title: Early Dialysis and Adverse Outcomes After Hurricane Sandy.
abstract: 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.
  
  
  METHODS
  Retrospective cohort analysis, using claims data from the Centers for Medicare & Medicaid Services Datalink Project.
  
  
  METHODS
  Patients receiving long-term hemodialysis in New York City and the state of New Jersey, the areas most affected by Hurricane Sandy.
  
  
  METHODS
  Receipt of early dialysis compared to their usual treatment pattern in the week prior to the storm.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC. Electronic address: nicole.lurie@hhs.gov.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lurie
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC.
authors.forename: Kristen
authors.initials: K
authors.lastname: Finne
authors.affiliation: Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Washington, DC.
authors.forename: Chris
authors.initials: C
authors.lastname: Worrall
authors.affiliation: Acumen LLC, Burlingame, CA.
authors.forename: Maria
authors.initials: M
authors.lastname: Jauregui
authors.affiliation: Acumen LLC, Burlingame, CA.
authors.forename: Tanayott
authors.initials: T
authors.lastname: Thaweethai
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC.
authors.forename: Gregg
authors.initials: G
authors.lastname: Margolis
authors.affiliation: Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Washington, DC.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kelman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055867:Cyclonic Storms; D004189:Disaster Planning; D005260:Female; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D009518:New York; D006435:Renal Dialysis / Q000592:standards; D013997:Time Factors
keywords: Disaster preparedness; Hurricane Sandy; adverse outcome; early dialysis; emergency department (ED) visit; emergency response; end-stage renal disease (ESRD); hemodialysis; hospitalization; missed dialysis session; mortality; natural disaster; vulnerable population