Insights into disaster nephrology and preparedness for kidney care in emergencies

Disasters are characterized by a high incidence and poor outcomes of acute kidney injury (AKI). In addition, people across the entire spectrum of chronic kidney disease (CKD) -including those not receiving kidney replacement therapy and those with kidney failure (i.e., glomerular filtration rate <15 mL/min/1.73 m2 or treatment by kidney replacement therapy) are disproportionately affected because their care depends on advanced technology, specific medications, and experienced personnel. Disaster-related logistical challenges significantly amplify the risks. These risks can be reduced through effective preparedness that integrates an all-hazards framework with disaster- and disease-specific strategies, requiring coordinated readiness of healthcare facilities, providers, and patients. Consequently, disaster nephrology has emerged as a distinct area of expertise within nephrology. Emergency responses may vary depending on the type and severity of the disaster and may involve medical and/or surgical management of injuries, mental health support, nutritional interventions, and logistical coordination. However, the management of AKI and CKD-particularly those with kidney failure-is complex and may be associated with high rates of morbidity and mortality. Following disasters, affected individuals should be systematically assessed not only for disaster-related complications but also for previously undiagnosed kidney and non-kidney conditions. Education of patients with kidney disease to anticipate and manage medical and logistical challenges during disasters is essential. Integrating preparedness planning, patient education, and coordinated response strategies is critical to minimizing preventable kidney-related morbidity and mortality in disaster settings.