Hurricanes and Mortality among Patients Receiving Dialysis. Issue 9 (September 2022)

• Record Type: Journal Article
• Authors: Blum, Matthew F.; Feng, Yijing; Anderson, G. Brooke; Segev, Dorry L.; McAdams-DeMarco, Mara; Grams, Morgan E.
• Is Part Of: Journal of the American Society of Nephrology. Volume 33:Issue 9(2022)
• Page Start: 1757
• Page End: 1766
• Publication Date: 2022-09
• Subjects: mortality risk -- extreme weather -- tropical cyclones -- hurricanes -- climate change -- dialysis -- USRDS
• DOI: 10.1681/ASN.2021111520
• Languages: English
• ISSNs: 1046-6673

Abstract

Significance Statement: Hurricanes are disruptive weather events that can impede the provision of dialysis. The mortality risk for patients who are dialysis dependent and exposed to hurricanes is unknown. This study describes the association between hurricane exposure and 30-day mortality in the eastern United States from 1997 to 2017. Exposure to a hurricane with peak local wind speeds of hurricane force (≥64 knots) was associated with a higher mortality risk that peaked immediately after the hurricane and waned over time. This suggests that patients who are dialysis dependent are vulnerable during hurricanes, and highlights the need to safeguard this population, especially amidst the predicted increased hurricane intensity in the setting of anthropogenic climate change. Visual Abstract: Abstract : Background: Hurricanes are severe weather events that can disrupt power, water, and transportation systems. These disruptions may be deadly for patients requiring maintenance dialysis. We hypothesized that the mortality risk among patients requiring maintenance dialysis would be increased in the 30 days after a hurricane. Methods: Patients registered as requiring maintenance dialysis in the United States Renal Data System who initiated treatment between January 1, 1997 and December 31, 2017 in one of 108 hurricane-afflicted counties were followed from dialysis initiation until transplantation, dialysis discontinuation, a move to a nonafflicted county, or death. Hurricane exposure was determined as a tropical cyclone event with peak local wind speeds ≥64 knots in the county of a patient's residence. The risk of death after the hurricane was estimated using time-varying Cox proportional hazards models. Results: The median age of the 187, 388 patients was 65 years (IQR, 53–75) and 43.7% were female. There were 27 hurricanes and 105, 398 deaths in 529, 339 person-years of follow-up on dialysis. In total, 29, 849 patients were exposed to at least one hurricane. Hurricane exposure was associated with a significantly higher mortality after adjusting for demographic and socioeconomic covariates (hazard ratio, 1.13; 95% confidence interval, 1.05 to 1.22). The association persisted when adjusting for seasonality. Conclusions: Patients requiring maintenance dialysis have a higher mortality risk in the 30 days after a hurricane.