Texas dialysis units have largely recovered from the loss of water and power from powerful winter storms, but their patients still face fallout from it.
“I work with three different chains — American Renal Associates, DaVita, and U.S. Renal Care — and none of them had good water pressure to dialyze in their units,” said Mahendra Agraharkar, MD, medical director at those clinics in suburbs around Houston. “It really taxed our healthcare system so much.”
After a week of outages in some areas, nearly all facilities are back to regular dialysis schedules.
“Everything was business as usual as of this Monday,” said Ramiro Saavedra, RD, LD, a dietitian at a DaVita facility in Houston.
Dialysis units are still working through a lot of fluid overload and likely will be for months, noted Faith Story, LMSW, U.S. Renal’s regional lead social worker for the Texas Gulf Coast and an ambassador for the American Kidney Fund (AKF).
“Last week, it was lucky if we were able to get patients in [for dialysis] 2 hours maybe one time for the week,” she said in an interview monitored by AKF media relations. “We’re slowly recovering.”
Story still had some patients without water in the Pasadena area as of Wednesday, but access to the foods needed for renal health was the bigger issue.
Many end-stage renal disease patients rely on assistance in obtaining food, but meal services didn’t deliver, family and friends were unable to drop off groceries as usual, and public transportation was spotty, Saavedra added.
Also, “the systems were down for SNAP food stamps, so they’re relying on charities and food banks,” Story told MedPage Today. “However, since so many people are without, those are going really quickly.” In addition, many items are out of stock even for those who can afford them.
She met with other lead social workers from around Texas and heard the same issues all over the state. The only exception was El Paso, which is on a different power grid and didn’t suffer the same outages and issues, she said.
“Resources are just limited right now,” agreed Joni Justice, RD, LD, a nurse manager for the home dialysis and renal program at Texas Children’s Hospital in Houston. “People still need help, still need food. The hard part is the stipulations they put you through to even qualify for it. You see families saying this was a disaster, I wasn’t able to work, I’m not getting paid. There’s a lot of need here.”
The AKF activated its Disaster Relief Program to provide $200 emergency grants to help kidney patients affected by the storm in Texas. President Biden issued an emergency declaration for the state due to the winter storms, and HHS declared a public health emergency for it as well.
Healthcare workers have been affected too: Some were out of work and lost income during the shutdown of many centers, while others worked extra through the disaster to manage logistics and make sure everyone was safe, then came home to the same problems with burst pipes and damaged homes, Justice noted. “You’re still trying to manage that work-life balance.”
Her pediatric patients normally use peritoneal dialysis and were able to continue with manual exchanges of dialysate, so the disruptions were less severe for them, and Justice predicted no long-term consequences.
For adults doing hemodialysis, those missed days and abbreviated sessions during the storm and its aftermath likely will have an impact on both hospitalization and mortality, Agraharkar said.
Patients tipped over into heart failure by the delays in dialysis may find it to be permanent as well, Story pointed out.
“We do prepare the patients ahead of time for disaster preparedness. We talk to them several times a year, especially right before hurricane season, about what kind of items they need to stock up on and what diet to follow in an emergency situation,” Saavedra noted.
In prior disasters, there’ve always been at least a few dialysis clinics where patients could be sent, but “this was something new,” he said. “It’s kind of a wake-up call.”