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Dialysis Centers
Topic Collection
April 25, 2019

Topic Collection: Dialysis Centers

Disasters can significantly impact patients who are being treated with maintenance dialysis in several ways. Structural damage to roadways or to the dialysis and healthcare facilities can hamper a patient’s access to their treatment site, delaying scheduled treatment. Disasters may also contaminate water supplies or compromise other utilities. This may affect a facility’s ability to provide safe dialysis treatments to their patients. Some disasters, such as earthquakes, may result in crush injuries that injure the kidneys and therefore increase the demand on inpatient dialysis services.

When disasters strike, dialysis clinics and healthcare facilities will need time to recover from the impacts on their services. This includes staff affected by the disaster who may not be able to report to work. These resources highlight lessons learned from recent events, information on dialysis center recovery, strategies for post-disaster dialysis patient care, and plans, tools, and templates that can be modified for facility-specific needs.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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ASPR TRACIE. (2021). Post-Disaster Lessons Learned: Dialysis Patient Management.
ASPR TRACIE presents findings from resources and references related to post-disaster dialysis operations in response to numerous requests for technical assistance. A previously completed technical assistance response on the post-Sandy improvements to dialysis patient management is included for additional reference.
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Centers for Disease Control and Prevention (2018). Dialysis Care After a Disaster.
CDC provides links to information on post-disaster dialysis care, including bringing water systems back on line after a disaster, using "tanker water" for dialysis, and how to handle "boil water advisories."
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Centers for Medicare and Medicaid Services (2011). Disaster Preparedness: A Guide for Chronic Dialysis Facilities. Second Edition.
This emergency operations plan manual includes templates that can be tailored to the needs of dialysis and end stage renal disease facilities.
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Dent, L. (2015). Progress in Emergency Preparedness for Dialysis Care 10 Years After Hurricane Katrina. American Journal of Kidney Diseases. 66(5): 742-744.
The authors review the improvements in preparedness for dialysis care between 2005 and 2015, and recommend additional efforts to enhance preparedness. Recommendations include increased patient education around emergency diet needs; encouraging patients to carry dialysis plan information and medication lists at all times; and state-level legislation requiring dialysis facilities to have back-up generators.
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Fournier, C. (2011). Re-Establishing Clean Water in a Disaster. (Abstract only.) Nephrology News and Issues. 25(10): 28-9, 34.
The author identifies and discusses the five steps a dialysis clinic should take to ensure their water systems are safe and functional after a disaster.
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Kelman, J., Finne, K., Bogdanov, A., et al. (2015). Dialysis Care and Death Following Hurricane Sandy. American Journal of Kidney Disease. 65(1): 109-15.
The authors of this study address the variation in dialysis care patterns and mortality for patients with end stage renal disease in New York City and the State of New Jersey after Hurricane Sandy. They discuss their findings and conclude that members of the study group (those living in areas affected by Sandy) had higher rates of post-storm visits to the emergency department, hospitalizations, and 30-day mortality than members of the comparison groups.
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Kleinpeter, M. A., Norman, L., and Krane, N.K. (2006). Disaster Planning for Peritoneal Dialysis Programs. (Abstract only.) Advances in Peritoneal Dialysis. 22: 124-9.
The authors share the story of a peritoneal dialysis center's experience with Hurricane Katrina, from the planning, response, and follow-up phases of the event.
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Kopp, J., Ball, K., Cohen, A., et al. (2007). Kidney Patient Care in Disasters: Emergency Planning for Patients and Dialysis Facilities. Clinical Journal of the American Society of Nephrology. 2(4): 825-38.
The authors of this article review the disaster-specific patient care recommendations that have been put forward by the Kidney Community Emergency Response Coalition. They also provide a detailed overview of the disaster planning process from the perspectives of kidney patients, dialysis facilities, and volunteer nephrology professionals who may participate in disaster relief.
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Lempert K. and Kopp, J. (2013). Hurricane Sandy as a Kidney Failure Disaster. American Journal of Kidney Disease. 61(6):865-8.
The authors review lessons learned after recent disasters and provide "the cardinal features of kidney failure disaster preparedness."
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Lurie, N., Finne, K., Worrall, C., et al. (2015). Early Dialysis and Adverse Outcomes After Hurricane Sandy. American Journal of Kidney Diseases. 66(3):507-512.
The authors conducted a retrospective cohort analysis to determine the effect of early dialysis before Hurricane Sandy on outcomes for hemodialysis patients in New York and New Jersey. They found that patients who received early dialysis had significantly lower odds of having an Emergency Department (ED) visit (20%) and hospitalization (21%) in the week of the storm and of dying within 30 days (28%).
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National Kidney Foundation. (2013). Planning for Emergencies: A Guide for People With Chronic Kidney Disease. National Kidney Foundation.
The authors share tips for people with kidney disease to consider in preparation for various types of disasters.
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Stoler, G., Johnston, J., Stevenson, J., and Suyama, J. (2013). Preparing Emergency Personnel in Dialysis: A Just-In-Time Training Program for Additional Staffing During Disasters. (Abstract only.) Disaster Medicine and Public Health Preparedness. 7(3): 272-7.
Preparing Emergency Personnel in Dialysis is a just-in-time training program that aims to teach those with minimum familiarity with basic dialysis to support dialysis staff during a disaster. The authors pilot-tested the curriculum and found a nearly 30% improvement in knowledge as a result of the program.
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U.S. Food and Drug Administration. (2018). Reopening Dialysis Clinics After Restoration of Power and Water.
This report includes steps facility staff can take to reopen clinics after water or power outages.
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Dialysis Center Recovery

* Buttimore, A. (2011). Renal Dialysis Services in the Christchurch Earthquakes of 2010-2011. Renal Society of Australasia Journal. 7(2): 66-68.
The author provides a timeline of events following an earthquake that struck New Zealand, and discusses how the event impacted dialysis centers.
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Centers for Disease Control and Prevention (2018). Dialysis Care After a Disaster.
CDC provides links to information on post-disaster dialysis care, including bringing water systems back on line after a disaster, using "tanker water" for dialysis, and how to handle "boil water advisories."
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Fournier, C. (2011). Re-Establishing Clean Water in a Disaster. (Abstract only.) Nephrology News and Issues. 25(10): 28-9, 34.
The author identifies and discusses the five steps a dialysis clinic should take to ensure their water systems are safe and functional after a disaster.
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* Kamei, D., Kuno, T. Sato, S. et al. (2012). Impact of the Fukushima Daiichi Nuclear Power Plant Accident on Hemodialysis Facilities: An Evaluation of Radioactive Contaminants in Water Used for Hemodialysis. (Free registration required.) Therapeutic Apheresis and Dialysis 16(1): 87-90.
The authors of this study discuss the nuclear power plant accident and the impacts it had on hemodialysis facilities. They discuss their methodological approach and their findings and emphasize the need to clarify the maximum safety level of radiation in dialysate for chronic hemodialysis patients.
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* Matsumura, T., Osaki, S., Kudo, D., et al. (2015). Water Supply Facility Damage and Water Resource Operation at Disaster Base Hospitals in Miyagi Prefecture in the Wake of the Great East Japan Earthquake. Prehospital and Disaster Medicine. 30(2): 193-8.
The goal of this study was to highlight the challenges associated with damage to water supply facilities (including dialysis centers) in Japan after the 2011 earthquake and tsunami.
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U.S. Food and Drug Administration. (2018). Reopening Dialysis Clinics After Restoration of Power and Water.
This report includes steps facility staff can take to reopen clinics after water or power outages.
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Education and Training

Martin-Lester, M. and Thomas, J. (2015). Emergency Shelters: Medical Triage Considerations for ESRD (End Stage Renal Disease) Patients. Kidney Community Emergency Response Coalition.
This 57-minute webinar discusses how disasters, particularly those with water or prolonged power outages, adversely impact individuals who rely on regular dialysis services. It covers basic emergency planning for the renal community, and managing dialysis patients in the shelter, and during the triage process.
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New York City Department of Health and Mental Hygiene. (2018). Emergency Planning and Response for Dialysis Centers and Opioid Treatment Programs.
This 21-minute video educates dialysis and opioid treatment program facilities on responding to events that can impact operations, and on emergency preparedness before, response to, and after a critical event. It includes topics such as recognition of an event that would compromise the provision of critical services, patient and staff communications, and service recovery.
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Event-Specific Lessons Learned

Abir, M., Jan, S., Jubelt, L. et al. (2013). The Impact of a Large-Scale Power Outage on Hemodialysis Center Operations. Prehospital and Disaster Medicine. 28(6): 543-6.
The authors examined how power outages in Washington, DC, and five counties in West Virginia and Maryland impacted operations in a sample of 36 hemodialysis centers. They found that those with pre-existing plans, including provisions for back-up generators and referral agreements with other dialysis centers, offered continuity of care to their patients.
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Adalja, A. A., Watson, M., Bouri, N. et al. (2014). Absorbing Citywide Patient Surge during Hurricane Sandy: A Case Study in Accommodating Multiple Hospital Evacuations. Annals of Emergency Medicine. 64(1): 66-73.e1.
The authors used a qualitative, interview-based method to study medical surge strategies used at hospitals receiving patients from evacuated healthcare facilities during and after Hurricane Sandy. One gap noted was a challenge associated with the increase in the number of dialysis patients sent to hospitals.
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Anderson, A. H., Cohen, A. J., Kutner, N.G. et al. (2009). Missed Dialysis Sessions and Hospitalization in Hemodialysis Patients after Hurricane Katrina. Kidney International. 75(11): 1202-8.
The authors interviewed dialysis patients and listed the reasons they provided for missing sessions after Hurricane Katrina. As a result, the authors stress the need for emphasizing patient awareness and activating emergency plans early in the response phase.
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ASPR TRACIE. (2019). Evacuating, Treating, and Tracking People on Dialysis.
After Hurricane Irma struck the U.S. Virgin Islands (USVI), many patients were evacuated to Puerto Rico (PR) to ensure continuity of care. Once Hurricane Maria ravaged PR, however, many USVI residents were evacuated a second time, including renal dialysis patients. This article highlights lessons learned from the evacuation of these patients from a federal patient movement perspective.
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ASPR TRACIE. (2021). Post-Disaster Lessons Learned: Dialysis Patient Management.
ASPR TRACIE presents findings from resources and references related to post-disaster dialysis operations in response to numerous requests for technical assistance. A previously completed technical assistance response on the post-Sandy improvements to dialysis patient management is included for additional reference.
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Bonilla-Félix, M. and Suárez-Rivera, M. (2018). Disaster Management in a Nephrology Service: Lessons Learned from Hurricane Maria. (Abstract only.) Blood Purification.
The authors discuss their experiences treating dialysis patients after Hurricane Maria, and provide recommendations for future disaster preparedness and response. These recommendations include: creating a registry of patients with updated contact information, as well as contact information for relatives and a physical address where an emergency rescue team can be dispatched; developing a contingency plan to move patients to another center in case the unit is rendered nonfunctional after the storm; and accounting for the needs of staff in response and recovery plans.
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* Buttimore, A. (2011). Renal Dialysis Services in the Christchurch Earthquakes of 2010-2011. Renal Society of Australasia Journal. 7(2): 66-68.
The author provides a timeline of events following an earthquake that struck New Zealand, and discusses how the event impacted dialysis centers.
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Davis, M. and Kopp, J. (2015). Preparing for Disasters for Patients on Dialysis. Clinical Journal of American Society of Nephrology. 10(8): 1316–1317.
This literature review highlights lessons learned from disasters across the U.S. The authors highlight reasons for missing dialysis after disasters, the importance of early dialysis (e.g., when a storm such as a hurricane is pending), and preparedness strategies that can be implemented in advance of predictable natural disasters.
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Edmondson, D., Gamboa, C., Cohen, A. et al. (2013). Association of Posttraumatic Stress Disorder and Depression with All-Cause and Cardiovascular Disease Mortality and Hospitalization among Hurricane Katrina Survivors with End-Stage Renal Disease. American Journal of Public Health. 103(4): e130-7.
The authors discuss their study findings, one of which is a positive association between psychiatric symptoms in the year after Hurricane Katrina and hospitalization and mortality in patients with end-stage renal disease. While not specific to dialysis, program managers should be aware of the potential impact and consider screening patients post-disaster.
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Haga, N., Hata, J., Yabe, M. et al. (2013). The Great East Japan Earthquake Affected the Laboratory Findings of Hemodialysis Patients in Fukushima. BMC Nephrology. 14: 239.
The authors investigate the impact of the Great East Japan Earthquake on laboratory findings in chronic hemodialysis patients in Fukushima whose treatment was shortened for up to an hour after the disaster. Results indicated that treatment duration can be decreased without significantly changing effectiveness based on lab results.
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Hyre, A. D., Cohen, A.J., Kutner, N.G., et al. (2008). Psychosocial Status of Hemodialysis Patients One Year after Hurricane Katrina. American Journal of the Medical Sciences. 336(2): 94-98.
The authors used various tools to measure hemodialysis patients' psychosocial status after Hurricane Katrina. Results suggest the need for more screening and management of psychosocial issues in these patients after disasters, particularly those in shelters or inpatient environments for whom depression was a major issue.
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Ikegaya, N., Seki, G. and Ohta, N. (2016). How Should Disaster Base Hospitals Prepare for Dialysis Therapy after Earthquakes? Introduction of Double Water Piping Circuits Provided by Well Water System. BioMed Research International. Article ID 9647156.
This article reviews the effects that recent earthquakes have had on dialysis facilities in Japan. The authors discuss how their hospital installed a generator and a water system that could pull in well water so they could continue providing dialysis after the Great East Japan Earthquake, and emphasize the importance of informing local water authorities of dialysis facilities’ needs before, and after, a disaster.
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Ishida, K., Sawa, M., Fujiwara, K. et al. (2013). Study of Electrical Power Facilities and Measures for Planned Outages in Japanese Hemodialysis Clinics after the Great East Japan Earthquake. (Abstract only.) Therapeutic Apheresis and Dialysis. 17(1): 65-71.
The authors analyzed more than 175 questionnaires submitted by hemodialysis clinics to better understand how they handled the power outage that followed the 2011 earthquake and tsunami in Japan. Nearly all of the clinics reported that they had established procedures to deal with future planned outages and nearly as many reported implementing lessons learned just after the disaster struck.
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* Kamei, D., Kuno, T. Sato, S. et al. (2012). Impact of the Fukushima Daiichi Nuclear Power Plant Accident on Hemodialysis Facilities: An Evaluation of Radioactive Contaminants in Water Used for Hemodialysis. (Free registration required.) Therapeutic Apheresis and Dialysis 16(1): 87-90.
The authors of this study discuss the nuclear power plant accident and the impacts it had on hemodialysis facilities. They discuss their methodological approach and their findings and emphasize the need to clarify the maximum safety level of radiation in dialysate for chronic hemodialysis patients.
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Kelman, J., Finne, K., Bogdanov, A., et al. (2015). Dialysis Care and Death Following Hurricane Sandy. American Journal of Kidney Disease. 65(1): 109-15.
The authors of this study address the variation in dialysis care patterns and mortality for patients with end stage renal disease in New York City and the State of New Jersey after Hurricane Sandy. They discuss their findings and conclude that members of the study group (those living in areas affected by Sandy) had higher rates of post-storm visits to the emergency department, hospitalizations, and 30-day mortality than members of the comparison groups.
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Kleinpeter, M. A., Norman, L., and Krane, N.K. (2006). Disaster Planning for Peritoneal Dialysis Programs. (Abstract only.) Advances in Peritoneal Dialysis. 22: 124-9.
The authors share the story of a peritoneal dialysis center's experience with Hurricane Katrina, from the planning, response, and follow-up phases of the event.
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* Kopp, J., Ball, K., Cohen, A., et al. (2007). Kidney Patient Care in Disasters: Emergency Planning for Patients and Dialysis Facilities. Clinical Journal of the American Society of Nephrology. 2(4): 825-38.
The authors of this article review the disaster-specific patient care recommendations that have been put forward by the Kidney Community Emergency Response Coalition. They also provide a detailed overview of the disaster planning process from the perspectives of kidney patients, dialysis facilities, and volunteer nephrology professionals who may participate in disaster relief.
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Kuehn, B. (2017). Back-to-Back Disasters Put Response Systems to the Test. Kidney News. 9(12).
This brief article discusses the experiences of responders assisting dialysis patients following hurricanes Irma, Maria, and Harvey.
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Lempert K. and Kopp, J. (2013). Hurricane Sandy as a Kidney Failure Disaster. American Journal of Kidney Disease. 61(6):865-8.
The authors review lessons learned after recent disasters and provide "the cardinal features of kidney failure disaster preparedness."
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Lin, C. J., Pierce, L.C., Roblin, P. M., and Arquilla, B. (2014). Impact of Hurricane Sandy on Hospital Emergency and Dialysis Services: A Retrospective Survey. (Abstract only.) Prehospital and Disaster Medicine. 29(4): 374-9.
The authors conducted a retrospective study on hospital dialysis services provided after Hurricane Sandy. They found challenges with: lack of dialysis documentation from transient dialysis patients (92.3%); staff shortage (50%); staff transportation (71.4%); and communication with other agencies (53.3%).
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Lurie, N., Finne, K., Worrall, C., et al. (2015). Early Dialysis and Adverse Outcomes After Hurricane Sandy. American Journal of Kidney Diseases. 66(3):507-512.
The authors conducted a retrospective cohort analysis to determine the effect of early dialysis before Hurricane Sandy on outcomes for hemodialysis patients in New York and New Jersey. They found that patients who received early dialysis had significantly lower odds of having an Emergency Department (ED) visit (20%) and hospitalization (21%) in the week of the storm and of dying within 30 days (28%).
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Masakane, I., Akatsuka, T., Yamakawa, T., et al. (2016). Survey of Dialysis Therapy During the Great East Japan Earthquake Disaster and Recommendations for Dialysis Therapy Preparation in Case of Future Disasters. Renal Replacement Therapy. 2(48).
The authors review the effects that the Great East Japan Earthquake had on dialysis therapy, and present recommendations for future disaster preparedness and response that may be applied to earthquakes and other disasters.
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* Matsumura, T., Osaki, S., Kudo, D., et al. (2015). Water Supply Facility Damage and Water Resource Operation at Disaster Base Hospitals in Miyagi Prefecture in the Wake of the Great East Japan Earthquake. Prehospital and Disaster Medicine. 30(2): 193-8.
The goal of this study was to highlight the challenges associated with damage to water supply facilities (including dialysis centers) in Japan after the 2011 earthquake and tsunami.
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Miller, A. C. and Arquilla, B. (2008). Chronic Diseases and Natural Hazards: Impact of Disasters on Diabetic, Renal, and Cardiac Patients. Prehospital and Disaster Medicine. 23(2): 185-94.
The authors reviewed resources from PubMed, Ovid, and Medline combined with real-life experience treating chronic disease after disasters. They found that the international nephrology community had formed an effective organization (the Renal Disaster Relief Task Force), and emphasize that patients have emergency diet and renal fluid restriction plans and be prepared to modify dialysis schedules and methods. Suggestions for facilities are also provided.
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Moynahan, L. (2011). The 2011 Queensland Floods: A Dialysis Clinical Nurse Manager’s Personal Account. Renal Society of Australasia Journal. 7(2): 56-58.
This paper details the experiences of the author, a nurse unit manager, in 2011 when working for four days in the Wesley Hospital, located on the (then-flooding) Brisbane River.
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Nishimura, H., Kagara, I., Inokuchi, S., et al. (2014). Local Dialysis Disaster Relief during Two Torrential Downpours on Amami-Ohshima Island. (Abstract only; free registration required to access full article.) Journal of Disaster Research. 9(1): 86-91.
The authors share information about two storms that affected Japan's Amami-Ohshima island's dialysis treatment centers. Communication and transportation proved to be challenging, but responders reallocated patients, changed dialysis schedules, and used a satellite phone.
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Renal & Urology News. (2017). Dialysis Care in an Emergency: Lessons From Hurricane Harvey.
This article reviews lessons learned shared by 2 physicians who treated dialysis patients after Hurricane Harvey hit the Houston area in 2017. Challenges experienced (e.g., lack of medical record information and transportation for patients), and triage protocols used, are discussed.
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General Resources

ASPR TRACIE. (2021). End Stage Renal Disease Facilities Requirements: CMS Emergency Preparedness Final Rule (Updated).
This document combines excerpts from the Final Rule and the recently released Interpretive Guidelines from CMS to provide a consolidated overview document of requirements for End Stage Renal Comprehensive Outpatient Rehabilitation Facilities.
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Dent, L. (2015). Progress in Emergency Preparedness for Dialysis Care 10 Years After Hurricane Katrina. American Journal of Kidney Diseases. 66(5): 742-744.
The authors review the improvements in preparedness for dialysis care between 2005 and 2015, and recommend additional efforts to enhance preparedness. Recommendations include increased patient education around emergency diet needs; encouraging patients to carry dialysis plan information and medication lists at all times; and state-level legislation requiring dialysis facilities to have back-up generators.
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* Foster, M., Brice, J., Shofer, F., et al. (2011). Personal Disaster Preparedness of Dialysis Patients in North Carolina. Clinical Journal of the American Society of Nephrology. 6(10): 2478-84.
The authors note that dialysis patients are particularly vulnerable to disaster and sought to study their levels of preparedness. They found that in general, dialysis patients were not prepared for critical incidents, regardless of demographic characteristics.
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Kidney Community Emergency Response Coalition (2009). Emergency Management and Dialysis: What Emergency Planners Need to Know about Dialysis Patients and Facilities.
This brochure highlights important facts regarding dialysis patients and facilities for emergency planners.
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* Murakami,N., Siktel, H.B., Lucido, D. et al. (2015). Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy. Clinical Journal of the American Society of Nephrology. 10(8): 1389–1396.
The authors conducted a cross-sectional survey of patients who received maintenance hemodialysis before and after the landfall of Hurricane Sandy in 2012, to determine number of missed dialysis sessions after the storm, and assess their preparedness using a checklist from the National Kidney Foundation. They concluded that, “provider- or facility-oriented enhancement of awareness of the disease and preparedness should be a priority.”
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National Academies of Sciences, Engineering, and Medicine. (2019). Dialysis Transportation: Intersection of Transportation and Healthcare.
In every disaster, transportation is the second most common failure to access to dialysis treatment after facility closures. This report examines the relationship between the increase in chronic kidney and end stage renal disease and the use of specialized public sector transportation (e.g., ADA paratransit, Medicaid's non-emergency medical transportation, Veterans Administration vehicles, human service agencies, taxis, and ambulances). Strategies for improving reliability and addressing funding challenges are discussed throughout the report.
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Sever, M., Lameire, N., Van Biesen, W., and Vanholder, R. (2015). Disaster Nephrology: A New Concept for an Old Problem. Clinical Kidney Journal. 8(3): 300-309.
The authors discuss the concept of “disaster nephrology,” which they define as, “the handling of the many medical and logistic problems in treating kidney patients in difficult circumstances.” They review post-disaster clinical and logistical challenges that arise in treating both patients with chronic kidney disease, and those with acute kidney injury as a result of the disaster.
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Stoler, G., Johnston, J., Stevenson, J., and Suyama, J. (2013). Preparing Emergency Personnel in Dialysis: A Just-In-Time Training Program for Additional Staffing During Disasters. (Abstract only.) Disaster Medicine and Public Health Preparedness. 7(3): 272-7.
Preparing Emergency Personnel in Dialysis is a just-in-time training program that aims to teach those with minimum familiarity with basic dialysis to support dialysis staff during a disaster. The authors pilot-tested the curriculum and found a nearly 30% improvement in knowledge as a result of the program.
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Patient Care

American Society of Nephrology. (2014). Frequently Asked Questions (FAQs) Regarding Ebola Virus Disease and Dialysis.
This resource reviews key considerations related to dialysis and ebola patients, including how providers should handle dialysate effluent/spent dialysate, and how machines should be cleaned upon patient discharge from isolation.
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Centers for Disease Control and Prevention (2010). Cryptosporidium: Dialysis During a Boil Water Advisory.
Healthcare providers can use the information on this web page to assess steps to take when treating dialysis patients during a boil water advisory.
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Centers for Disease Control and Prevention. (2018). Recommendations for Safely Performing Acute Hemodialysis in Patients with Ebola Virus Disease in U.S. Hospitals.
This resource can be used to help medical professionals safely perform renal replacement therapy in critically ill patients infected with Ebola.
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* Kopp, J., Ball, K., Cohen, A., et al. (2007). Kidney Patient Care in Disasters: Emergency Planning for Patients and Dialysis Facilities. Clinical Journal of the American Society of Nephrology. 2(4): 825-38.
The authors of this article review the disaster-specific patient care recommendations that have been put forward by the Kidney Community Emergency Response Coalition. They also provide a detailed overview of the disaster planning process from the perspectives of kidney patients, dialysis facilities, and volunteer nephrology professionals who may participate in disaster relief.
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Zoraster, R., Vanholder, R., and Sever, M. (2007). Disaster Management of Chronic Dialysis Patients. (Abstract only.) American Journal of Disaster Medicine. 2(2): 96-106.
Patients who are dialysis-dependent (with end-stage renal disease [ESRD]) are at particularly high risk after disasters. Dialysis may be delayed and the authors write that few physicians are experienced or trained in the nondialytic management of ESRD. Strategies such as dietary restrictions, potassium removal via resins and cathartics, and adaptations of acute treatment can help patients who can not receive dialysis. The authors emphasize the need for medical facilities to plan and stockpile medications such as Kayexalate to help minimize morbidity and mortality.
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Patient Resources

Centers for Medicare & Medicaid Services. (2023). Preparing for Emergencies: A Guide for People on Dialysis.
This booklet provides information for people on dialysis that can help them prepare for an emergency. It includes information on go-kits, grocery items to stock in a "3-day emergency diet," how to handle being home bound after a disaster, what people can do when they must leave their homes, and what to do if their dialysis facility is closed. Access the Spanish version of this document here: https://www.kcercoalition.com/contentassets/e1a0ac6fedeb4ba190e64de0cd6a9a9c/spanish_cmspreparingforemergencies_508-compliant-_updated-3.2023.pdf
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* DaVita. (n.d.). Emergency Preparedness for People with Kidney Disease. (Accessed 1/24/2023.)
DaVita shares emergency preparedness information for patients on dialysis to ensure they can receive necessary treatment or lessen the impact of missing a dialysis session.
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* Foster, M., Brice, J., Shofer, F., et al. (2011). Personal Disaster Preparedness of Dialysis Patients in North Carolina. Clinical Journal of the American Society of Nephrology. 6(10): 2478-84.
The authors note that dialysis patients are particularly vulnerable to disaster and sought to study their levels of preparedness. They found that in general, dialysis patients were not prepared for critical incidents, regardless of demographic characteristics.
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Kidney Community Emergency Response Coalition. (n.d.). Emergency Disconnect Procedure for In-Center Hemodialysis Patients. (Accessed 4/24/2019.) End Stage Renal Disease National Coordinating Center.
This graphic demonstrates the 3 steps patients need to take to disconnect themselves from their dialysis machine during an emergency.
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* Murakami,N., Siktel, H.B., Lucido, D. et al. (2015). Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy. Clinical Journal of the American Society of Nephrology. 10(8): 1389–1396.
The authors conducted a cross-sectional survey of patients who received maintenance hemodialysis before and after the landfall of Hurricane Sandy in 2012, to determine number of missed dialysis sessions after the storm, and assess their preparedness using a checklist from the National Kidney Foundation. They concluded that, “provider- or facility-oriented enhancement of awareness of the disease and preparedness should be a priority.”
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National Kidney Foundation. (2013). Planning for Emergencies: A Guide for People With Chronic Kidney Disease. National Kidney Foundation.
The authors share tips for people with kidney disease to consider in preparation for various types of disasters.
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North Help Coalition. (n.d.). A Guide to Emergency Preparedness for Dialysis Patients. (Accessed 3/21/2019.)
This booklet provides dialysis patients with information on emergency preparedness and steps they can take to prepare for disasters/ emergencies. It includes template forms for important contact and health information, as well as useful tips related to food and nutrition and transportation.
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North Help Coalition. (2017). Dialysis Patient Preparedness.
This short video, geared towards dialysis patients, provides information on emergency preparedness. It presents three steps dialysis patients can take before disaster strikes: make a plan, gather supplies, and be informed.
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U.S. Department of Health and Human Services. (2015). Preparedness Tip for Dialysis Patients.
This 10-second (un-narrated) video emphasizes the point that dialysis patients should learn more about alternate treatment options before a storm or other type of critical incident.
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U.S. Department of Health and Human Services. (2015). Preparedness Tip: Dialysis & Early Treatment.
This 10-second (un-narrated) video encourages dialysis patients to ask their provider about receiving treatment before a storm strikes.
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Plans, Tools, and Templates

ASPR TRACIE. (2017). Dialysis Checklist for Disaster Areas.
Checklists, guidance documents, and information obtained from an ASPR TRACIE SME Cadre member on the needs of dialysis patients post-disaster and the requirements for temporary dialysis facilities are all included in this ASPR TRACIE TA response. Related Topic Collection: Dialysis Centers.
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Association of Private Kidney Care Providers of Malaysia. (2015). Disaster Preparedness and Contingency Plan for Dialysis Facilities.
This manual was created to “assist hospital-based and stand-alone dialysis facilities to cope with disasters which may affect dialysis operations and severely impact patients’ access to care. It includes guidance for each phase of emergency management—mitigation, preparedness, response, and recovery.
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Centers for Medicare and Medicaid Services (2011). Disaster Preparedness: A Guide for Chronic Dialysis Facilities. Second Edition.
This emergency operations plan manual includes templates that can be tailored to the needs of dialysis and end stage renal disease facilities.
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* DaVita. (n.d.). Emergency Preparedness for People with Kidney Disease. (Accessed 1/24/2023.)
DaVita shares emergency preparedness information for patients on dialysis to ensure they can receive necessary treatment or lessen the impact of missing a dialysis session.
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ESRD Network 13: Health Services Advisory Group. (n.d.). Shelter Triage Check List for Hemodialysis (HD)/ Peritoneal Dialysis (PD) Patients. (Accessed 3/25/2019.)
This 1-page checklist may be used to triage hemodialysis and peritoneal dialysis patients at an emergency shelter.
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Kansas Department of Health and Environment. (n.d.). Emergency Management Plan for Kansas Chronic Dialysis Facilities. (Accessed 7/11/2019.)
This is an emergency management plan template for chronic dialysis facilities in Kansas that may be adapted for other facilities. (Note that this template was created prior to the release of the 2016 Centers for Medicare & Medicaid Services [CMS] Emergency Preparedness [EP] Rule, which planners should reference to ensure compliance for their organizations.)
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Kidney Community Emergency Response Coalition. (n.d.). Professional Resources. (Accessed 3/25/2019.)
This webpage includes information to assist health professionals with preparing for dialysis facility emergency response. Links to tabletop exercise templates for hurricanes and earthquakes are included.
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Kidney Emergency Response Coalition. (2008). Save a Life: What You Need to Know About Emergency Preparedness for Individuals with Kidney Disease.
This fact sheet includes information for patients, providers, and emergency responders to help them prepare to meet the needs of dialysis patients during emergencies and disasters.
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Midwest Kidney Network. (2015). Disaster Plan Toolkit: Dialysis Facilities.
This resource includes a checklist to support emergency plan development, as well as templates for communicating with local emergency management, and power and water suppliers, in advance of an emergency.
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Wisconsin Department of Health Services. (2018). CMS Emergency Preparedness Rule Toolkits.
This webpage includes links to toolkits and other resources designed to help certain types of healthcare facilities better understand the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule. There is both a PDF (toolkit) and Word version (workbook) for each facility type, and the relevant CMS rules for each facility type are included. Each toolkit includes sample templates and planning worksheets that can help facilities develop compliant plans, policies, and procedures.
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End Stage Renal Disease Networks

Network 1 (CT, ME, MA, NH, RI, VT):. (n.d.). End-Stage Renal Disease Network of New England.
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Network 11 (MI, MN, ND, SD):. (n.d.). Renal Network 11.
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Network 12 (IA, KS, MO, NE):. (n.d.). Heartland Kidney Network.
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Network 13 (OK, AR, LA):. (n.d.). End-Stage Renal Disease Network 13.
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Network 14 (TX). (n.d.). End-Stage Renal Disease Network of Texas.
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Network 15 (AZ, CO, NM, NV, UT, & WY):. (n.d.). InterMountain ESRD Network, Inc.
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Network 17 (AS, Guam, HI, Mariana Islands, Northern CA):. (n.d.). Western Pacific Renal Network, LLC.
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Network 18 (Southern CA):. (n.d.). ESRD Network 18 of Southern California.
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Network 2 (NY):. (n.d.). End-Stage Renal Disease Network of New York.
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Network 3 (NJ, PR, U.S. VI):. (n.d.). Quality Insights (Renal Network 3).
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Network 4 (PA, DE):. (n.d.). Quality Insights (Renal Network 4).
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Network 5 (MD, VA, WV, District of Columbia):. (n.d.). Mid-Atlantic Renal Coalition.
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Network 7 (FL):. (n.d.). ESRD Network 7.
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Network 8 (AL, MS, TN). (n.d.). Network 8.
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Network 9. (n.d.). ESRD Network of the Ohio River Valley (Network 9).
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Qsource. (2020). ESRD Network 10.
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Large Dialysis Organizations

(n.d.). DaVita.
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(n.d.). Dialysis Clinic, Inc.
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(n.d.). Fresenius Medical Care.
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Small Dialysis Organizations (limited list)

(n.d.). American Renal Associates.
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(n.d.). Atlantic Dialysis Management Services.
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(n.d.). Centers for Dialysis Care.
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(n.d.). Northwest Kidney Centers.
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(n.d.). Satellite Healthcare, Inc.
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(n.d.). U.S. Renal Care.
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(n.d.). U.S. Renal Care, Inc.
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Agencies and Organizations

American Association of Kidney Patients (AAKP).
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American Kidney Fund, Disaster Relief for Dialysis Patients.
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American Nephrology Nurses Association (ANNA).
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American Society of Nephrology.
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American Society of Pediatric Nephrology.
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Centers for Medicare and Medicaid Services End Stage Renal Disease Center.
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Dialysis Finder.
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End Stage Renal Disease National Coordinating Center.
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Kidney Community Emergency Response-En Español.
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Medical Education Institute.
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National Association for Nephrology Technicians/Technologists (NANT).
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Renal Physicians Association.
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The National Kidney Foundation.
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The Nephron Information Center. Dialysis Units in the U.S.A.
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This ASPR TRACIE Topic Collection was refreshed and comprehensively updated in April 2019 by the following subject matter experts (listed in alphabetical order): Alexandra Benoit, MBA, MHA, Vulnerable Populations Coordinator, Georgia Department of Public Health; Kristen Finne, Program Manager, HHS emPOWER Program; John Hick, MD, HHS ASPR and Hennepin County (MN) Medical Center; and Mary Russell, EdD, MSN, Healthcare Emergency Response Coalition Palm Beach County, FL.  

It was comprehensively reviewed in May 2015 by Joan Thomas, Director, Kidney Community Emergency Response and Angelo Belfiore, Emergency Management Specialist, Kidney Community Emergency Response. Additional assistance was provided by John Hick, MD, HHS ASPR and Hennepin County Medical Center; Kenneth D. Lempert, MD, MSPH, Physician Committee, Kidney Community Emergency Response Program; Alicia Livinski, Biomedical Librarian, HHS National Institutes of Health; and Paul E. Miller, MD, Kidney Consultants of Louisiana.

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