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Melvin Bonilla-Felix 

Melvin Bonilla-Felix is Professor of the Department of Pediatrics, Section of Pediatric Nephrology at the University of Puerto Rico Medical Sciences Campus and the past president of the Latin American Association of Pediatric Nephrology. His major interests include nephrology services in low-resource settings and disaster nephrology

Competitors for the Disaster Nephrology Region

Team 1: Kidney Care in Natural Disasters

vs

Team 2: Kidney Care in Conflicts

Image generated by Evan Zeitler using DALLE-E 3, accessed via ChatGPT at http://chat.openai.com, February 2025. After using the tool to generate the image, Zeitler and the NephMadness Executive Team reviewed and take full responsibility for the final graphic image.

The United Nations International Strategy for Disaster Reduction defines a hazard as “a process, phenomenon or human activity that may cause loss of life, injury or other health impacts, property damage, social and economic disruption or environmental degradation.” Conversely, disasters are the products of factors that increase the vulnerability of a population by limiting its capacity to cope with the hazard. In this regard, hazards can be natural or man-made. Disasters (even those that develop after a natural hazard), however, are never entirely natural, as the distribution of societal resources, preparedness, and even climate change are the result of human action or inaction.

It is not surprising that there is a strong association between disasters and poverty. Ninety percent of human losses in disasters occurs in low resource countries. For instance, fatality rates from storms in the Atlantic region strongly correlate with the affected country’s gross domestic product (GDP), with a 36-fold increase from the lowest to the highest income countries. Similarly, the mortality rate associated with earthquakes in Asian countries drops by 19%–25% as the country’s GDP doubles.

Patients with kidney disease are extremely vulnerable to disasters. Direct damage to healthcare facilities, power outages, lack of tap water, shortage of disposable products, interruption of transportation systems, and decreased access to maintenance medications, routine laboratories, and essential medical supplies can lead to life-threatening complications.

Likewise, the health of patients with kidney disease living in active war zones is challenged by disruption of the infrastructure and limited access to basic needs, including medications. For instance, displacement secondary to conflict and violence affected 47.2 million children globally by the end of 2023 by interrupting access to treatment centers, medications, and routine laboratories and their medical information–crucial for the management of patients with chronic conditions.

Preparedness, including patient education, is vital to protect the health of patients during and after a hazardous event. A formal registry of all patients–that includes their updated contact information as well as a physical address where an emergency unit can be dispatched–is essential. Each patient should be provided with a personalized package that includes emergency contact information for personnel, a summary of their clinical history, diet orders, and a list of their routine medications with alternatives in case they need to switch temporarily to another drug. In patients receiving kidney replacement therapy, a copy of their dialysis orders should be included, as well as contact information of a closer dialysis unit in case their unit suffers major damage and ends up non-functional after the event. In cases of small children receiving hemodialysis, ideally, a set of the specific pediatric filter and lines prescribed for the patient should be given to the families to keep at home as part of their emergency kit. The use of technology and social media has been reported to be reliable during emergencies, and represents an excellent alternative to maintain communication with families and personnel during the hazard and recovery periods.

Primary responsibility to build a resilient healthcare system and to reduce disaster risks lies with the public sector. However, this responsibility is shared with the private sector and non-govermental organizations. The subject of disaster nephrology should be included in the curriculum of nephrology training programs and other healthcare professionals. Improving education and preparedness are the most important strategies to mitigate the potential catastrophic effects of disasters on patients with kidney disease.

– Guest Post written by Melvin Bonilla-Felix

As with all content on the AJKD Blog, the opinions expressed are those of the author of each post and are not necessarily shared or endorsed by the AJKD Blog, AJKD, the National Kidney Foundation, Elsevier, or any other entity unless explicitly stated.

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