Preparing patients diagnosed with ESKD for climate-driven Atlantic hurricanes

Persons diagnosed with end-stage kidney disease (ESKD) who require in-center hemodialysis are among the most vulnerable patients in this era of compounding disasters. Climate change is making Atlantic hurricanes stronger and wetter, with a tendency to stall at the time of landfall, resulting in more powerful and damaging storms that may disrupt dialysis and clinical services for ESKD patients. COVID-19 and airborne disease transmission complicates hurricane evacuation and sheltering. This complex risk landscape requires tailored approaches to disaster preparedness for patients, clinicians, and dialysis providers. We interviewed dialysis providers about their 2022 Hurricane Ian experience. We developed a survey that examines ESKD patients’ hurricane threat appraisal, adaptation appraisal, hurricane experience, and disaster preparedness (household preparedness, COVID-19 prevention, ESKD-specific preparedness). Dialysis providers have developed elaborate strategies for warning, preparing, and predialyzing their patients when a hurricane is approaching. They prestage tanker trucks with pure water and with diesel fuel to power the auxiliary generators to provide electricity. Among 232 dialysis centers closed on the day when Hurricane Ian made landfall, 50% were operational 2 days poststorm and 99% were operational 5 days poststorm. Patient preparedness survey results will be presented. Compared with other medically vulnerable patient populations, patients with ESKD are disaster-prepared and supported by their network of dialysis providers to maintain or rapidly restart their life-sustaining treatments. Multilayered, climate-driven disaster risks amplify the urgency for developing effective approaches for safeguarding patients with ESKD, their caregivers, their providers, and their care systems.