Background

Chronic Kidney Disease (CKD) is a progressive loss of renal function, ranging from Stage 1 (mild disease) to Stage 5 (complete kidney failure), also know as end-stage renal disease (ESRD)

• ESRD requires dialysis or kidney transplant

• Two types of dialysis: • Peritoneal dialysis

• Hemodialysis

Natural Disasters disrupt the critical infrastructure (water and electricity) necessary for dialysis

• The adverse outcomes associated with missed dialysis sessions are likely exacerbated in most island settings where poorly constructed buildings; lack of economic safety nets; limited resources, and inadequate health care personnel are common challenges

Methods

Conducted a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines

In consultation with a research librarian, PubMed, Scopus, CINAHL, and Cochrane Library were explored using the following search terms and derivatives:

Natural disasters, dialysis, healthcare delivery, mortality, morbidity, hospitalization, emergency department use, adverse outcomes, health services accessibility, quality of life, patient satisfaction, patient care, surveys, questionnaires, patient experiences, patient care management, treatment outcome, complications, mental health

Inclusion criteria: original research articles, English, Americas, 2009 to 2019

Results

15 papers were included in the final analysis, and were divided into four groups; the themes from each group are highlighted below

Discussion

Natural disasters have both direct and indirect effects on dialysis patients.

The findings from this systematic review has several implications for emergency planning in the Cayman Islands. Emergency preparedness planners should consider:

• Early dialysis

• Dialysis-specific preparedness and awareness

• Mental health of dialysis patients post-natural disasters • Educating patients on the emergency renal diet

• Increase in ED utilization

• Increase in hospitalizations • Planning for dialysis patient surge and how this might impact treatment

• Having patient medication lists and comorbidities readily available

• Planning for power outage, lack of transportation, and lack of clean water, which all have indirect effects on patients

Efforts to mitigate the impact of disasters on on dialysis patients will require coordination among public health professionals and other key personnel, carefully designed emergency preparedness plans, and education and training of all involved.

Strengths & Limitations

Strengths • Consulted with a research librarian

• Two reviewers independently searched the databases and screened the articles • We searched four databases

Limitations • Outcomes of interest were limited to the definition of “effects”

• All the articles included focus on the effects of hurricanes on dialysis patients and do not address other natural disasters

• All but one study reported findings in the United States. Dialysis-dependent patients living on islands may encounter additional challenges not present in non-island settings

• We did not search the grey literature

The Effects of Natural Disasters on Dialysis Patients and the Implications for Emergency Planning: A Systematic ReviewRashida Smith, MPH(c)Mentor: Rosemary Frasso, PhD, MSc, MSc, CPH

Indirect Effects of Natural Disasters

Lack of electricity/power outage

• Closure of dialysis units • Inability to use dialysis machines

Lack of potable water

• Inability to use dialysis machines • Using unsafe drinking water can cause bacterial peritonitis

in peritoneal dialysis patients

Disrupted communication system

• Inability to communicate with dialysis patients • Challenges communicating with dialysis centers and staff

Lack of transportation

• Missed dialysis sessions Blocked roads

• Challenges moving dialysis patients

Dialysis unit closure• Missed dialysis sessions

• Inability to receive dialysis (for patients on hemodialysis)

• Surge of dialysis patients in “host” hemodialysis centers • Cause dialysis patients to receive dialysis treatments at

nonregular dialysis units, affiliate sites or in emergency rooms

Evacuation and disturbed living situation

• Missed dialysis sessions

Direct Physical/Medical Effects of Natural Disasters

Increase in emergency department (ED) utilization

• Patients with dialysis-dependence as a primary diagnosis contributed to higher ED utilization

Increase in hospitalizations

• Hospital admissions for dialysis complaints significantly increased after Hurricane Sandy

Effects of Natural Disasters on Mental Health

Depression

• Positive depression screening was associated with 33% higher risk of all-cause and cardiovascular-related hospitalization and mortality in dialysis patients

Post-traumatic stress disorder (PTSD)

• ESRD patients with PTSD had a higher incidence of all-cause hospitalization or mortality

Other

Dialysis-specific preparedness and awareness

• Dialysis-specific preparedness was associated with a significantly lower incidence of missed dialysis sessions

Early Dialysis

• Patients who received early dialysis were found to have lower odds of ED visits, and hospitalizations in the week of Hurricane Sandy

Acknowledgements

Thank you to Rosie Frasso, capstone mentor; Paul Hunter, librarian, and Robert Zucker, reviewer for your support on this project.

Justification and the Cayman Islands • Hurricane season from June to November each year

• 68 patients on dialysis, 2 dialysis facilities • Depending on the magnitude of a hurricane, dialysis

patients may be flown overseas to receive dialysis treatments

• A better understanding of the effects of natural disasters can inform disaster management for dialysis patients in the Cayman Islands