Kidney Week Edition October/November 2011 | Vol. 3, Numbers 10 & 11 Dialysis Patients: Ready for Disasters? By Tracy Hampton require coordinated efforts from dialysis facilities, large dialysis organizations, and national foundations, the authors said. ost dialysis patients are not “If these findings are representative prepared to effectively handle of the dialysis community at large, and man-made or natural disas- they may well be, the dialysis community Mters, finds a study appearing in the Oc- needs to develop and validate innovative tober Clinical Journal of the American educational approaches that will improve Society of Nephrology. The findings held disaster preparedness for our patients,” even for patients receiving relevant edu- said Jeffrey Kopp, MD, of the Kidney cational materials from dialysis centers. Community Emergency Response Coali- “A dialysis patient is reliant on fre- tion (KCERC) and the National Institute quent visits to a dialysis facility to main- of Diabetes and Digestive and Kidney tain his or her health, and when this Diseases. cannot be achieved due to lack of clean Other experts agree. “The educational water, lack of electricity, impassable road- materials have been disseminated, but ways, etc., severe medical complications perhaps we need to explore what are the leading to significant morbidity and mor- other barriers to preparedness, including tality can occur quite quickly,” said medi- financial and motivational,” said Richard cal student Mark Foster of the University Zoraster, MD, medical director of the of North Carolina School of Medicine, National Hospital Preparedness Program who led the study. “This research is im- at the Los Angeles County Emergency portant because it sheds light on this lack Medical Services Agency. of preparation and can serve as a stimulus to enact measures to ensure better prepa- disasters and dialysis ration for future disasters.” Mitigating the effects of disaster on di- Patients on dialysis depend on technolo- alysis patients will require local, regional, gy to keep them alive, and they must take and national leadership. Because disaster certain steps to avoid becoming seriously preparedness was not related to level of sick or dying in the face of a disaster such education, literacy, socioeconomic status, as the recent tornadoes in the Midwest or age, it is clear that the lack of prepa- or the earthquake in Japan. Several years ration is a systemic problem that will Continued on page 2 Inside k Idney Week ScIentIfIc SeSSIonS k4 idney Week Preview 13 tHURSdAy What Are the Essential Elements for Reform of a Care Delivery Leptin and the Biological Basis of Obesity System? 7 ASn in Review State-of-the-Art Lecture: Jeffrey M. Friedman Christopher R. Blagg Endowed Lectureship: Mark B. McClellan 9 Meet ASn’s next President Mechanisms and Regulation of Vascular Calcification Modulation of ENaC Function by Pendrin-Dependent Cl-/HCO3 Jack W. Coburn Endowed Lectureship: Cecilia M. Giachelli 11 HdL and ckd Barry M. Brenner Endowed Lectureship: Susan M. Wall 28 Journal View 14 fRIdAy 16R SAtU dAy Biomaterials and Biotechnology: From the Discovery of 32 diet and ckd From C. Elegans to Mammals: Genes that Can Increase Lifespan Angiogenesis Inhibitors to the Development of Controlled Drug State-of-the-Art Lecture: Cynthia Kenyon 34 obesity and kidney Health Delivery Systems and the Foundation of Tissue Engineering State-of-the-Art Lecture: Robert S. Langer 36 Physical Activity and the kidney 18d SUn Ay To Serve and Protect: Classical and Novel Roles for Na, K-ATPase Up in Space: Medicine off the Earth 39 cRoWnWeb Progress Homer W. Smith Address: Anita Aperia State-of-the-Art Lecture: Jonathan B. Clark 40 Policy Update The Origins of Fibroblasts: From Tissue Injury to Fibrosis Kidney Fibrosis: Where Kidney Repair Went Awry Robert W. Schrier Endowed Lectureship: Eric G. Neilson Young Investigator Award: Katalin Susztak 2 | ASN Kidney News | October/November 2011 Disasters tions have done a very good job by edu- When this happens, dialysis patients administrators to ascertain their centers’ cating dialysis patients about what to do should be careful how much they drink, disaster preparedness activities. Continued from page 1 in the case of a disaster,” said Didier Por- have a stockpile of appropriate foods and The researchers asked questions re- tilla, MD, a member of the American So- medications, and notify local police, fire, garding demographics, general disaster ago, the KCERC developed a disaster re- ciety of Nephrology’s Disaster Relief Task electric, water, and emergency services. preparedness using Homeland Security sponse plan that addresses the particular Force and a professor at the University of recommended item lists, dialysis specific needs of dialysis patients and includes im- Arkansas College of Medicine. dialysis patients’ preparedness preparation for an individual to shelter in plementation and dissemination of best Disaster scenarios fall along two lines To assess how well dialysis centers and place, and preparatory steps for a forced practices at the state, local, and individ- of response. Often, people must evacu- their patients are prepared for disasters, evacuation. The cross-sectional analysis ual level (http://www.ncbi.nlm.nih.gov/ ate their homes and seek shelter in other Foster and his colleagues—including Jane revealed that all dialysis centers had a pubmed/17699500). The KCERC and the locations. Dialysis patients should know Brice, MD, Maria Ferris, MD, PhD, and disaster preparedness program in place, National Kidney Foundation have pro- where alternative dialysis clinics are, have others—surveyed 311 end stage kidney but most patients were not well-prepared vided information to both dialysis clinics medications on hand, and carry medical disease patients who received care at six for a disaster. Only 43 percent of patients and patients regarding the necessary steps documentation of their kidney condition. different regional dialysis centers in cen- knew of alternative dialysis centers. Only for disaster preparedness. Other events such as severe snowstorms tral North Carolina between June and Au- 42 percent had adequate medical records “KCERC and large dialysis organiza- require people to stay in their homes. gust 2009. They also interviewed dialysis at home that they could take with them on short notice. Only 40 percent had discussed the possibility of staying with a friend or relative during a disaster, and only 15 percent had a medical bracelet or necklace they could wear if they were forced to leave their homes. Also, while in- dividuals should maintain personal stores of potassium exchange resins along with instructions for use to mitigate hyperkale- mia, only 13 percent of patients had any knowledge of the medication, and only 6 percent had the medication in their homes. “These results were found to be inde- pendent of age, gender, race, education, household income, and literacy level, in- dicating that all sorts of people were un- prepared no matter what their socioeco- nomic status,” Foster said. Preparedness was slightly better when patients were asked about their plans for disasters that would force them to stay in their homes, the researchers found. Fifty- seven percent knew what diet they should ™ follow during a disaster, and 63 percent had Adimea a two-week supply of extra medications. Home peritoneal dialysis patients were significantly more likely to be prepared for a disaster than hemodialysis patients. All 27 home peritoneal dialysis patients Real-Time Dialysis Monitoring studied knew how to order extra sup- Adimea provides doctors and the nursing staff with a continuous monitoring and plies. Still, only 40 percent had an extra display of the dialysis effectiveness (Kt/V or URR) during the patient’s treatment. supply of antibiotics, only 38 percent had notified the local power company of their health condition, and 20 percent had no- Adimea only requires the simple entry of the patient’s weight. tified the local water company. Once activated, the Adimea user interface provides: “This is an excellent and timely paper Cumulative display of URR and Kt/V pointing out the vulnerability of dialysis Selection and monitoring of target Kt/V value patients who experience a natural disaster,” Fast access to treatment parameters to influence outcome said Allen Nissenson, MD, chief medical officer of DaVita Inc. “With experts now stating that climate change will drive an For more information, contact your local B. Braun Sales Representative, or call increase in extreme weather throughout Customer Support at 800-848-2066. the country, it is essential that patients and providers understand the risks and the key role of education and preparation to mini- mize the impact on patient health.” Ways to Improve The findings about dialysis patients’ dis- aster preparedness may apply to other patients as well, said study author Mark Foster. “With the recent string of natural disasters, including the recent tornadoes www.bbraunusa.com of the spring of 2011, the earthquake in Japan, Hurricane Katrina in 2005, and many others, it is quite relevant for all Rx only. ©2010 B. Braun Medical Inc. All rights reserved. 10-2324_RBT_10/10_JH folks, especially those who are living with chronic illnesses who require frequent monitoring and intervention to maintain their health.” 10-2324_Adimea ad 10-10.indd 1 9/30/2010 5:12:43 PM PUMP0004 ASN KidNews DR 9/26/11 12:12 PM Page 1 get ready to gettotally pumped a NEW way to deliver Automating soon! head to Booth 700 at ASN exclusively from Venofer® is manufactured under license from Vifor (International) Inc., Switzerland and American Regent, Inc., Shirley, NY. Venofer® is a registered trademark of Vifor (International) Inc. used by permission. Fresenius Medical Care is a trademark of Fresenius Medical Care Holdings, Inc. or its affiliated companies. © 2011 Fresenius Medical Care North America. For more information contact Customer Service: 800.323.5188 ext.6615 101592-01 Rev. A 09/2011 4 | ASN Kidney News | October/November 2011 editorial Staff editor-in-chief: Pascale H.