Emergency Partnership Initiative prepares nephrology community for disasters
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Key takeaways:
- EPI formed after hurricanes in 2017 and worked with the CDC to support patients with kidney diseases during COVID-19.
- EPI provides tools to prepare the kidney community to respond to a variety of emergencies.
In the aftermath of Hurricanes Irma and Maria, which struck the Caribbean in September 2017, the American Society of Nephrology was asked to provide logistical support to kidney care providers and patients with kidney diseases.
The ASN helped inform the affected kidney community about the extent of the emergency and identify which dialysis centers were open and functioning. ASN helped to locate patients in need of care. ASN also communicated with nephrologists who were willing to travel to Puerto Rico to volunteer and nephrologists in states like Florida who would be able to care for patients arriving there from the affected Caribbean islands. In taking on these roles, ASN recognized that it needed better tools to provide support for those impacted by emergencies.
Building the partnership
To create the needed infrastructure, ASN developed the Emergency Partnership Initiative (EPI) in 2019. Nicole Lurie, MD, MSPH, the assistant secretary of health for preparedness and response under President Obama, agreed to co-chair EPI with me and set its initial goal to facilitate communication among stakeholders. The EPI team included nephrologists, dialysis providers, governmental agencies like the Kidney Community Emergency Response Coalition and the CDC, and non-governmental organizations including Direct Relief and Renal Dynamics. Each took different roles and had different priorities in the aftermath of an emergency.
EPI sought to reach out to nephrologists in affected areas to understand the needs of patients and providers directly impacted by emergencies. The group researched best practices to help patients and providers prepare for the emergencies likely to arise in their regions. Following Lurie’s mantra to “never let a good crisis go to waste,” EPI took lessons from Hurricane Katrina in 2005 and Superstorm Sandy in 2012, and advised proactive steps, such as preparing an emergency supply of medications and nonperishable kidney-safe food and compiling medical information, including medical history, dialysis prescription and an updated medication list.
COVID-19 response
Many emergency situations are predictable, but others are not. Even before COVID-19 reached pandemic status, it became clear it had a disproportionate impact on patients with kidney disease compared with other populations. Patients requiring maintenance dialysis were more susceptible to infection because they had to attend dialysis treatments three times per week, increasing exposure to the virus, and their immune systems did not respond as vigorously as the general population to exposure, making them more susceptible to complications of COVID-19. Those with kidney transplants had weaker ability to ward off the complications from infection due to the anti-rejection medication required to maintain kidney function.
Combining EPI leadership with its infection prevention team, Nephrologists Transforming Dialysis Safety, ASN formed the COVID-19 Response Team in March 2020. Under the leadership of Alan S. Kliger, MD, and Liz McNamara MN, RN, we organized four work groups with the following focuses: acute kidney disease, home dialysis, outpatient dialysis and kidney transplant.
Our work groups, made up of adult and pediatric nephrologists, nephrology nurses, social workers, mental health professionals and kidney patients produced dozens of webinars and podcasts, published dozens of peer-reviewed articles and stood up multiple online modules. In addition to scientific analyses of prevention, diagnosis and treament of COVID-19, we explored a wide range of topics from personal wellness and safety to mental health and more.
To further support patients with kidney diseases, we collaborated with the broader kidney community. We argued against the exclusion of patients with kidney diseases from clinical trials of vaccines and therapeutic agents. We explained the critical importance of their inclusion because of the differential handling of these agents in patients with kidney diseases and the potential for significant safety events if the agents were not evaluated prior to approval by the FDA.
Working with the CDC, we advocated for easier access to vaccines for those with kidney diseases and for the distribution of vaccines through dialysis providers so patients could be vaccinated in their medical homes. The White House allocated vaccines to dialysis centers through a hub-and-spoke model to ensure all patients had access in their home dialysis centers. In response to this distribution, vaccination rates among patients with kidney diseases increased dramatically and relationships among kidney care providers were strengthened.
Extreme weather events
As the COVID pandemic waned, we reorganized EPI with a new set of priorities. In addition to continuing our efforts to foster communication, EPI aimed to provide tools to help the kidney community prepare for and respond to a variety of emergencies, recognizing that the new normal is simply the time between events. Taking lessons learned from prior weather events, EPI provided patients and caregivers with information about preparation for emergencies. In the face of climate change, EPI recognized that patients and caregivers needed to prepare not just for events common in their geographic regions, but for unusual events as well.
In September 2024, an unusual event hit western North Carolina when Hurricane Helene caused devastating flooding in a mountainous region rarely struck by hurricanes. Leveraging the relationships built during the COVID pandemic, EPI and the chief medical officers of U.S. dialysis providers collaborated to respond to the shortage of peritoneal dialysis solutions in Helene’s wake. In response to concerns that patients would have insufficient supply of fluids for optimal treatment, we authored a letter to the FDA. In response, the FDA provided waivers for the importation of solutions so patients could continue peritoneal dialysis at home safely. The kidney community collaborated to author guidelines for preservation of peritoneal dialysis fluids while avoiding negative impact on patient care and outcomes.
EPI has supported the kidney community through a variety of emergencies related to weather, infections and other circumstances. To further its mission, EPI is collaborating with the European Renal Association and the International Society of Nephrology to ensure that best practices are shared around the world and resources are available to all patients with kidney diseases and those who support them.
For More Information:
Jeffrey Silberzweig, MD, FACP, FASN, is a Healio | Nephrology News & Issues Editorial Board Member. He is chair of the American Society of Nephrology Emergency Partnership Initiative and co-chair of the Current and Emerging Threats Workgroup. He is the chief medical officer for the Rogosin Institute, professor of clinical medicine at Weill Cornell Medical College and medical director of dialysis services at New York-Presbyterian Hospital/Weill Cornell and Lower Manhattan Hospitals. He can be reached at jis2003@nyp.org.
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