June 29, 2015
HHS study finds early dialysis saved lives following Hurricane Sandy
People with end-stage renal disease (ESRD) who receive dialysis in advance of natural disasters, such as hurricanes, are significantly less likely to need an emergency department visit or hospitalization in the week following the disaster and less likely to die within 30 days after the disaster, according to a U.S. Department of Health and Human Services study published Friday in the American Journal of Kidney Diseases.
The study found that receiving early dialysis was associated with 20 percent lower odds of having an emergency department visit or 21 percent lower odds of a hospitalization in the week of the storm, and 28 percent lower odds of death 30 days after the storm.
“Every disaster holds the potential to impact health and often disproportionately affect people who are medically vulnerable, including people who require dialysis,” explained Dr. Nicole Lurie, HHS assistant secretary for preparedness and response and one of the study’s authors. “This study provides the first evidence that receiving early dialysis in advance of potential disasters helps protect health and saves lives for dialysis patients and suggests that early dialysis should become a standard practice and protective measure.”
Dialysis patients’ lives depend on receiving multiple dialysis treatments each week. Disasters, particularly those with prolonged power outage and water restrictions, can cause facility closures and disrupt treatment schedules. Early dialysis in advance of a storm’s landfall helps protect patients while their facilities recover and reopen.
HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) conducted the study in collaboration with the Centers for Medicare & Medicaid Services (CMS) using Medicare fee-for-service data for 13,836 patients who received dialysis across the State of New Jersey and New York City, the areas most impacted by Hurricane Sandy. The data was provided in a way that protected personally identifiable information and individual patient privacy.
Researchers sought to determine if early dialysis reduced the odds of a dialysis patient having an adverse outcome that included an emergency department visit or hospitalization in the week of the storm and death 30 days after the storm. Before Hurricane Sandy made landfall, 60 percent of ESRD patients received early treatment in 70 percent of the facilities in the impacted area.
“This study is part of a growing movement in the research community to provide scientific evidence to help patients, doctors, and community officials make decisions about how best to safeguard health from the impacts of disasters,” Dr. Lurie said. “The study also affirms the importance of dialysis facilities being fully prepared for disasters.”
The authors recommended that dialysis facilities conduct disaster drills to test emergency and communications plans and assess the staff’s ability to coordinate early dialysis in advance of an emergency. Drills also help determine their patients’ ability to understand, implement and arrive for treatment and identify potential gaps in facility and patient personal preparedness.
Patients must understand how to request early dialysis and how to use emergency renal diet options to manage treatment delays. They also need to know how to seek care at pre-identified alternate dialysis facilities, which requires patients to be prepared to bring copies of their dialysis treatment plan and a list of their current medications when seeking treatment at an alternative facility or, as a last resort, in a hospital emergency department.
The study is part of a broader effort by the ASPR to help the nation become better prepared to address the needs of other at-risk populations, including children and medically vulnerable residents, during disasters.
HHS is the principal federal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. These services include Medicare programs and health emergency preparedness, response, and recovery programs. This summer marks the 50th anniversary of the enactment of amendments to the Social Security Act that established the Medicare and Medicaid programs.
ASPR leads HHS’ efforts to prepare the nation to respond and recover from adverse health effects of emergencies, supporting communities’ ability to withstand adversity, strengthening health and response systems, and enhancing national health security.
To learn more about ASPR and about preparedness, response and recovery from the health impacts of disasters, visit the HHS public health and medical emergency website, www.phe.gov