Hurricane Sandy Stranded Dialysis Patients. Lessons Learned?

When Hurricane Sandy hit New York City in October 2012, millions were affected by blackouts, empty gas stations and damaged homes. And, in addition to those losses, patients who require regular medical maintenance, like those who need frequent dialysis, were left in a bind.

Twenty-six percent of dialysis patients in Manhattan missed at least one dialysis session in the week following the storm, according to a study presented Thursday at a meeting of the American Society of Nephrology. Dialysis machines filter harmful substances from the blood when a patient's kidneys can no longer do so. While it's a lifesaving treatment, dialysis requires electricity, water and trained staff.

The study surveyed 357 patients who attended any of the five regional centers in Manhattan that lost electricity for some period after the hurricane. Of those who missed at least one session, 70 percent missed one or two, and about 20 percent missed three to five dialysis sessions, says Dr. Naoka Murakami, a resident at Mount Sinai Beth Israel Medical Center, and lead author of the study. Any sort of disruption can be serious, she says.

"If the patient misses dialysis once or twice, their potassium level in the blood increases and that may lead to arrhythmia — an irregular heartbeat," Murakami tells Shots.

In addition, 66 percent of the patients surveyed said that, in the wake of the storm, they wound up having to go to a dialysis center they don't normally attend. Knowing ahead of time the location of an alternative center and how to get to it could have been helpful and saved time, Murakami says.

"Many of the [backup] locations were located uptown," she points out, while most of the patients normally attended a facility in lower Manhattan. In the week after the storm, some patients headed instead to crowded hospital emergency rooms for dialysis — and didn't always get the treatment there that they needed.

Interestingly, a year after the storm, only 17 percent of the patients reported improvement in their disaster preparedness for dialysis, should another crisis come their way.

"We thought that the experience of the Hurricane Sandy might improve the disaster preparedness for the patient — but actually it didn't," says Murakami. "We have to strongly encourage the patients to get more prepared."

Particularly, say kidney specialists, because even though every dialysis center is required to have an emergency plan, those plans can change quickly — when a backup facility suddenly finds itself underwater, for example.

It's not just a problem in New York; many patients think they're more prepared than they are. In a recent study that surveyed 124 dialysis patients in Chicago, 60 percent said they were prepared for an emergency but 80 percent clearly weren't — they didn't have a plan to ensure their special dietary needs would be met in an emergency, for example, or they didn't know of a backup dialysis facility, or hadn't ever discussed such contingency plans with their doctors.

Just a bit of patient training and a simple emergency information card aimed at dialysis patients can help solve the problem, says Dr. Anuradha Wadhwa, a nephrologist at Loyola University Medical Center, who led the Chicago study.

She and colleagues created a laminated card for each patient that identifies him or her as someone needing dialysis, and lists the patient's insurance and contact information for neighboring dialysis centers in the metropolitan area.

Eighty percent of patients who got the card, along with brief emergency training with nutritionists, social workers and nurses, met the preparedness criteria a month later.

Face-to-face communication between patients and dialysis providers is best, Wadhwa says. "The key is that patients should really talk to their unit."