outages and facilitydamage, “which may have enabledus to better understand the utilizationpattern seen.”