Patients receiving maintenance dialysis have a significant 13% increased risk of death within 30 days of hurricanes compared with those not exposed to these storms after adjusting for demographic and socioeconomic factors.
The finding is from a study of 187,388 patients from the 1997-2017 US Renal Data System database. Of the cohort, 29,849 patients were exposed to at least 1 of 27 hurricanes in 108 hurricane-afflicted US counties.
The risk of mortality was greatest immediately after a hurricane, then diminished. Hurricane-associated mortality risk doubled 1 day after a storm, and stayed elevated at 59%, 32%, 17%, and 13% at 3, 7, 14, and 30 days after a hurricane, respectively, Matthew F. Blum, MD, of Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues reported in the Journal of the American Society of Nephrology. Mortality risk did not differ by race and ethnicity.
Power failures, disruptions in water supply and transportation systems, patient displacement, and hospital surges can all impede dialysis access, the investigators explained.
“Dialysis sessions missed due to weather may contribute to early mortality after a hurricane event,” they wrote. “Potassium, fluid, and uremic toxins accumulate with missed dialysis, leaving patients susceptible to cardiovascular events.” Patients may also lack medication access. The investigators noted that tropical cyclone exposure has been linked to higher death rates from infectious, respiratory, cardiovascular, neuropsychiatric, and injury-related causes in the general population. High temperatures also have been linked to mortality among patients on dialysis.
According to the Kidney Community Emergency Response Coalition, administering early dialysis treatment before hurricanes may help prevent adverse outcomes, such as death. The study investigators did not find improved survival rates with home dialysis modalities perhaps due to the small sample size.
“Future efforts should prioritize safeguarding this vulnerable population,” Dr Blum’s team concluded.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Blum MF, Feng Y, Anderson GB, Segev DL, McAdams-DeMarco M, Grams ME. Hurricanes and mortality among patients receiving dialysis. J Am Soc Nephrol. Published online July 14, 2022. doi:10.1681/ASN.2021111520