When the earth shakes unexpectedly: impact on nephrology services and patients.

PURPOSE OF REVIEW: This review examines the impact of earthquakes on nephrology services and patients, highlighting the urgent need for integrated disaster preparedness in renal care. With earthquakes increasing in frequency and affecting densely populated regions, the relevance of this topic to both clinical practice and policy has never been greater.

RECENT FINDINGS: Earthquakes disrupt dialysis infrastructure, impede access to care, and create surges in acute kidney injury (AKI) due to crush syndrome. Hemodialysis (HD) services are highly vulnerable to power, water, and transportation failures, whereas peritoneal dialysis (PD) offers greater resilience but faces hygiene and supply challenges. Special populations - pediatric patients, transplant recipients, and displaced persons - face unique vulnerabilities. Global experiences demonstrate that flexible modalities, patient education, and coordinated international responses can mitigate risks. Despite this, PD remains underutilized and disaster-specific planning is often lacking.

SUMMARY: Earthquakes expose critical weaknesses in nephrology systems but also provide lessons in resilience. Proactive strategies - including PD-first policies, interoperable patient registries, emergency kits, and mobile dialysis units - are essential to protect kidney patients during future disasters. Integrating nephrology into disaster frameworks is both a clinical imperative and a humanitarian necessity.