Disasters and hazard exposure in end-stage kidney disease: a scoping review of patient outcomes.

INTRODUCTION

The vulnerability of patients with end-stage kidney disease (ESKD) to natural and societal hazards is acknowledged. However, evidence remains dispersed across various hazards, settings, and sample sizes. We aimed to synthesize empirical literature analyzing the impact of hazard exposure on patient outcomes.

METHODS

This was a scoping review conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines of contemporary literature (2000 onwards) that examined medical or psychosocial outcomes among patients with ESKD needing kidney replacement therapy.

RESULTS

Of the 10 040 titles and abstracts screened, 30 studies from 10 countries/regions met our inclusion criteria. Hazards assessed included inclement weather (n = 5), wars/conflicts (n = 7), and natural disasters (n = 18). Accounting for cohort overlaps, we synthesized the outcomes of 1065 750 adult patients on dialysis, 45 children, and 64 531 transplant recipients. Mortality (n = 16) was the most frequently reported outcome: 9%-45% higher risk with extreme heat events, 5%-139% higher risk with poor air quality, and the majority reporting/implying a higher risk with natural disasters or war/conflict. Increased hospitalization risk was reported (n = 10), and among 10 of 11 included studies, 23%-59% of the sample experienced dialysis-related disruptions. Limited literature existed on modality switch/changes, graft failure, and medical complications. Seven reported a high prevalence of psychosocial outcomes. In stratified analysis, older age, diabetes and other co-morbid condition/s, prior hospitalizations, lack of preparedness, fragile health systems, and psychosocial vulnerability were risk factors for inferior outcomes.

CONCLUSION

Our review consolidates findings across multiple studies and highlights the profound vulnerability of ESKD patients to hazards. Evidence gaps are highlighted to guide future research and policy efforts.