Rising From the Storm: Applying Lessons From Disasters

Disasters, whether natural or man-made, adversely impact patients with kidney diseases, particularly those reliant on dialysis or transplantation, due to disrupted health care systems and limited access to essential therapies. CKD affects approximately 10% of the global population, leaving millions vulnerable during catastrophes. Acute kidney injury is common in disasters, with crush-related acute kidney injury being the most recognized, although other etiologies also contribute. Lessons from past disasters such as earthquakes, hurricanes, and conflicts reveal critical gaps in preparedness and response. Key findings include the importance of early dialysis, efficient logistical planning, and international collaboration. For instance, the Marmara and Kahramanmaras earthquakes underscored the need for rapid hyperkalemia management in crush victims, whereas Hurricane Katrina highlighted the vulnerability of dialysis-dependent patients even in well-developed health care systems. Ethical dilemmas in resource allocation during crises demand transparent and equitable decision-making. This review synthesizes experiences to propose strategies for improving outcomes, including patient education on emergency protocols, enhanced disaster training for health care providers, and robust international partnerships. By applying lessons from past events, the global nephrology community can mitigate risks and improve survival for kidney patients during future disasters.