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• W2009442612 abstract "To investigate whether Hurricane Katrina's landfall in August 2005 resulted in excess mortality, we conducted a cohort study of patients who started dialysis between January 2003 and late August 2005 and who received treatment at 94 Katrina-affected clinics in the area. Survival, regardless of patient location after the storm, was followed through February 2006. In adjusted Cox proportional hazards models, Hurricane Katrina (time-varying indicator) was not significantly associated with mortality risk for patients from regions of the Gulf Coast affected by Katrina or those from a subset of 40 New Orleans clinics. Subgroup analyses indicated no significant increased mortality risk by race, income status, or dialysis modality. Sensitivity analyses indicated no significant increased mortality risk for patients from clinics closed for 10 days or longer, patients in their first 90 days of dialysis, or patients not evacuated from the affected areas. Patients remaining in the New Orleans area may have been more vulnerable due to age and comorbidities; however, the change in their mortality risk in the month following the storm was not statistically significant. We suggest that disaster-related education for patients must be ongoing, and that each disaster may present a different set of circumstances and challenges that will require unanticipated response efforts. To investigate whether Hurricane Katrina's landfall in August 2005 resulted in excess mortality, we conducted a cohort study of patients who started dialysis between January 2003 and late August 2005 and who received treatment at 94 Katrina-affected clinics in the area. Survival, regardless of patient location after the storm, was followed through February 2006. In adjusted Cox proportional hazards models, Hurricane Katrina (time-varying indicator) was not significantly associated with mortality risk for patients from regions of the Gulf Coast affected by Katrina or those from a subset of 40 New Orleans clinics. Subgroup analyses indicated no significant increased mortality risk by race, income status, or dialysis modality. Sensitivity analyses indicated no significant increased mortality risk for patients from clinics closed for 10 days or longer, patients in their first 90 days of dialysis, or patients not evacuated from the affected areas. Patients remaining in the New Orleans area may have been more vulnerable due to age and comorbidities; however, the change in their mortality risk in the month following the storm was not statistically significant. We suggest that disaster-related education for patients must be ongoing, and that each disaster may present a different set of circumstances and challenges that will require unanticipated response efforts. Disaster planning for health services has gained worldwide salience in the wake of recent natural and manmade disasters and the continuing threat of epidemics and terrorist activities. Any large-scale disaster is likely to interrupt the regular dialysis treatments that are needed by patients with kidney failure. The international renal community has become increasingly aware of the disaster-related challenges that are involved for patients with kidney failure as well as for patients who may incur acute kidney injury.1.Lameire N. Vanholder R. Clement J. et al.The organization of the European Renal Disaster Relief Task Force.Ren Fail. 1997; 19: 665-671Crossref PubMed Scopus (20) Google Scholar,2.Lameire N. Mehta R. Vanholder R. et al.The organization and interventions of the ISN Renal Disaster Relief Task Force.Adv Ren Replace Ther. 2003; 10: 93-99Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar The benefits of the advance planning promoted by the Renal Disaster Relief Task Force established by the International Society of Nephrology were recognized in the 1999 Marmara, Turkey, earthquake and the 2005 Kashmir earthquake.3.Vanholder R. Sever M.S. De Smet M. et al.Intervention of the Renal Disaster Relief Task Force in the 1999 Marmara, Turkey earthquake.Kidney Int. 2001; 59: 783-791Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar,4.Vanholder R. van der Tol A. De Smet M. et al.Earthquakes and crush syndrome casualties: lessons learned from the Kashmir disaster.Kidney Int. 2007; 71: 17-23Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar In the United States, the salience of disaster planning for dialysis patients was significantly increased by the experience of Hurricane Katrina in 2005.5.Kopp J.B. Ball L.K. Cohen A. et al.Kidney patient care in disasters: lessons from the hurricanes and earthquake of 2005.Clin J Am Soc Nephrol. 2007; 2: 814-824Crossref PubMed Scopus (54) Google Scholar Evidence of patients’ increased risk for missed treatments and hospitalization and for psychosocial problems after Hurricane Katrina has identified issues that need continued attention.6.Anderson A.H. Cohen A.J. Kutner N.G. et al.Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina.Kidney Int. 2009; 75: 1202-1208Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 7.Hyre A.D. Cohen A.J. Kutner N. et al.Prevalence and predictors of posttraumatic stress disorder among hemodialysis patients following Hurricane Katrina.Am J Kidney Dis. 2007; 50: 585-593Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 8.Hyre A.D. Cohen A.J. Kutner N. et al.Psychosocial status of hemodialysis patients one year after Hurricane Katrina.Am J Med Sci. 2008; 336: 94-98Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar The question of whether Hurricane Katrina was also associated with ‘excess’ mortality among dialysis patients remains unclear.5.Kopp J.B. Ball L.K. Cohen A. et al.Kidney patient care in disasters: lessons from the hurricanes and earthquake of 2005.Clin J Am Soc Nephrol. 2007; 2: 814-824Crossref PubMed Scopus (54) Google Scholar Hurricane Katrina's landfall on 29 August 2005 forced the evacuation of over one million people from the US Gulf Coast,9.Weisler R.H. Barbee IV, J.G. Townsend M.H. Mental health and recovery in the Gulf Coast after Hurricanes Katrina and Rita.JAMA. 2006; 296: 585-588Crossref PubMed Scopus (144) Google Scholar and extensive flooding multiplied storm damage in the New Orleans metropolitan area. More than 1800 deaths related to Hurricane Katrina had been reported as of July 2006,9.Weisler R.H. Barbee IV, J.G. Townsend M.H. Mental health and recovery in the Gulf Coast after Hurricanes Katrina and Rita.JAMA. 2006; 296: 585-588Crossref PubMed Scopus (144) Google Scholar but the full extent of mortality that was associated with Hurricane Katrina in the general population will probably remain unknown. Estimating excess mortality is difficult in a destabilized population, but the United States Renal Data System (USRDS) tracks patients’ treatment location and outcomes, facilitating an in-depth observation of survival of dialysis-dependent kidney failure patients regardless of their location after Hurricane Katrina. Using updated USRDS Standard Analysis Files (SAFs) released in 2008, we investigated mortality among dialysis patients who were affiliated with clinics in the US Gulf Coast Katrina-affected area and in the New Orleans metropolitan area specifically, using multiple analytic approaches. Of the 94 dialysis clinics that the US federal Centers for Medicare and Medicaid Services (CMS) reported to have been affected by Hurricane Katrina, local End Stage Renal Disease (ESRD) Network officials specified that 55 clinics were located in Louisiana, 30 clinics were located in Mississippi, and 9 clinics were located in Alabama. More than two-thirds of the 55 Louisiana clinics were reported to have closed for ≥10 days after the storm (Table 1). Among the 40 Louisiana clinics located in the New Orleans metropolitan area, 35 (87.5%) clinics were reported to have been closed for ≥10 days.Table 1Katrina-affected dialysis clinics, by stateNumber of clinics reported as Katrina-affected clinicsNumber of clinics (%) reported closed for 10 days or longer within the Katrina-affected geographic areaLouisiana55aForty of these clinics were located in the New Orleans metropolitan area.37 (67%)Mississippi307 (23%)Alabama91 (11%)Total9445 (48%)a Forty of these clinics were located in the New Orleans metropolitan area. Open table in a new tab Table 2 shows crude mortality rates calculated over 6 months for (a) the population of 5865 patients who were receiving dialysis as of 31 August 2005 in the broad Katrina-affected area and in the New Orleans area specifically (n=2212); and (b) the population of 5601 patients who were receiving dialysis in the same broad geographic area and in the New Orleans area specifically (n=2131) as of 31 August 2004, 1 year earlier. Crude mortality rates for these two populations, with deaths counted wherever patients were located after the storm, were generally similar for the 6 months after Hurricane Katrina and the same 6-month period 1 year earlier.Table 2Crude monthly mortality rates for ‘frozen’ patient populations undergoing dialysis in the study areas as of 31 August 2005 and 31 August 2004Total Katrina-affected area, 2005–2006a5865 patients undergoing dialysis as of 31 August 2005.New Orleans metropolitan area separately, 2005–2006b2212 patients undergoing dialysis as of 31 August 2005.Patient-yearscVarying number of days in the month influences patient-years.Patient deathsMortality ratedMortality rate is per 100 patient-years.Patient-yearscVarying number of days in the month influences patient-years.Patient deathsMortality ratedMortality rate is per 100 patient-years.2005 September47512526.31794625.7 October48111624.11814022.1 November4569420.61723721.5 December4629921.41744123.62006 January45112227.11705431.8 February3999323.31504127.3Total Katrina-affected area, 2004–2005e5601 patients undergoing dialysis as of 31 August 2004.New Orleans metropolitan area separately, 2004–2005f2131 patients undergoing dialysis as of 31 August 2004.2004 September45511525.31734023.1 October4608418.31753721.1 November43610423.91654829.1 December43210323.81594628.92005 January42110625.21554327.7 February3719024.81353425.2a 5865 patients undergoing dialysis as of 31 August 2005.b 2212 patients undergoing dialysis as of 31 August 2005.c Varying number of days in the month influences patient-years.d Mortality rate is per 100 patient-years.e 5601 patients undergoing dialysis as of 31 August 2004.f 2131 patients undergoing dialysis as of 31 August 2004. Open table in a new tab Cox proportional hazards analysis was used to investigate survival from the start of treatment for 5031 patients who began dialysis between 1 January 2003 and 29 August 2005 and who received treatment in Katrina-affected dialysis clinics before the storm. Table 3 shows demographic and clinical characteristics of these patients. The average patient age at the start of treatment was 61 years, and the cohort was almost equally divided between men and women. Fewer than half of patients in the cohort were white. Over one-fourth of the cohort had Medicaid coverage, an indicator of lower income status. On average, one documented cardiovascular condition was present at the start of treatment. At initiation of dialysis, the average hemoglobin was 9.9 g per 100 ml and the average serum albumin was 3.2 g per 100 ml. Almost half of the cohort had developed kidney failure as a result of diabetes. Over 90% of patients used hemodialysis (HD) as their initial treatment modality; the remainder started on peritoneal dialysis (PD). The characteristics of the 2238 patient subset who received dialysis treatment in the New Orleans clinics before Hurricane Katrina matched the characteristics of all patients in the larger Katrina-affected area (n=5031) quite closely. Compared with the overall population of patients who started dialysis during the same time period in the United States (data not shown), patients in the Katrina-affected clinics were less likely to be white (42% white vs 65% white in the overall US dialysis population) and were younger by 2 years on average at the start of dialysis, reflecting black patients’ younger average age at dialysis initiation.10.Kutner N.G. Zhang R. Brogan D. Race, gender, and incident dialysis patients’ reported health status and quality of life.J Am Soc Nephrol. 2005; 16: 1440-1448Crossref PubMed Scopus (33) Google Scholar No other differences were evident between the Katrina-affected study populations and the overall population of patients starting dialysis in the United States.Table 3Demographic and clinical characteristics of dialysis patients included in Cox proportional hazards modelsCharacteristicTotal Katrina area dialysis patients (n=5031)New Orleans area dialysis patient subset (n=2238)Age at treatment start (years; mean (s.d.))61.2 (16.1)61.8 (16.1)Male (%)5153White race (%)4243Medicaid coverage (%)3026Number of cardiovascular conditionsaCardiovascular conditions include congestive heart failure, coronary artery disease, myocardial infarction, cardiac arrest, dysrhythmia, cerebral vascular disease, and/or peripheral vascular disease. (mean (s.d.))1.0 (1.2)1.0 (1.2)Hemoglobin (g per 100 ml; mean (s.d.))bData available for 4211 Katrina area patients and for 2077 New Orleans area patients.9.9 (1.8)9.9 (1.8)Serum albumin (g per 100 ml; mean (s.d.))cData available for 3217 Katrina area patients and for 1490 New Orleans area patients.3.2 (0.7)3.2 (0.8)Diabetic ESRD (%)4846COPD (%)77Non-ambulatory (%)65Started on HD (%)9395COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease; HD, hemodialysis.a Cardiovascular conditions include congestive heart failure, coronary artery disease, myocardial infarction, cardiac arrest, dysrhythmia, cerebral vascular disease, and/or peripheral vascular disease.b Data available for 4211 Katrina area patients and for 2077 New Orleans area patients.c Data available for 3217 Katrina area patients and for 1490 New Orleans area patients. Open table in a new tab COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease; HD, hemodialysis. Multivariable Cox proportional hazards analyses (Table 4) indicated that Hurricane Katrina was not associated with an increased risk for all-cause mortality among all 5031 patients who received dialysis in the broad Katrina-affected area before the hurricane (hazard ratio (HR): 0.98; 95% confidence interval (95% CI): 0.86–1.11; P=0.75) or among the subset of 2238 patients who received dialysis treatment in the New Orleans area before the hurricane (HR: 0.90; 95% CI: 0.74–1.09; P=0.28). Significant predictors of increased mortality risk included older patient age, male gender, white race, lower income status, number of cardiovascular conditions, non-ambulatory status, and HD as initial dialysis modality.Table 4Multivariable Cox proportional hazards models predicting dialysis patient mortality riskTotal Katrina-area patients (n=5031)New Orleans area patient subset (n=2238)Risk factorAll-cause mortality hazard ratio (95% CI)P-valueAll-cause mortality hazard ratio (95% CI)P-valueAge at treatment start (years)1.03 (1.03, 1.04)<0.00011.03 (1.03, 1.04)<0.0001Male gender1.20 (1.09, 1.32)0.00031.09 (0.95, 1.25)0.24White race1.31 (1.18, 1.45)<0.00011.25 (1.08, 1.45)0.003Medicaid coverage1.49 (1.34, 1.66)<0.00011.77 (1.51, 2.07)<0.0001Number of cardiovascular conditionsaCardiovascular conditions include congestive heart failure, coronary artery disease, myocardial infarction, cardiac arrest, dysrhythmia, cerebral vascular disease, and/or peripheral vascular disease.1.11 (1.07, 1.16)<0.00011.04 (0.98, 1.10)0.17Diabetic ESRD0.93 (0.84, 1.02)0.130.94 (0.82, 1.08)0.39COPD1.10 (0.93, 1.29)0.261.09 (0.85, 1.40)0.51Non-ambulatory1.90 (1.62, 2.24)<0.00011.88 (1.48, 2.38)<0.0001HD1.96 (1.50, 2.56)<0.00012.08 (1.35, 3.22)0.0009KatrinabTime-varying indicator.0.98 (0.86, 1.11)0.750.90 (0.74, 1.09)0.28CI, confidence interval; COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease; HD, hemodialysis.a Cardiovascular conditions include congestive heart failure, coronary artery disease, myocardial infarction, cardiac arrest, dysrhythmia, cerebral vascular disease, and/or peripheral vascular disease.b Time-varying indicator. Open table in a new tab CI, confidence interval; COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease; HD, hemodialysis. Additional Cox proportional hazards models restricted to patients for whom serum albumin and hemoglobin values were available in addition to all other covariates (n=3018 Katrina-area patients and n=1447 New Orleans area patients) gave similar results (data not shown). In these models, Hurricane Katrina was not a significant predictor of mortality risk among Katrina-area patients (HR: 0.98; 95% CI: 0.83–1.15; P=0.80) or among the New Orleans patient subset (HR: 1.06; 95% CI: 0.84–1.34; P=0.61). Serum albumin was a significant predictor of mortality risk in both models. Lower hemoglobin was a borderline significant predictor of increased mortality risk in the model that included patients who received dialysis in the broad Katrina-affected area before the storm. For the Katrina-area study population (n=5031), HRs for Katrina-related mortality risk in the first 30 days, 31–60 days, and 61–183 days after the storm were 1.06 (95% CI: 0.83–1.35; P=0.65), 0.96 (95% CI: 0.74–1.25; P=0.77), and 0.96 (95% CI: 0.82–1.12; P=0.60), respectively. For the New Orleans metropolitan area patient subset (n=2238), HRs for Katrina-related mortality risk in the first 30 days, 31–60 days after, and 61–180 days after the storm were 1.10 (95% CI: 0.78–1.56; P=0.59), 0.64 (95% CI: 0.40–1.03; P=0.07), and 0.91 (95% CI: 0.72–1.14; P=0.41). We conducted several subgroup analyses for the Katrina-area study population to examine the effect of Hurricane Katrina on mortality risk in subgroups with selected patient characteristics. We observed no significant effects of Hurricane Katrina among black patients or lower income (Medicaid coverage) patients. This was also true with regard to dialysis modality; the Katrina-related HR among HD patients was 0.98 (95% CI: 0.86–1.12; P=0.78), and the Katrina-related HR among PD patients was 0.94 (95% CI: 0.49–1.83; P=0.86). In our first sensitivity analysis, when the study population was restricted to 2551 patients affiliated with the 45 clinics that were reported closed for ≥10 days, the HR for mortality risk associated with Hurricane Katrina was 0.98 (95% CI: 0.83–1.17; P=0.86). A second sensitivity analysis that included 4646 patients indicated that the mortality risk associated with Hurricane Katrina was not increased during patients’ first 90 days on dialysis (HR: 1.01; 95% CI: 0.63–1.63; P=0.97). Finally, a sensitivity analysis to restrict the Katrina effect only to the period when patients remained in the broad Katrina-affected area (but not after they transferred to a clinic outside this area) yielded a HR of 0.99 (95% CI: 0.86–1.14; P=0.88) for the Katrina indicator. For the subset of patients who remained in the New Orleans metropolitan area, this HR was 1.03 (95% CI: 0.82–1.30; P=0.81). Restricting the follow-up period to the first 30 days after Hurricane Katrina, this HR for the patient subset remaining in New Orleans was 1.15 (95% CI: 0.78–1.68; P=0.49). Determining whether dialysis patients incurred ‘excess’ mortality in association with Hurricane Katrina is challenging. Mortality rates are subject to seasonal variation. In addition, comparison of rates across time is not meaningful when there is a marked change in the structure of the population. In Katrina-affected clinics, there was a dramatic decrease in patient-years at risk in the month after Hurricane Katrina, reflecting the exodus of a large number of patients from the area. For example, the number of patient-years at risk, the denominator in the crude mortality rate, declined from 185 in August 2005 to 85 in September 2005 for clinics in the New Orleans metropolitan area. A large number of patients displaced from Katrina-area clinics went to dialysis clinics in Baton Rouge, Louisiana; Houston, Texas; and Atlanta, Georgia. As a simple comparison of monthly mortality rates was not meaningful due to the markedly reduced size of the dialysis population remaining in the area after the storm, we calculated crude mortality rates for a ‘frozen’ population of patients (i.e., all patients treated in Katrina-affected clinics as of 31 August 2005), counting patient deaths wherever they occurred, and compared these rates with those calculated similarly for a frozen population 1 year earlier. We found that post-storm patient-level crude mortality was generally similar to rates observed for the patient population present in the study areas at the same time period in the preceding year (Table 2). Consistent with this observation, adjusted Cox proportional hazards models did not show significantly higher mortality risk associated with Hurricane Katrina. We examined characteristics of the reduced dialysis population that remained in the subset of New Orleans metropolitan area clinics through the month of September 2005, compared with characteristics of patients who transferred out of the area between 22 August 2005 (1 week before the storm) and 30 September 2005. Those who remained were older at the start of treatment (mean age: 58.7 vs 53.4 years; P<0.0001), were more likely to have diabetes as the primary cause of their renal failure (48 vs 40%; P=0.0009), and began dialysis with a larger number of cardiovascular comorbid conditions (P=0.0004). Patients who remained in the New Orleans area may have been more vulnerable due to older age and medical comorbidities; nonetheless, as reported above, their Katrina-related mortality risk in the month after the storm was not statistically significant (HR: 1.15; 95% CI: 0.78–1.68). It is important to consider potential limitations of our study. For the primary analysis, we did not have information about parameters such as dialysis adequacy that may have influenced patient mortality. The interpretation of the proportional hazards assumption is not straightforward when time-varying indicators are included in the Cox model. We do, however, report HRs for three time intervals after Hurricane Katrina (the first month, the second month, and an additional 3 months), none of which were statistically significant. The CMS designation of ‘Katrina-affected’ clinics, which we used in this study, served to define a population at risk. The extent of individual clinic disruption ranged from power outages to severe structural damage and even permanent closing. The information we received from the ESRD Network offices indicated that almost half of the 94 clinics (n=45) were closed for ≥10 days, and we examined patients’ mortality risk in a sensitivity analysis that included these 45 clinics. Although the ESRD Networks supplied information about the approximate time that clinics remained closed, they stressed that their focus had been on patient tracking and care management rather than on detailed record-keeping about clinic status. Regardless of the specific experience of each of the 94 Katrina-affected clinics, dialysis patients in the geographic area served by these clinics were at risk when Hurricane Katrina impacted the area. Mortality surveillance by the Centers for Disease Control includes not only deaths directly related to the physical force of a hurricane but also indirectly related deaths precipitated by unsafe or unhealthy conditions during the evacuation phase, the hurricane itself, and the post hurricane/cleanup phase.11.Centers for Disease Control Mortality associated with Hurricane Katrina—Florida and Alabama, August–October 2005.MMWR Morb Mortal Wkly Rep. 2006; 55 (no. 9; March 10): 239-242PubMed Google Scholar The USRDS database is continuously updated, and it is unlikely that ascertainment of dialysis patients’ deaths after Hurricane Katrina remains incomplete. At the same time, the database contains little cause of death information for patients who died from 30 August 2005 to 30 September 2005, following the storm making landfall on 29 August 2005. Cause of death information is available for only 9 of the 49 patients affiliated with New Orleans clinics who had death dates from 30 August 2005 through 29 September 2005, whereas cause of death information is available for 45 of the 52 patients affiliated with New Orleans clinics who had death dates during the same number of days 2 months earlier (29 June 2005 through 29 July 2005). Medical record-keeping and reporting were disrupted in the time period immediately after Hurricane Katrina, and the value of electronic medical records has been emphasized in subsequent discussions of needed health system changes.12.Voelker R. In post-Katrina New Orleans, efforts under way to build better health care.JAMA. 2006; 296: 1333-1334Crossref PubMed Scopus (3) Google Scholar Apart from the question of whether Hurricane Katrina was associated with excess mortality among dialysis patients, other serious outcomes must be acknowledged. As reported in a previous study, we conducted telephone interviews during April to October 2006 with 391 survivors who had been receiving HD at nine New Orleans clinics before Hurricane Katrina. The patients we interviewed more often reported symptoms of post-traumatic stress disorder (23.8%),7.Hyre A.D. Cohen A.J. Kutner N. et al.Prevalence and predictors of posttraumatic stress disorder among hemodialysis patients following Hurricane Katrina.Am J Kidney Dis. 2007; 50: 585-593Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar compared with dialysis patients generally (17%).13.Tagay S. Kribben A. Hohenstein A. et al.Posttraumatic stress disorder in hemodialysis patients.Am J Kidney Dis. 2007; 50: 594-601Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Among the 391 Hurricane Katrina survivors in our previous study who reported having missed more than two HD treatments (16.6% of those interviewed), there was a significantly increased risk of subsequent hospitalization.6.Anderson A.H. Cohen A.J. Kutner N.G. et al.Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina.Kidney Int. 2009; 75: 1202-1208Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar It has been suggested that greater use of PD therapy by patients in disaster-prone areas could decrease the likelihood of treatment interruptions.14.McCall B. Expecting the worst: how disaster management is taking the kidney community by storm.Nephrol News Issues. 2007; 21 (44, 46, 50)PubMed Google Scholar It should be noted, however, that maintaining and transporting adequate PD supplies, and maintaining sterile conditions for PD exchanges, could be very difficult in an environment such as the one created by Hurricane Katrina. The acute and chronic effects of Hurricane Katrina posed a severe test for delivery of care by the renal community, as has been extensively documented.5.Kopp J.B. Ball L.K. Cohen A. et al.Kidney patient care in disasters: lessons from the hurricanes and earthquake of 2005.Clin J Am Soc Nephrol. 2007; 2: 814-824Crossref PubMed Scopus (54) Google Scholar, 15.Clemons G.P. A matter of time? Learn from the past, prepare for the future.in: National Disaster Summit. First Annual Meeting of the Kidney Community Emergency Response Coalition (KCERC), Washington, DC19 January 2006Google Scholar, 16.Kenny R.J. Emergency preparedness concepts for dialysis facilities: reawakened after Hurricane Katrina.Clin J Am Soc Nephrol. 2007; 2: 809-813Crossref PubMed Scopus (18) Google Scholar, 17.ESRD Network 13. 2005 Annual Report. Available at http://www.network13.org/Data_Reports/Annual_Reports/2005/NW13_AR_2005.pdf; accessed on September 3 2008.Google Scholar Communication maintenance and optimal functioning of the dialysis infrastructure during a disaster are complicated challenges.16.Kenny R.J. Emergency preparedness concepts for dialysis facilities: reawakened after Hurricane Katrina.Clin J Am Soc Nephrol. 2007; 2: 809-813Crossref PubMed Scopus (18) Google Scholar,17.ESRD Network 13. 2005 Annual Report. Available at http://www.network13.org/Data_Reports/Annual_Reports/2005/NW13_AR_2005.pdf; accessed on September 3 2008.Google Scholar CMS and ESRD Network representatives established daily conference calls to identify solutions to multiple problems affecting provision of services to patients, including finding transportation and housing for patients and staff, and assisting clinics to restore power and safe water supplies. Dialysis units extended their hours and added additional shifts to provide routine dialysis to patients displaced from their home clinics, and renal professionals orchestrated care for dialysis patients living in shelters. New clinics were able to open after emergency certification by CMS. All of this activity requires intense effort on the part of care providers. As Sever et al.18.Sever M.S. Erek E. Vanholder R. et al.Features of chronic hemodialysis practice after the Marmara earthquake.J Am Soc Nephrol. 2004; 15: 1071-1076Crossref PubMed Scopus (44) Google Scholar observed with respect to provision of chronic HD treatments to patients after the Marmara earthquake, pre-disaster plans should include detailed consideration of how to maximize efficiency of available staff, who are likely to be asked to cope with a larger number of patients as compared with the pre-disaster period. Existing disaster plans and ongoing problem-solving communication may have helped dialysis patients survive Hurricane Katrina and its aftermath. If possible," @default.
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• W2009442612 title "Effect of Hurricane Katrina on the mortality of dialysis patients" @default.
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