• Among patients scheduled to have dialysis during the landfall of Hurricane Sandy at clinics where electricity had been deprived, 26.3% missed dialysis sessions and 66.1% received dialysis at non-regular dialysis units.

• The percentage of patients who carried their insurance information and detailed medication lists with them were 75.9% and 44.3%, respectively.

Washington, DC (July 28, 2015) -- Patients on dialysis are very vulnerable during emergencies or disasters due to their dependence on technology and infrastructure such as transportation, electricity and water to sustain their lives. A study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN) shows that many are unprepared for such situations.

James Winchester, MD, Naoka Murakami, MD, PhD (Mount Sinai Beth Israel), and their colleagues assessed the preparedness of 357 adults receiving outpatient dialysis during the landfall of Hurricane Sandy in New York City in October 2012 at 5 facilities where electricity had been deprived.

The researchers found that 26.3% of patients missed dialysis sessions and 66.1% received dialysis at non-regular dialysis units. The percentage of participants who carried their insurance information and detailed medication lists were 75.9% and 44.3%, respectively.

Patients whose dialysis centers distributed a "dialysis emergency packet"--which includes information on a patient's medications, dialysis schedule, comorbid conditions, and geographical/contact information for dialysis centers--after the storm were more likely to later have copies of their medical records stored at home.

"Disasters affect all of the population, but patients with specific needs such as dialysis are especially vulnerable, dialyze in buildings often above the ground floor, and underline the need for emergency generators," said Dr. Murakami. "There is a need to strengthen both patients' and dialysis facilities' awareness and preparedness to improve outcomes in natural disasters," she added.

In an accompanying editorial, Michael Davis, CRNP and Jeffrey Kopp, MD (National Institutes of Health) noted that the study also pointed to various factors--such as having access to alternate dialysis in an integrated system, getting access to transportation, and having a stable social situation--that could be important for avoiding missed dialysis treatments. "The list includes both socio-demographic factors that indicate which dialysis patients will require particular attention and factors that can be addressed with new intervention strategies," they wrote.

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Study co-authors include Nikolas Harbord, MD, David Lucido, PhD, and Hira Babu Siktel, MD.

Disclosures: The authors reported no financial disclosures.

The article, entitled "Disaster Preparedness and Awareness of Hemodialysis Patients following Hurricane Sandy," will appear online at http://cjasn.asnjournals.org/ on July 28, 2015.

The editorial, entitled "Disaster Nephrology: Impact of Early Dialysis Treatments and Missed Dialysis Treatments," will appear online at http://cjasn.asnjournals.org/ on July 28, 2015.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 15,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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• There was only a 5% error rate when patients with chronic kidney disease used mobile health technologies designed to help them use medications appropriately.

Washington, DC (July 28, 2015) -- It can be difficult for patients with complex chronic diseases to take medications appropriately, but a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN) finds that tailored mobile health technologies can help ensure the safety of their care.

To determine whether user-friendly mobile technologies might help keep patients with chronic kidney disease (CKD) on track with their medications, Clarissa Jonas Diamantidis, MD, MHS, of the Duke University School of Medicine, and her colleagues at the University of Maryland School of Medicine evaluated the home-based usability of a mobile health medication inquiry system (MIS) that they designed as a patient-centered medication safeguard. The MIS application responds to study medications with 3 potential responses: "not safe in chronic kidney disease", "use with caution, speak with your healthcare provider", and "safe in chronic kidney disease."

The investigators randomized 20 patients with CKD to a text-based MIS platform or a personal digital assistant (PDA)-based MIS platform. Participants were then mailed 3 randomly selected sample prescription pill bottles and asked to input the medication into the MIS and record the system responses to determine their appropriateness in CKD.

"General usability of the MIS application was high, regardless of platform type, with only a 5% error rate," said Dr. Diamantidis. Two errors occurred in the text-based group and 1 in the PDA-based group. "The majority of participants found the application easy to use and helpful in avoiding the use of harmful medications, and they would recommend the application to others."

Despite general proficiency with the mobile health MIS application, the study uncovered variable electronic health literacy among patients. When participants were administered the eHealth Literacy Scale, which evaluates individuals' perceived abilities to effectively apply electronic health information to health problems, the majority of participants felt the Internet was a useful source of health information, but only about half felt they knew where to find helpful health resources on the Internet. Even fewer reported being able to tell high quality from low quality Internet-based health information.

In an accompanying editorial, Bryan Becker, MD, of the University of Chicago, noted that harnessing mobile technology to better treat CKD is logical. "What Diamantidis and colleagues have done is extend that treatment platform beyond traditional care settings into the home," he wrote. "They have used a tool to create a small but very important first step in achieving patient engagement and patient satisfaction in self-care."

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Study co-authors include Jennifer Ginsberg, MS, Marni Yoffe, MA, Lisa Lucas, Divya Prakash, MS, Saurabh Aggarwal, PhD, Wanda Fink, MS, RN, Stefan Becker, MD, and Jeffrey Fink, MD, MS.

Disclosures: Dr. Fink has received prior research funding from Amgen, Inc. and honoraria from Sandoz, Inc. and Amgen, Inc.

The article, entitled "Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD," will appear online at http://cjasn.asnjournals.org/ on July 28, 2015.

The editorial, entitled "2015Medication Safety + Mobile Health = Patient Engagement in Chronic Kidney Disease," will appear online at http://cjasn.asnjournals.org/ on July 28, 2015.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 15,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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