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Dialysis Care for US Military Veterans in Puerto Rico during the 2017 Atlantic Hurricane Season

Published online by Cambridge University Press:  06 May 2022

Lilia R. Lukowsky ,
Aram Dobalian ,
Kamyar Kalantar-Zadeh  and
Claudia Der-Martirosian
Lilia R. Lukowsky*
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA
Aram Dobalian
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
Kamyar Kalantar-Zadeh
Affiliation:
Division of Nephrology and Hypertension, UCI School of Medicine, Orange, CA, USA
Claudia Der-Martirosian
Affiliation:
Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA, USA
*
Corresponding author: Lilia Lukowsky, Email: Lilia.Lukowsky@va.gov.
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Abstract

Objectives:

Patients with end stage kidney disease (ESKD) are at higher risk for increased mortality and morbidity due to disaster-related disruptions to care. We examine effects of Hurricanes Irma and Maria on access to dialysis care for US Department of Veterans Affairs (VA) ESKD patients in Puerto Rico.

Methods:

A retrospective, longitudinal cohort study was conducted among VA patients with at least 1 dialysis-related encounter between September 6, 2016, and September 5, 2018. The annual number of dialysis encounters, visits to an emergency department (ED), and the number of deaths pre- and post-hurricanes were compared. A random effects logistic regression model for correlated binary outcomes was fitted for predictors of mortality. Chi-square tests were for differences between pre- and post-hurricane visits.

Results:

The number of ED visits increased in post-hurricane period (1172 [5.7%] to 1195 [6.6%]; P < 0.001). ESKD-related ED visits increased from 200 (0.9%) to 227 (1.3%) (P < 0.05). Increase in mortality was associated with age (OR = 1.66; CI: 1.23-2.17), heart failure (OR = 2.07; CI: 1.26-3.40), chronic pulmonary disease (OR = 3.26; CI: 1.28-8.28), and sepsis (OR = 3.16; CI: 1.89-5.29).

Conclusions:

There was an increase in dialysis services at the San Juan VA Medical Center post-Irma/Maria, and access to dialysis care at the non-VA clinics was limited. The role of VA dialysis centers in providing care during disasters warrants further investigation.

Keywords

dialysisdisastersend stage kidney diseasehurricanesPuerto Ricoveterans
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 17 , 2023 , e187
Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.
Copyright
© US Department of Veterans Affairs, 2022.

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References

Murakami, N, Siktel, HB, Lucido, D, et al. Disaster preparedness and awareness of patients on hemodialysis after Hurricane Sandy. Clin J Am Soc Nephrol. 2015;10(8):1389-1396.CrossRefGoogle ScholarPubMed
Lempert, KD, Kopp, JB. Hurricane Sandy as a kidney failure disaster. Am J Kidney Dis. 2013;61(6):865.CrossRefGoogle ScholarPubMed
Bonilla-Felix, M, Suarez-Rivera, M. Disaster management in a nephrology service: lessons learned from Hurricane Maria. Blood Purif. 2019;47(1-3):199-204.CrossRefGoogle Scholar
Lempert, KD, Kopp, JB. Renal failure patients in disasters. Disaster Med Public Health Prep. 2019;13(4):782-790.CrossRefGoogle ScholarPubMed
Fukagawa, M. Nephrology in earthquakes: sharing experiences and information. Clin J Am Soc Nephrol. 2007;2(4):803-808.CrossRefGoogle ScholarPubMed
Kopp, JB, Ball, LK, Cohen, A, et al. Kidney patient care in disasters: lessons from the hurricanes and earthquake of 2005. Clin J Am Soc Nephrol. 2007;2(4):814-824.CrossRefGoogle ScholarPubMed
Kenney, RJ. Emergency preparedness concepts for dialysis facilities: reawakened after Hurricane Katrina. Clin J Am Soc Nephrol. 2007;2(4):809-813.CrossRefGoogle ScholarPubMed
Anderson, AH, Cohen, AJ, Kutner, NG, et al. Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina. Kidney Int. 2009;75(11):1202-1208.CrossRefGoogle ScholarPubMed
Howard, D, Zhang, R, Huang, Y, Kutner, N. Hospitalization rates among dialysis patients during Hurricane Katrina. Prehosp Disaster Med. 2012;27(4):325-329.CrossRefGoogle ScholarPubMed
Lukowsky, LR, Dobalian, A, Goldfarb, DS, et al. Access to care for VA dialysis patients during Superstorm Sandy. J Prim Care Community Health. 2019;10:2150132719863599.CrossRefGoogle ScholarPubMed
Santoro, D, Benedetto, F, Mondello, P, et al. Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis. 2014;7:281-294.CrossRefGoogle ScholarPubMed
Yan, Y, Ye, D, Yang, L, et al. A meta-analysis of the association between diabetic patients and AVF failure in dialysis. Renal Fail. 2018;40(1):379-383.CrossRefGoogle ScholarPubMed
Suri, RS, Larive, B, Sherer, S, et al. Risk of vascular access complications with frequent hemodialysis. J Am Soc Nephrol. 2013;24(3):498-505.CrossRefGoogle ScholarPubMed
Ellingson, KD, Palekar, RS, Lucero, CA, et al. Vascular access hemorrhages contribute to deaths among hemodialysis patients. Kidney Int. 2012;82(6):686-692.CrossRefGoogle ScholarPubMed
Astor, BC, Eustace, JA, Powe, NR, et al. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol. 2005;16(5):1449-1455.CrossRefGoogle Scholar
Eslami, MH, Zhu, CK, Rybin, D, et al. Simple predictive model of early failure among patients undergoing first-time arteriovenous fistula creation. Ann Vasc Surg. 2016;35:46-52.CrossRefGoogle ScholarPubMed
Lopez-Cardalda, G, Lugo-Alvarez, M, Mendez-Santacruz, S, et al. Learnings of the complete power grid destruction in Puerto Rico by Hurricane Maria. 2018 IEEE International Symposium on Technologies for Homeland Security (HST); October 23-24, 2018; Woburn, MA, USA. DOI: 10.1109/THS.2018.8574120.CrossRefGoogle Scholar
FEMA. 2017 Hurricane Season FEMA After-Action Report. Published July 12, 2018. Accessed April 7, 2022. https://www.fema.gov/sites/default/files/2020-08/fema_hurricane-season-after-action-report_2017.pdf Google Scholar
Rodríguez-Díaz, CE. Maria in Puerto Rico: natural disaster in a colonial archipelago. Am J Public Health. 2018;108(1):30-32.CrossRefGoogle Scholar
Alcorn, T. Puerto Rico’s health system after Hurricane Maria. Lancet. 2017;390(10103):e24.CrossRefGoogle ScholarPubMed
Kuss, O. How to use SAS for logistic regression with correlated data. Proceedings of the 27th Annual SAS Users Group International Conference; 2002. 2002. https://support.sas.com/resources/papers/proceedings/proceedings/sugi27/p261-27.pdf Google Scholar
Lalonde, TL, Nguyen, AQ, Yin, J, et al. Modeling correlated binary outcomes with time-dependent covariates. J Data Sci. 2013;11(4): 715-738.CrossRefGoogle Scholar
Norris, K, Harford, R, Flaque, J, et al. SUN-192 missed hemodialysis treatments and mortality in Puerto Rico before and after the 2017 hurricanes: a medium dialysis organization experience. Kidney Int Rep. 2020;5(3):S279-S280.CrossRefGoogle Scholar
Lin, C-J, Pierce, LC, Roblin, PM, Arquilla, B. Impact of Hurricane Sandy on hospital emergency and dialysis services: a retrospective survey. Prehosp Disaster Med. 2014;29(04):374-379.CrossRefGoogle Scholar
Martín, Y, Cutter, S, Li, Z, et al. Using geotagged tweets to track population movements to and from Puerto Rico after Hurricane Maria. Popul Environ. 2020;42:4-27.CrossRefGoogle Scholar
Hick, J. Evacuating, treating, and tracking people on dialysis: lessons learned from the 2017 hurricane season. Exchange. 2018;1(6):12-14.Google Scholar
Mayer, CC, Matschkal, J, Sarafidis, PA, et al. Association of ambulatory blood pressure with all-cause and cardiovascular mortality in hemodialysis patients: effects of heart failure and atrial fibrillation. J Am Soc Nephrol. 2018;29(9):2409-2417.CrossRefGoogle ScholarPubMed
Kalantar-Zadeh, K, Abbott, KC, Salahudeen, AK, et al. Survival advantages of obesity in dialysis patients. Am J Clin Nutr. 2005;81(3):543-554.CrossRefGoogle ScholarPubMed
Saran, R, Robinson, B, Abbott, KC, et al. US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2017;69(3):A7-A8.CrossRefGoogle ScholarPubMed