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Climate disasters require emergency plans for dialysis patients, experts say

The Canadian Society of Nephrology is calling for environmentally sustainable kidney care to reduce the large amounts of wastewater, energy and single-use plastics involved in dialysis. Francis Silva undergoes dialysis treatment at St. Paul's Hospital in Vancouver, B.C., Tuesday, May 7, 2024. THE CANADIAN PRESS/Darryl Dyck The Canadian Society of Nephrology is calling for environmentally sustainable kidney care to reduce the large amounts of wastewater, energy and single-use plastics involved in dialysis. Francis Silva undergoes dialysis treatment at St. Paul's Hospital in Vancouver, B.C., Tuesday, May 7, 2024. THE CANADIAN PRESS/Darryl Dyck
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When catastrophic floods severed a bridge and washed away or closed highways in southern British Columbia, Mitchell Dyck and other patients needing regular life-saving dialysis had to be flown to hospital by helicopter.

The flooding caused by record-breaking rain in November 2021 shut down every route to the rest of Canada and made it impossible for Dyck to make the 25-minute drive from his home in Chilliwack to the dialysis unit of the Abbotsford Regional Hospital.

Dyck, now 25, was receiving overnight dialysis three times a week because his kidneys did not filter waste and excess fluids from his blood due to a genetic disease diagnosed a year earlier. He said a nurse called him and others to say they should head to the Chilliwack airport to board a helicopter, but the anxious patients encountered "chaos" there and he arrived at the hospital just in time for his treatment.

"It was a little bit concerning, and my family was definitely concerned too with whether I was going to be able to get there," Dyck said of the scramble for treatment during a climate disaster that forced nearly 15,000 residents in several communities out of their homes and killed five people in a landslide.

While some dialysis patients were put up in hotels, Dyck stayed with his grandparents in Abbotsford until portions of Highway 1 were open to traffic two weeks later. After receiving dialysis for nearly two years, Dyck had a kidney transplant in August 2022 and now takes eight medications, including immunosuppressants and drugs for high blood pressure that he always stocks in case of an emergency.

A 2022 Environment Canada study suggested that climate change made the B.C. floods at least twice as likely and it's possible that similar events will increase as greenhouse gases keep entering the atmosphere.

The likelihood of more disasters, including wildfires and droughts, has nephrologists calling for better emergency planning across the country to ensure that uniquely vulnerable dialysis patients have access to treatment without which kidney failure could cause life-threatening conditions or death.

Dr. Shaifali Sandal, a transplant nephrologist at the McGill University Health Centre in Montreal, is working on a project with the Canadian Society of Nephrology to determine how best to manage kidney patients during disasters.

She said Montreal General Hospital cared for at least 20 extra dialysis patients last summer after Cree Nation communities in northern Quebec were evacuated due to wildfires.

"Our units are already over capacity and we actually requested the help of neighbouring units that are not affiliated with us," Sandal said.

As part of the project funded by the Canadian Institutes of Health Research, she will be setting up a task force to get feedback from health professionals and patients across the country to understand how care can be better co-ordinated during emergencies.

Sandal is also reviewing research papers on the lessons learned in other countries about caring for kidney patients during various emergencies.

"We want to apply experiences from disasters including an earthquake that displaced people in Japan and experiences in Ukraine due to war and climate-change emergencies that forced people out of their communities," Sandal said.

"They're saying, 'Have a contingency plan, have a communication plan, have a network within your region, so that if you have to accommodate extra patients, you can do it. Have a disaster co-ordinator in each region.'"

Sandal said BC Renal, a network in British Columbia that plans and co-ordinates care of patients with kidney diseases, could serve as a model for the rest of Canada because it offers "amazing" resources to help patients prepare for an emergency.

"I think we just need BC Renal's permission to share them with every other centre and translate them into different languages," she said.

Sarah Thomas, a registered nurse and emergency management lead at BC Renal, said the network is unique because it works with the province's five regional health authorities in planning for emergencies so dialysis patients can be sent out of their home community if an evacuation order has been issued.

"That might mean every health authority is looking at their capacity to take patients," Thomas said. "We offer that support to the health authorities, which are busy taking care of patients."

BC Renal recently created an emergency team of 12 hospital-based dialysis nurses who can be deployed to one of the province's 29 community clinics or another hospital offering the treatment rather than airlifting patients — unless the area has been evacuated, Thomas said.

Each nurse on the team educates patients to start their renal diet during an emergency by limiting fluids and eating low-potassium food, which includes berries, cauliflower and broccoli. Patients must also take a prescribed powder that can be mixed with water to lower blood potassium levels for the short term until treatment is available.

BC Renal will also be developing a policy on how to accommodate dialysis patients when water restrictions are in place during a drought or if a water main breaks in a hospital. Each dialysis session uses up to 500 litres of water, three times a week per patient, as part of the procedure that is also dependent on electric power.

"In the worst case we probably have to relocate (patients) to another area," Thomas said.

"I know people think (intensive care units) are life support. But dialysis is also life support," she said. "We had to come up with something to ensure that we had agile emergency procedures in place because if our patients don't get the treatment they will get sick, end up in hospital and could die."

Health information about all kidney patients, whether they get dialysis or have received a transplant, is stored on an electronic registry that is available anywhere in B.C., unlike other patient records, Thomas said.

"It's unique to B.C. We've created this. The rest of Canada is saying, 'What's BC Renal doing?'" she said of interest in the emergency preparedness program.

Thomas said the network's bolstered emergency response plans began during the COVID-19 pandemic and a trio of climate-change calamities that hit British Columbia in 2021 — record-setting wildfires, including one that nearly destroyed the town of Lytton, an unprecedented heat dome that led to 619 deaths in the province, and an atmospheric river that caused flooding in the Abbotsford area.

"We know that more and more climate emergencies are going to happen, and we are going to be better prepared to make sure patients have the care that they need."

This report by The Canadian Press was first published June 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.  

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