Dialysis patients are at particular and added risk during natural disasters and armed conflicts. Infrastructure breakdowns, lack of clean water, and closure of dialysis centers disrupt critical treatments and jeopardize lives. The Fresenius Medical Care (FME) Global Disaster Response Team (GDRT) has developed protocols that allow them to deploy quickly in times of crisis. The team has extensive experience delivering supplies and medical personnel when and where they are needed worldwide.
For people who need safe and reliable dialysis services, situations such as natural disasters and geopolitical conflict can cause unpredictability and instability. Delivering care without access to critical services like reliable electrical power and clean water requires preparation and coordination. The FME GDRT keeps a close watch on situations where risk can escalate and is prepared to implement a comprehensive response strategy. Several Incident Command Teams staffed by volunteer leaders and managers are available to be dispatched on short notice (24–48 hours) for immediate disaster response. Their activities include arranging resources such as fuel, water, medical supplies, security, and meals to assist local management in restoring facility operations.
Critical components of emergency response efforts may include scheduling treatments outside of routine times and locations, ensuring supply chains remain intact, and maintaining proper hygiene and sanitation standards to prevent infections among people who need dialysis treatment, who are inherently more susceptible. During these crises, psychological support services are also critical, to help patients navigate associated stress and trauma.
A systematic literature review describes various effects of disasters on people undergoing dialysis treatment. Disruptions in dialysis care from loss of electricity, lack of clean water, blocked roads, lack of transportation, and closure of dialysis centers can lead to missed or shortened dialysis treatments. The clinical consequences can include increased emergency department visits, hospitalization, and mortality. Other reported effects include psychological repercussions, as disasters can cause or worsen depression and post-traumatic stress disorder. Moreover, during disasters, people who need dialysis treatment may encounter significant challenges. For example, relocation, if required, may result in prolonged periods away from family and social support networks. Supply shortages can lead to a lack of vital medical supplies and health care workers may not be available. The authors emphasize the importance of disaster preparedness for dialysis units.1
The role of peritoneal dialysis (PD) during natural disasters and conflicts has been highlighted in several publications.2,3,4 The advantages of PD include simplicity, since manual PD exchanges can be done without electrical power and do not require a water supply. The ability to perform treatment at home reduces reliance on transportation to dialysis facilities. According to Auguste,2 future disaster preparedness strategies should aim to increase the adoption of PD and consider it as an initial modality for replacement therapy for end-stage kidney disease (ESKD) patients in high-risk regions.
Children who require dialysis need specialized treatment and care, particularly in the context of natural disasters and conflict. Children with kidney conditions often have unique medical needs that must be addressed with sensitivity and expertise. During emergencies, ensuring the safety and well-being of children requiring specialized kidney care becomes even more critical due to their heightened vulnerability. Children who require hemodialysis (HD) may be at greater risk than adults on HD due to the limited availability of pediatricsized equipment and personnel with pediatric dialysis experience. Additionally, children are usually less able to tolerate missed dialysis sessions.5
Disruptions in dialysis care from loss of electricity, lack of clean water, blocked roads, lack of transportation, and closure of dialysis centers can lead to missed or shortened dialysis treatments.
FME has responded to many emergencies related to natural disasters and geopolitical conflicts in the last five years. Specific examples of FME’s response are described below.
Natural Disasters and Phenomena
NORTH AMERICA
In September 2022, Hurricane Ian, a Category 4 storm, was predicted to make landfall in Tampa, Florida. The storm took an unexpected turn, heavily damaging and disabling power for more than two million homes and businesses in southwestern Florida. Two DRT Incident Command Teams were deployed within 48 hours along with fuel and water tankers, food, supplies, and security personnel, to assist with reopening clinics and locating those who needed care. As a precautionary measure, Fresenius Kidney Care (FKC) closed 107 clinics in Central Florida and, within three days, all but one were open and all staff and patients were accounted for.
In August 2023, a Category 4 hurricane in the Pacific Ocean collided with another wind event to knock down power lines in Lahaina, Maui, igniting drought-stricken sugar cane fields into a wildfire. The fire ultimately destroyed the entire Lahaina community, affecting every resident.
While the FKC Kahana clinic outside Lahaina suffered little damage, in the aftermath of the fire, people could not access the facility. Another independent dialysis facility in Lahaina was heavily damaged, resulting in service interruption for 80 residents of Lahaina who required dialysis treatment. An FKC facility in Maulana, 20 miles from Lahaina, was able to open an additional shift and accommodate everyone in Lahaina.
As a testament to the teamwork and resilience of the FKC staff in Maui, all the people who were receiving treatment at the Kahana clinic were located within three days and received their required treatments the week of the fire. Nine people on home peritoneal dialysis (PD) who were without power switched from continuous cycler peritoneal dialysis (CCPD) to continuous ambulatory peritoneal dialysis (CAPD) and performed manual exchanges until power was restored. Three people on home hemodialysis (HD) converted to self-contained training packs (Express Packs) when the local water supply in Lahaina was reported as contaminated with cobalt, lead, and other materials, making it unusable for in-center and Home HD. Express Packs do not require the introduction of a local water supply to complete the process. People with Kidney Community Emergency Response (KCER) ID cards identifying them as on dialysis were permitted to travel to the clinic in Maulana for treatment and return home without restriction. Water supplies in Maulana and Kahana were not contaminated.
During emergencies, ensuring the safety and well-being of children requiring specialized kidney care becomes even more critical due to their heightened vulnerability.
Local FKC leadership, in cooperation with the Hawaii Emergency Healthcare Management (HEHM) coalition, were able to provide the names of all their staff and people on dialysis to the authorities, allowing them priority access through Lahaina. HEHM also allowed the technical teams access to the Kahana facility to prepare the clinic for operations. FKC’s GDRT shipped 100 fleece blankets to the centers and arranged hotel rooms for staff.
On April 8, 2024, the Great Northern American Eclipse covered a swath of North America from Mexico to Canada. Previous experiences with solar phenomena have seen impassable road congestion caused by eclipse enthusiasts, impacting the ability of emergency responders to access FKC clinics. More than 100 clinics in the path of totality were asked to close or alter operating hours to allow those needing to dialyze to do so in advance of the eclipse.
Insecure environments hinder access to healthcare, exacerbating the vulnerability of those who require care.
Each day presents new opportunities for FME to prioritize the health and safety of the people on dialysis who entrust them with their care.
Responding to Natural Disasters and Geopolitical Conflicts
PDF, 1 MBIn this section:
- Understanding Dialysis Publications
- Advancing and Personalizing Kidney Disease Care
- Kidney Disease: Evolving the Standard of Care
- Strategy to Expand HVHDF Worldwide
- Home Dialysis Today: More than a Different Place for ESKD Care
- Predicting Population Trends in Kidney Health Using Advanced Mathematical Modeling
- Interventions to Improve Survival in People with ESKD on Dialysis
- Improving Food Security in People with ESKD
- A Bold Vision to Accelerate Adoption of Value-Based Kidney Care
- The Challenges and Benefits of Generative AI in Kidney Care
- Responding to Natural Disasters and Geopolitical Conflicts
1 R.S. Smith, R.J. Zucker, and R. Frasso, “Natural Disasters in the Americas, Dialysis Patients, and Implications for Emergency Planning: A Systematic Review,” Preventing Chronic Disease 17 (2020): E42. doi.org/10.5888/PCD17.190430.
2 B. Auguste, “The Role of Peritoneal Dialysis in Pandemics and Natural Disaster,” in Applied Peritoneal Dialysis: Improving Patient Outcomes (Springer Cham, 2021): 457–64. doi.org/10.1007/978-3-030-70897-9_32.
3 C. Gorbatkin, F.O. Finkelstein, and R.T. Kazancioglu, “Peritoneal Dialysis During Active War,” Seminars in Nephrology 40, no. 4 (2020): 375–85. doi.org/10.1016/j.semnephrol.2020.06.005.
4 M.A. Kleinpeter, L.D. Norman, and N.K. Krane, “Dialysis Services in the Hurricane-Affected Areas in 2005: Lessons Learned,” American Journal of the Medical Sciences 332, no. 5 (2006): 259–63. doi.org/10.1097/00000441-200611000-00017.
5 L. Sever, G. Pehlivan, N. Canpolat, et al., “Management of Pediatric Dialysis and Kidney Transplant Patients After Natural or Man-Made Disasters,” Pediatric Nephrology 38, no.2 (2023): 315–23. doi.org/10.1007/s00467-022-05734-8.
6 N.A. Gray, M. Wolley, A. Liew, and M. Nakayama. “Natural Disasters and Dialysis Care in the Asia-Pacific,” Nephrology 20, no. 12 (2015): 873–80. doi.org/10.1111/nep.12522.
7 T. Gopolan, C.M. Ornelas-Brauer, T. Barbar, Z. Mithani, and J. Silberzweig, “Conflict Nephrology: War and Natural Disasters,” Kidney360 4, no. 3 (2023): 405–408. doi.org/10.34067/KID.0000000000000071.
8 J. S. Cameron, “The Effect of Armed Conflict on Dialysis Patients,” Nephrology Dialysis Transplantation 8, no. 1 (1993): 6. doi.org/10.1093/oxfordjournals.ndt.a092273.
9 M. Sekkarie, L. Murad, A. Al-Makki, F. Al-Saghir, O. Rifai, and M. Isreb, “End-Stage Kidney Disease in Areas of Armed Conflicts: Challenges and Solutions,” Seminars in Nephrology 40, no. 4 (2020): 354–62. doi.org/10.1016/j.semnephrol.2020.06.003.
10 M.S. Sever, R. Vanholder, V. Luyckx, et al., “Armed Conflicts and Kidney Patients: A Consensus Statement from the Renal Disaster Relief Task Force of the ERA,” Nephrology Dialysis Transplantation 38, no. 1 (2023): 56–65. doi.org/10.1093/ndt/gfac247.
11 N. Stepanova, “War in Ukraine: The Price of Dialysis Patients’ Survival,” Journal of Nephrology 35, no. 3 (2022): 717–8. doi.org/10.1007/s40620-022-01308-x.
12 V. Novakivskyy, R. Shurduk, I. Grin, et al., “War in Ukraine and Dialysis Treatment: Human Suffering and Organizational Challenges,” Clinical Kidney Journal 16, no. 4 (2023): 676–83. doi.org/10.1093/ckj/sfad003.