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Abstract: PO0841

Hurricane Harvey Increased Need for Emergency Care in Patients with ESKD

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lemaistre, Frederick Ian, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Schaefer, Caroline M., The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States
  • Molony, Donald A., The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
Background

During natural disasters, end-stage kidney disease (ESKD) patients may represent a particularly vulnerable population due to interruption in care. We hypothesize that mortality and medical complications significantly increased in ESKD patients as a result of the disruptions in care related to Hurricane Harvey (HH).

Methods

Ten outcome variables for patients receiving outpatient, inpatient and home dialysis in FEMA designate hurricane disaster areas during the months of Aug 2017 – Dec 2017 representing exposure to the effects of Hurricane Harvey, were compared with the same time periods in 2016 and 2018. In this retrospective cohort study, ESKD patients were stratified by dialysis modality. Inclusion criteria were patients identified with ESKD by Medicare, had received at least one dialysis treatment within the observed timeframe, and were continuously enrolled for the four months before and/or four months after HH landfall or enrollment was dropped due to death. Main outcomes of the study included mortality, inpatient admissions, emergency department (ED) visits, and diagnosis of complications.

Results

Using deidentified Medicare Claims data we identified 7,362 patients in the outpatient, 862 in the inpatient, and 810 in the home setting and compared outcomes in approximately stable populations in the years 2016 and 2018. Odds of ED visit was 31% greater (OR= 1.31, CI= [1.19, 1.44]) in 2017, compared to 2016 and 25% greater (OR= 1.25, CI= [1.14, 1.38]) compared to 2018. Odds of hyperkalemia was 37% greater (OR= 1.37, CI= [1.22, 1.55]) in 2017 than 2016. Nonwhite patients and men experienced lower odds of the outcomes of interest compared to white patients and women. Odds of gastrointestinal infection was 2.34 times more likely (OR= 2.33, CI= [1.32, 4.12]) in 2017 versus 2018. Black patients experienced increased odds of cerebrovascular accident (CVA) compared to white patients.

Conclusion

Using Medicare claims data we found significant differences in Emergency Department (ED) visits and incidence of hyperkalemia in HH exposed patients compared to patients receiving outpatient dialysis in 2016 and 2018. Catastrophic events represent dangers for ESKD populations with increased risk of complications and burden on the healthcare system. Better preparation for natural disasters may improve health outcomes associated with limited access to dialysis.

Funding

  • Private Foundation Support