Nephrology Care in Man-Made and Natural Disasters: Addressing the Unique Challenges for the Provision of Home Dialysis in Disasters.

Dialysis-dependent patients, especially those on peritoneal dialysis and home hemodialysis, rely heavily on uninterrupted access to electricity, clean water, and supply chains. Disasters, both natural and man-made, disrupt these critical systems, placing patients at significant risk of treatment interruptions, hospitalization, and mortality. Preparing for these challenges is vital to ensure continuity of life-saving care during crises. This review aims to examine the unique challenges faced by dialysis patients during disasters, including logistical barriers, workforce shortages, and infrastructure dependency. It also highlights the role of organizations in ensuring dialysis care continuity through preparedness strategies and collaborative efforts. A comprehensive literature review was conducted using PubMed, focusing on dialysis care during natural and man-made disasters. Keywords included dialysis, natural disasters, peritoneal dialysis, home hemodialysis, and disaster preparedness. Case studies and systematic reviews were analyzed to evaluate the impact of crises on dialysis care and identify actionable solutions. Disasters result in increased hospitalization rates among dialysis patients, compounded by communication failures, infrastructure damage, and limited access to essential resources. Case studies such as Hurricane Katrina and the Christchurch earthquake demonstrate the multifaceted nature of these challenges. The review also underscores the advantages of home dialysis modalities during crises, such as their operational flexibility, while highlighting their limitations, including dependence on utilities and patient preparedness. Ensuring dialysis care during emergencies requires strategies for reliable infrastructure, patient awareness, and resource readiness. Strengthening support systems and health care coordination is the key to minimizing disruptions and protecting vulnerable patients.