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Yang F, Zhu L, Li S. Treatment-related Problems and Countermeasures for Patients Undergoing Maintenance Hemodialysis Following Tropical Cyclones: A Scoping Review. Disaster Med Public Health Prep 2024; 18:e117. [PMID: 39291376 DOI: 10.1017/dmp.2024.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND Patients undergoing maintenance hemodialysis face heightened vulnerability during disasters like tropical cyclones, yet there is sparse research on their treatment-related challenges and countermeasures. This scoping review aims to highlight the issues maintenance hemodialysis patients encounter following tropical cyclones. METHODS A systematic scoping review of 19 articles from 2000 to 2023 was conducted, evaluating eligibility against predefined criteria. RESULTS Hemodialysis patients encounter substantial challenges during and after tropical cyclones in the United States, Puerto Rico, Australia, and Taiwan. Thematic analysis identified 3 themes related to "challenges" (Hemodialysis health-related challenges, socially relevant challenges, and challenges of management inefficiencies). "Recommendations" comprised 4 themes and 4 phases across the "mitigation phase" (fortifying healthcare infrastructure and mobilizing community-focused risk mitigation initiatives), "preparedness" (emergency plan development, training, and patient education), "response" (activation of emergency plans and providing emergency healthcare services), and "recovery" (intersectoral collaboration for recovery and rebuilding). CONCLUSION This scoping review underscores challenges confronted by patients undergoing maintenance hemodialysis post-tropical cyclones, highlighting the urgent need for targeted strategies to ensure the continuity of dialysis care during and after such disasters.
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Affiliation(s)
- Fengxue Yang
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
| | - Linfang Zhu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Sijian Li
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hum Hung, China
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Abdellatif DA. Social and humanitarian issues in nephrology and hypertension. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00186. [PMID: 39258991 DOI: 10.1097/mnh.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
PURPOSE OF REVIEW Chronic kidney disease and hypertension, two widely prevalent conditions worldwide, present an urgent and pressing need for immediate action. The review describes how social conditions and humanitarian issues can influence hypertension and kidney disease. RECENT FINDINGS Undoubtedly, social determinants of health (SDoH) are key influencers in the development of many noncommunicable diseases, including hypertension and kidney disease. Healthcare professionals, including public health workers, play a crucial role in addressing these issues. Poverty, low education level, poor nutrition, housing, exposure to environmental hazards, and stress-related disorders are all factors that can be addressed, either directly or indirectly, through improved awareness and access to proper healthcare services. Besides personal factors, national, regional, or global factors cause serious apprehension. Disasters, whether natural or man-made, can lead to significant aftermaths on the healthy person and certainly on kidney disease and hypertensive patients. A Global Overview Report, 2023 turned out to be one of the most violent years since the end of the Cold War. In 2023, 59 state-based conflicts were recorded in 34 countries, the highest number registered since 1946. The wars in Ukraine and Gaza were the primary contributors with a significant impact on the kidney population, especially people living on dialysis and transplantation patients. They also yielded many refugees or displaced persons with ongoing suffering. SUMMARY It is crucial to recognize that social and humanitarian conditions can quickly exacerbate the health of vulnerable populations, particularly those with noncommunicable diseases like hypertension and chronic kidney disease. These patients, who often require continuous follow-up, especially those on dialysis, are particularly vulnerable during difficult times. Their lives depend on uninterrupted access to dialysis or transplantation medications, making the need for special attention and care more pressing. Further research and advocacy are needed to address these issues and ensure the health and well being of these populations.
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Blum MF, Feng Y, Tuholske CP, Kim B, McAdams DeMarco MA, Astor BC, Grams ME. Extreme Humid-Heat Exposure and Mortality Among Patients Receiving Dialysis. Am J Kidney Dis 2024:S0272-6386(24)00808-4. [PMID: 38876272 DOI: 10.1053/j.ajkd.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 06/16/2024]
Abstract
RATIONALE & OBJECTIVE Exposure to extreme heat events has been linked to increased morbidity and mortality in the general population. Patients receiving maintenance dialysis may be vulnerable to greater risks from these events, but this is not well understood. We characterized the association of extreme heat events and the risk of death among patients receiving dialysis in the United States. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Data from the US Renal Data System were used to identify adults living in US urban settlements prone to extreme heat who initiated maintenance dialysis between 1997 and 2016. EXPOSURE An extreme heat event, defined as a time-updated heat index (a humid-heat metric) exceeding 40.6°C for≥2 days or 46.1°C for≥1day. OUTCOME Death. ANALYTICAL APPROACH Cox proportional hazards regression to estimate the elevation in risk of death during a humid-heat event adjusted for age, sex, year of dialysis initiation, dialysis modality, poverty level, and climate region. Interactions between humid-heat and these same factors were explored. RESULTS Among 945,251 adults in 245 urban settlements, the mean age was 63 years, and 44% were female. During a median follow-up period of 3.6 years, 498,049 adults were exposed to at least 1 of 7,154 extreme humid-heat events, and 500,025 deaths occurred. In adjusted models, there was an increased risk of death (hazard ratio 1.18 [95% CI, 1.15-1.20]) during extreme humid-heat exposure. The relative mortality risk was higher among patients living in the Southeast (P<0.001) compared with the Southwest. LIMITATIONS Possibility of exposure misclassification, did not account for land use and air pollution co-exposures. CONCLUSIONS This study suggests that patients receiving dialysis face an increased risk of death during extreme humid-heat exposure. PLAIN-LANGUAGE SUMMARY Patients who receive dialysis are vulnerable to extreme weather events, and rising global temperatures may bring more frequent extreme heat events. We sought to determine whether extreme heat exposure was associated with an increased risk of death in urban-dwelling patients receiving dialysis across the United States. We found that people receiving dialysis were more likely to die during extreme humid-heat events, defined by a heat index exceeding 40.6°C (105°F) for≥2 days or 46.1°C (115°F) for≥1day. These findings inform the nephrology community about the potential importance of protecting patients receiving maintenance dialysis from the risks associated with extreme heat.
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Affiliation(s)
- Matthew F Blum
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Yijing Feng
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Cascade P Tuholske
- Department of Earth Sciences, Montana State University, Bozeman, Montana; Geospatial Core Facility, Montana State University, Bozeman, Montana
| | - Byoungjun Kim
- Department of Surgery, Grossman School of Medicine, New York University, New York, New York
| | - Mara A McAdams DeMarco
- Department of Surgery, Grossman School of Medicine, New York University, New York, New York
| | - Brad C Astor
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Morgan E Grams
- Department of Medicine, Grossman School of Medicine, New York University, New York, New York
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Shultz JM, Galea S, Espinel Z, Nori-Sarma A, Shapiro LT, Dimentstein K, Shepherd JM, Nogueira LM. Safeguarding medically high-risk patients from compounding disasters. LANCET REGIONAL HEALTH. AMERICAS 2024; 32:100714. [PMID: 38510788 PMCID: PMC10951501 DOI: 10.1016/j.lana.2024.100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Affiliation(s)
- James M. Shultz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Don Soffer Clinical Research Center, #1013, 1120 NW 14 St., Miami, FL, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Zelde Espinel
- Department of Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Lauren T. Shapiro
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, USA
| | - Karen Dimentstein
- College of Psychology, Nova Southeastern University, Kennedy Krieger Institute/Johns Hopkins Hospital, Baltimore, MD, USA
| | - J. Marshall Shepherd
- Department of Atmospheric Sciences and Geography, University of Georgia, Athens, GA, USA
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Nallapothula D, Elaine Ku. What's the Weather Like Today? Forecasting a Chance of Shower, Snow, and… Missing Dialysis. Clin J Am Soc Nephrol 2023; 18:840-842. [PMID: 39074303 PMCID: PMC10356142 DOI: 10.2215/cjn.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Affiliation(s)
- Dhiraj Nallapothula
- Division of Nephrology, Department of Internal Medicine, University of California Davis Health School of Medicine, Sacramento, California
| | - Elaine Ku
- Division of Nephrology, Department of Medicine and Pediatrics, University of California San Francisco, San Francisco, California
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Kopp JB, Lempert K, Finne K. Disaster preparedness for patients with kidney disease. Nat Rev Nephrol 2023; 19:147-148. [PMID: 36747083 DOI: 10.1038/s41581-023-00678-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Kenneth Lempert
- Division of Nephrology, Wayne State University, Detroit, MI, USA
| | - Kristen Finne
- Empower Program, Department of Health and Human Services, Washington, DC, USA
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Young SE, Khoshnaw LJ, Johnson RJ. Climate and the Nephrologist: The Intersection of Climate Change, Kidney Disease, and Clinical Care. Clin J Am Soc Nephrol 2023; 18:411-417. [PMID: 36319069 PMCID: PMC10103360 DOI: 10.2215/cjn.08530722] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Climate change is upon us, and it will have a major effect on both kidney disease and the nephrology practice. But the converse is also true: our treatment of kidney disease has an effect on the climate. Much attention has focused on how rising temperatures can lead to acute and CKD and health exacerbations in patients with established kidney disease. Climate change is also associated with rising air pollution from wildfires and industrial wastes and infectious diseases associated with flooding and changing habitats, all of which heighten the risk of acute and CKD. Less well recognized or understood are the ways nephrology practices, in turn, contribute to still more climate change. Hemodialysis, although lifesaving, can be associated with marked water usage (up to 600 L per dialysis session), energy usage (with one 4-hour session averaging as much as one fifth of the total energy consumed by a household per day), and large clinical wastes (with hemodialysis accounting for one third of total clinical medicine-associated waste). Of note, >90% of dialysis occurs in highly affluent countries, whereas dialysis is much less available in the poorer countries where climate change is having the highest effect on kidney disease. We conclude that not only do nephrologists need to prepare for the rise in climate-associated kidney disease, they must also urgently develop more climate-friendly methods of managing patients with kidney disease.
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Affiliation(s)
- Sarah E. Young
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laveen J. Khoshnaw
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Sapkota A, Kotanko P. Climate change-fuelled natural disasters and chronic kidney disease: a call for action. Nat Rev Nephrol 2023; 19:141-142. [PMID: 36670273 DOI: 10.1038/s41581-023-00682-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Amir Sapkota
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA.
| | - Peter Kotanko
- Renal Research Institute, New York, NY, USA.,Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
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Stigant CE, Rajan T, Barraclough KA, Miller FA. The Necessity of Environmentally Sustainable Kidney Care. Can J Kidney Health Dis 2023; 10:20543581231166484. [PMID: 37091496 PMCID: PMC10116004 DOI: 10.1177/20543581231166484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/27/2023] [Indexed: 04/25/2023] Open
Affiliation(s)
- Caroline E. Stigant
- Division of Nephrology, Island Health Authority, Department of Medicine, University of British Columbia, Vancouver, Canada
- Caroline E. Stigant, Division of Nephrology, Island Health Authority, Department of Medicine, University of British Columbia, #201-1990 Fort Street, Vancouver, BC V8R 6V4, Canada.
| | - Tasleem Rajan
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Katherine A. Barraclough
- Department of Nephrology, Royal Melbourne Hospital, Melbourne Health, Parkville, VIC, Australia
- School of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Fiona A. Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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Roth D, Segal MS, Sastry AD, Aslam N. Organizing Nephrologists at the State Level: The Florida Experience. Clin J Am Soc Nephrol 2023; 18:124-126. [PMID: 36344210 PMCID: PMC10101568 DOI: 10.2215/cjn.09430822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Affiliation(s)
- David Roth
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida
| | - Mark S. Segal
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida
- Renal Section, Florida/South Georgia Veteran Healthcare System, Gainesville, Florida
| | - Ashok D. Sastry
- Department of Medicine, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, Florida
| | - Nabeel Aslam
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida
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