Hurricanes Up Mortality Risk for Patients on Dialysis

Hurricanes Up Mortality Risk for Patients on Dialysis

Patients on dialysis who live through a hurricane are at a higher risk of death in the 30 days following the event, with mortality risk attenuating over time, a retrospective cohort analysis suggests.

“Natural disasters disrupt transportation, water, and power systems, all of which are necessary for the provision of outpatient dialysis,” lead author Matthew Blum, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland, told Medscape Medical News.

“Our findings suggest that dialysis-dependent patients are vulnerable during hurricanes and highlight the need to safeguard this population, especially given the predicted increased hurricane intensity with climate change,” Blum added in a statement.

The study was recently published online in the Journal of the American Society of Nephrology.

One Tropical Cyclone

The analysis included 187,388 patients who initiated dialysis between January 1997 and December 2017 in the eastern half of the United States where at least one tropical hurricane occurred during the study interval. Local peak winds sustained a speed of at least 64 knots (approximately 74 mph) during the episode. “The primary outcome was all-cause mortality,” the authors note.

In total, 27 hurricanes affected the counties included in the analysis. Of the 29,849 patients exposed to at least one hurricane, there were 105,398 deaths after a mean of 2.8 years spent on dialysis. In the unadjusted model, exposure to a hurricane was associated with a 21% higher mortality risk at a hazard ratio of 1.21, but in a demographically and socioeconomically adjusted model, the risk was lower, at only 13% and a hazard ratio of 1.13, the authors note.

“Hurricane-associated mortality risk was highest 1 day after the hurricane and then waned over time,” investigators note. As Blum and colleagues point out, the disruption to dialysis services brought forth by natural disasters is an increasing threat to the safety of patients on dialysis.

For example, after Hurricane Katrina in 2005, 94 Gulf Coast dialysis units were closed for at least 1 week, resulting in missed dialysis sessions and excess hospitalizations although no increase in mortality.

In contrast, following Hurricane Sandy in 2012, “patients receiving dialysis were found to have a higher 30-day mortality,” the authors observe. The authors also found that hurricane-force winds carried a higher mortality rate among patients on dialysis than gale-force winds.

“This is concerning in light of the projected increase in high-intensity hurricanes with climate change,” they observed, “[and] suggests that high cyclone-related wind speeds may drive death more than cumulative precipitation.” Slower-moving storms may produce higher amounts of rainfall but no increase in mortality.

“It is tragic for any patient requiring dialysis to die in a hurricane as, ideally, no patient, especially not one requiring dialysis, will die in this setting,” Blum observed, adding that the study included patients receiving home or in-center dialysis and there was no difference in the risk of death between these two groups.

The Kidney Community Emergency Response Coalition was formed to guide responses for patients with kidney conditions. The authors point out that the kidney community should continue to advocate for policies to mitigate climate change.

Additional disaster response resources include the CDC website and National Kidney Foundation.

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