Hurricane Ida Recovery Could Have Been Much Worse for Dialysis Care

Hurricane Ida didn’t become a full-fledged dialysis disaster in part due to the lessons from Hurricane Katrina, but there are bigger challenges ahead, according to one disaster preparedness expert.

In 2005, Katrina obliterated dialysis services in New Orleans and elsewhere on the Gulf Coast, as Myra Kleinpeter, MD, MPH, a nephrologist at Tulane University School of Medicine in New Orleans, and others have recounted.

Since Ida hit on the anniversary of that historic storm on August 29, New Orleans has remained without power and looks likely to stay that way for possibly weeks more, as all electrical transmission lines into the city were knocked offline. Water access and sewage have also been affected in many areas.

Dialysis patients are the ones most acutely affected by a delay in healthcare, Kleinpeter said in an interview monitored by media relations for the American Kidney Fund, for which she serves on the prevention committee.

“It’s an ‘all hands on deck’ type of thing to try to get the patients dialyzed, and then get them back to their regular state of health, and then make sure they are able to continue living in this community if they so desire,” Kleinpeter told MedPage Today.

On Tuesday, officials urged those who have evacuated to stay where they are. Many of the New Orleans metropolitan area’s some 6,000 dialysis-dependent patients have evacuated, although the exact numbers are not clear.

For those who remain, the number of dialysis facilities able to come online with generator power rose from about three facilities in the first couple of days to roughly two dozen by Monday, Kleinpeter said.

“We are able to dialyze those patients who are in the city now within the time frame” that will keep them out of the hospital, she said. “No one has been turned away. We may have had to have them come back for a different time slot, but we’ve been able to accommodate those patients.”

The city’s electrical provider, Entergy, announced that power would be back on for some 90% of New Orleans customers by the end of Wednesday. Thousands in the hardest hit areas could wait up to 3 weeks longer.

One of the things holding back further reopening of dialysis clinics is lack of staffing, as families are staying away until power returns, Kleinpeter noted. Also, because “the ongoing COVID pandemic and the Delta virus has the hospitals already full, it would be a challenge to take care of more dialysis patients at these hospitals,” she said. “That’s why we’re trying to work with these patients to have them stay where they are. We’re making arrangements for them to be dialyzed in their current community.”

Each natural disaster provides lessons for the future and shows up vulnerabilities in the system, Kleinpeter noted.

Hurricane Katrina alerted the world to the Gulf Coast’s vulnerability to natural disasters, she wrote in a 2007 paper in Hemodialysis International. “This vulnerability was most evident in poor, minority and elderly populations, and patients with chronic diseases requiring treatment such as dialysis.”

By 2008 with Hurricanes Gustav and Ike, those lessons had been applied: “As part of the hurricane preparation, dialysis units reviewed the disaster plans of patients, and patients made preparation for evacuation,” Kleinpeter documented in Advances in Peritoneal Dialysis. “Patients were prepared and experienced minimal interruption of dialysis services. Early planning and evacuation in the face of hurricane landfall — lessons learned from Hurricane Katrina in 2005 — prevented disruption of treatment.”

Now 16 years after Hurricane Katrina, “it’s more organized and the patients aren’t inundating the healthcare facilities,” Kleinpeter noted. “The patients are able to schedule dialysis without getting so ill they now require a hospital admission,” which is what happened after Katrina.

One advantage since then, she pointed out, has been the integration of electronic medical records to allow the sharing of dialysis information across institutions, and more recently, telemedicine as well to follow and coordinate care for end-stage renal disease patients.

There were still some surprises, Kleinpeter said. “We didn’t have enough people leave this time, because this storm [Ida] developed rapidly and moved into the Gulf quickly.”

Unpredictability is becoming an increasing problem, as illustrated by the mass power outages and water supply problems across Texas with the ice storm in February of this year, which created “catastrophic” conditions for dialysis patients.

Holly Kramer, MD, MPH, of Loyola University in Chicago and past president of the National Kidney Foundation, told MedPage Today at the time of the Texas disaster that the lessons are not just for the Gulf Coast region, because global warming is intensifying and shifting the usual weather-related concerns.

“We all need to have disaster planning for dialysis moving forward,” she said. “This just shows it’s not just hurricanes. It could be disasters from severe weather in places that are not used to it. We’re seeing such huge fluctuations in weather patterns across the entire United States. Disaster planning is something we should think about all the time now.”

U.S. Renal Care Chief Operating Officer Andy Johnston argued at the time that the Texas disaster’s impact on dialysis care was more a problem with the utilities and governance than preparedness by the industry: “I feel like we were prepared from a process standpoint but just surprised by how long this lasted, and then the water and power issues that we had to overcome.”

Kleinpeter agreed: Hurricane Katrina prompted building code advances, which resulted in fewer roofs coming off in Ida.

However, “the electrical grid is going to be the big concern, in terms of ensuring public-private cooperation to make sure the infrastructure is hardened enough to withstand these worsening storms,” she said. “They’re going to have some investments in infrastructure all over these hurricane-prone areas to be able to withstand these bigger and stronger storms.”

President Biden cited Hurricane Ida’s effects from New Orleans to New York in his push for the $550 billion infrastructure legislation that he said would improve resilience as such storms continue to come.

Meanwhile, the people making decisions about evacuation need to opt on the side of early evacuation and early warning, Kleinpeter advised.

Last Updated September 08, 2021