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Early Dialysis and Adverse Outcomes After Hurricane Sandy
Nicole Lurie1, Kristen Finne1, Chris Worrall2
1Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC.
Summary
Receiving early dialysis before a natural disaster like Hurricane Sandy significantly reduced emergency visits and hospitalizations for hemodialysis patients. This protective measure also lowered 30-day mortality rates in affected areas.
Area of Science:
- Nephrology
- Public Health
- Disaster Medicine
Background:
- Hemodialysis patients face increased risks and reduced care access during natural disasters.
- Evidence supporting
- early dialysis
- as a protective strategy is limited.
- Hurricane Sandy impacted end-stage renal disease (ESRD) patients in New York and New Jersey.
Purpose of the Study:
- To investigate the association between early dialysis and adverse outcomes in ESRD patients during Hurricane Sandy.
- To evaluate the effectiveness of pre-storm dialysis as a protective measure.
Main Methods:
- Retrospective cohort analysis of Medicare & Medicaid Services Datalink Project claims data.
- Study included 13,836 long-term hemodialysis patients in New York City and New Jersey.
- Compared outcomes for patients receiving early dialysis versus usual treatment patterns.
Main Results:
- 60% (8,256) of patients received early dialysis.
- Early dialysis was associated with significantly lower odds of emergency department visits (OR, 0.80; P=0.01) and hospitalizations (OR, 0.79; P=0.01) in the week following the storm.
- Early dialysis was also linked to a significant reduction in 30-day mortality (OR, 0.72; P=0.048).
Conclusions:
- Early dialysis demonstrated a protective effect for hemodialysis patients during Hurricane Sandy.
- Patients receiving early dialysis experienced fewer adverse events and lower mortality.
- Limitations include inability to determine if patients declined offered early dialysis or unmeasured confounding factors.
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