SUN-192 MISSED HEMODIALYSIS TREATMENTS AND MORTALITY IN PUERTO RICO BEFORE AND AFTER THE 2017 HURRICANES: A MEDIUM DIALYSIS ORGANIZATION EXPERIENCE

Abstract

Puerto Rico is a U.S. Territory that had a census of ~3,474,000 people in 2015. Patients with ESKD on Puerto Rico are mostly served by one large and one medium dialysis organization (LDO, MDO) caring for approximately 4000 and 2000 patients respectively. On September 6, 2017 Hurricane Irma landed on Puerto Rico with average winds of 80-100 mph followed on September 20, 2017 by Hurricane Maria classified as a Category 4 Hurricane with 155 mph winds leaving 100% of the island without electricity or potable water, 60,000 homes without roof and >90% without communications. Because dialysis facilities had generators and could create clean water many resumed dialysis within a few days and functioned as community support stations as well. However, many other health services were limited in their operations. In the early post hurricane period some dialysis patients arrived at alternate dialysis locations without their medical records or information about their dialysis regimen and hence may not have received optimal dialysis treatments, while many others relocated temporarily or permanently off island. We describe the MDO facility characteristics for 2016-17 and 2017-18 with an emphasis on September and October 2017. We calculated missed monthly hemodialysis treatments (both hospitalization and non-hospitalization absenteeism) as well as monthly mortality rates for facility patients for those periods reported as (deaths per month/unit census)*1000). The MDO August 2016 dialysis census was 2071 and by December rose 2118 patients. By contrast the August 2017 census was 2050 patients but following the hurricanes fell to only 1800 patients by December 2017 (15% drop; Figure 1) due mainly to off island transfers but also increased deaths. It is slowly returning to pre-hurricane levels. Missed hemodialysis treatments in Sept/Oct 2017 were 87% higher than Sept/Oct 2016, but fairly similar for other months across the two years (Figure 2). The normal distribution of causes for missed hemodialysis treatments for the MDO is 65% due to hospitalizations and 35% due to absenteeism (not related to hospitalizations), but immediate post hurricane 63% of missed hemodialysis treatments were due to absenteeism and 37% were due hospitalization. The immediate post hurricane deaths in Sept/Oct 2017 were more than twice that of Sept/Oct 2016 and then otherwise fairly similar by month across the two yearsView Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) In 2017 Hurricanes Irma and Maria caused major damage to Puerto Rico and had a dramatic impact on dialysis patients. There were high rates of migration off island, missed dialysis treatments and increased deaths. The magnitude is much greater than reports of hurricanes affecting the continental 50 U.S. states. Because most facilities were functional in a few days (16 of 17; 1 was severely damaged), the increase in missed treatments (and reduced treatment time) were likely due to hurricane impact on families and communities; loss of electricity, road closures, safety concerns. Increased deaths were likely due to the same, as well as limited access to food, health care, and potable water. Lessons learned may inform preparedness for future major hurricanes globally.