Chronic Kidney Disease and Disasters

Patients with ESRD live in a complex medicosocial milieu, composed in part of nephrologists, physicians, nurses, dieticians, technicians, social workers, and custodial personnel, as well as family, friends, or neighbors. To add to the complexity, patients with ESRD must interface with local and federal governmental and insurance and large dialysis organizations (1). Patients who have ESRD and are treated with dialysis are utterly dependent on peritoneal dialysis or hemodialysis techniques for survival. For these patients, water distribution systems, ground deliveries, and the existence and function of dialysis centers with adequate supplies, access, light, heat, water delivery systems, and transportation infrastructure are absolutely essential to life. Patients with chronic kidney disease have specific and critical needs regarding diet and medications. Disasters have shown us how tenuous our health care delivery systems may be, especially for patients with complex needs.Social support and networks are associated with differential survival of patients with and without renal disease (2). Residence is also a critical but poorly studied factor, which probably affects outcomes in patients with ESRD (3). Heart-rending stories of parents and children separated by airlifting to ensure provision of dialysis services to patients, perhaps at the expense of disruption of critical emotional relationships, highlight the essential nature of such family and social networks.Although Hurricane Katrina put these issues into stark focus recently, disasters that affect our patients can present in varied forms, including blackouts, floods, fires, tornadoes, earthquakes, explosions, and nuclear mishaps, as well as others that are perhaps too …