Early Dialysis and Adverse Outcomes After Hurricane Sandy

Background Hemodialysis patients have historically experienced diminished access to care and increased adverse outcomes after natural disasters. Although “early dialysis” in advance of a storm is promoted as a best practice, evidence for its effectiveness as a protective measure is lacking. Building on prior work, we examined the relationship between the receipt of dialysis ahead of schedule before the storm (also known as early dialysis) and adverse outcomes of patients with end-stage renal disease in the areas most affected by Hurricane Sandy. Study Design Retrospective cohort analysis, using claims data from the Centers for Medicare & Medicaid Services Datalink Project. Setting & Participants Patients receiving long-term hemodialysis in New York City and the state of New Jersey, the areas most affected by Hurricane Sandy. Factor Receipt of early dialysis compared to their usual treatment pattern in the week prior to the storm. Outcomes Emergency department (ED) visits, hospitalizations, and 30-day mortality following the storm. Results Of 13,836 study patients, 8,256 (60%) received early dialysis. In unadjusted logistic regression models, patients who received early dialysis were found to have lower odds of ED visits (OR, 0.75; 95% CI, 0.63-0.89; P = 0.001) and hospitalizations (OR, 0.77; 95% CI, 0.65-0.92; P = 0.004) in the week of the storm and similar odds of 30-day mortality (OR, 0.80; 95% CI, 0.58-1.09; P = 0.2). In adjusted multivariable logistic regression models, receipt of early dialysis was associated with lower odds of ED visits (OR, 0.80; 95% CI, 0.67-0.96; P = 0.01) and hospitalizations (OR, 0.79; 95% CI, 0.66-0.94; P = 0.01) in the week of the storm and 30-day mortality (OR, 0.72; 95% CI, 0.52-0.997; P = 0.048). Limitations Inability to determine which patients were offered early dialysis and declined and whether important unmeasured patient characteristics are associated with receipt of early dialysis. Conclusions Patients who received early dialysis had significantly lower odds of having an ED visit and hospitalization in the week of the storm and of dying within 30 days.