Why Dialysis Patients Are Most Vulnerable in Disasters

When a hurricane makes landfall, when the power grid fails, or when a wildfire forces mass evacuations, most people face disruption. For dialysis patients, the same event can be fatal within days.

This is not an exaggeration. It is a medical reality that shapes everything the Renal Preparedness Project does.

The 48-Hour Window

Healthy kidneys filter waste and excess fluid from the blood continuously — 24 hours a day, 7 days a week. For the approximately 560,000 Americans on dialysis, a machine performs this function three times per week, typically in three- to four-hour sessions.

Miss one session, and toxins begin to accumulate. Miss two, and dangerous fluid buildup strains the heart. Miss three, and the risk of cardiac arrest rises sharply. In a disaster that disrupts dialysis access for 72 hours or more, patients face a genuine medical emergency — not from the disaster itself, but from the interruption of routine care.

Why Dialysis Centers Are Vulnerable

Dialysis clinics depend on a fragile chain of resources:

• Electricity to power dialysis machines, water purification systems, and climate control
• Clean water in large volumes — a single dialysis session requires roughly 120 gallons of purified water
• Staffing — nurses and technicians who may themselves be displaced by the same disaster
• Supply chains for dialysate, filters, and other consumables

When a major storm or power outage hits a region, all of these can fail simultaneously. Clinics that appear operational may be running on backup generators with limited fuel. Others close entirely, sending patients scrambling to find alternative treatment sites — often hours away.

The Dietary and Medication Dimension

Beyond dialysis access, patients face a second layer of vulnerability: diet and medications.

Dialysis patients follow strict renal diets that limit potassium, phosphorus, sodium, and fluid intake. In a disaster, the foods available at shelters, relief distribution sites, and convenience stores are often exactly the wrong foods — high in potassium and sodium, with little regard for renal restrictions.

Eating the wrong foods during a missed dialysis session can accelerate the buildup of dangerous electrolytes, increasing the risk of cardiac arrhythmia. Patients who cannot access their medications — phosphate binders, blood pressure drugs, erythropoiesis-stimulating agents — face compounding risks.

Evacuation Adds Another Layer of Risk

Evacuation itself creates problems. Dialysis patients often cannot simply leave and find a clinic in another city. They must:

1. Locate a dialysis center in the destination area willing to accept emergency patients
2. Obtain a transfer of their medical records and current treatment prescription
3. Arrange transportation that accommodates their physical limitations
4. Bring enough medications and supplies for an extended stay

This process, which can take days under normal circumstances, must happen in hours during an emergency — often without phone service, internet access, or the ability to reach their regular care team.

Social Isolation Compounds the Risk

Many dialysis patients are elderly, live alone, or have limited mobility. They may not have family members nearby who can help them evacuate or navigate the emergency healthcare system. They may not know their neighbors. They may lack transportation.

In the aftermath of Hurricane Katrina, researchers found that dialysis patients were among the hardest-hit populations — not because they lacked warning, but because they lacked the resources and support networks to act on it.

What Preparedness Looks Like

The good news is that preparation makes a measurable difference. Patients who have taken specific steps before a disaster are far more likely to receive timely care and survive the event without serious medical complications.

Effective preparedness for dialysis patients includes:

• A written emergency plan that identifies at least two alternative dialysis centers within 100 miles, with phone numbers and addresses
• A dialysis emergency card carried at all times, listing current treatment prescription, medications, allergies, and emergency contacts
• A 3-day supply of renal-appropriate food — shelf-stable items that meet dietary restrictions
• A 7-day supply of medications kept separate from daily use supplies
• Registration with local emergency management as a person with a medical need

The Renal Preparedness Project exists to make these steps accessible. Our Pantry 2 Go Emergency Dialysis Kits are designed specifically for dialysis patients — with renal-friendly food, an emergency medication log, a dialysis emergency card, and a fluid restriction tracker — so that patients have what they need before the next disaster strikes.

The Cost of Unpreparedness

In 2017, Hurricane Maria devastated Puerto Rico's healthcare infrastructure. Dialysis centers closed. Patients went days without treatment. The death toll among dialysis patients was disproportionately high.

In 2021, Winter Storm Uri knocked out power across Texas. Dialysis clinics closed or operated at reduced capacity. Patients and families scrambled.

These are not isolated events. They are a pattern — and the pattern will continue as climate-related disasters become more frequent and more severe.

A Call to Action

Every dialysis patient deserves the chance to survive a disaster. That requires preparation — and preparation requires resources.

A single Pantry 2 Go Emergency Dialysis Kit costs $60. It can mean the difference between a patient who is ready and a patient who is not.

If you are a dialysis patient or caregiver, start your emergency plan today. If you want to help someone else prepare, consider donating a Pantry 2 Go Emergency Dialysis Kit through the Renal Preparedness Project.

No one should face a disaster without the tools to survive it.