Inclement Weather and Risk of Missing Scheduled Hemodialysis Appointments

Abstract

Background and Aim: Non-adherence to dialysis treatments results in health complications that are associated with increased morbidity and mortality in hemodialysis patients. We examined the association between different types of inclement weather conditions and missed dialysis treatments. Methods: We obtained health records on end-stage kidney disease (ESKD) patients who received hemodialysis at Fresenius Kidney Care (FKC) clinics across the Northeastern U.S. during 2001-2019. County-level daily meteorological data on rainfall, hurricane events, snowfall, snow depth, and wind speed were extracted through the National Oceanic and Atmosphere Agency (NOAA) database. A time-stratified case-crossover study design with conditional Poisson regression was employed to estimate the effect of inclement weather exposures on hemodialysis treatment adherence. We applied distributed lag non-linear model (DLNM) framework to estimate the delayed effect of inclement weather for up to one week. Results: We studied 28,620 ESKD patients from 27 northeastern counties who had any missed hemodialysis appointment. Overall, the missed appointment rate was higher for all of the inclement weather type (rainfall, hurricane, snowfall, snow depth, and wind advisory) compared to non-inclement weather days. The risk of missed appointment was highest at lag 0 for 10mm increase of rainfall (RR=1.027, 95% CI: 1.021, 1.032), snowfall (RR=1.019, 95% CI: 1.017, 1.021), and snow depth (RR=1.014, 95% CI: 1.013, 1.016). Hurricane events showed the highest RR at lag 5 (RR=1.163, 95% CI: 1.016, 1.332). Wind advisory showed sustained higher risk compared to non-exposure days through up to lag 5. Conclusions: All types of inclement weather events showed increased risk of missed hemodialysis appointments. Since inclement weather events are projected to increase due to ongoing climate change, our findings suggest the need for enhanced climate readiness by health care delivery systems that include early warning systems disaster response plans for delivering uninterrupted dialysis-related health services. Keywords: inclement weather, climate change, hemodialysis