Emergency Preparedness for People with Kidney Disease

An emergency can strike at any time. It may be widespread like a natural disaster or terrorist act; or it could happen on an individual basis, like a car accident. Regardless of its nature, an emergency can have a direct impact on you and your ability to receive dialysis. There are several steps you can take to make sure that in an emergency situation, you can receive the treatment you need, or at the very least, lessen the impact of missing a dialysis session.

The basic emergency kit for kidney disease patients

In an emergency, power may be interrupted for several minutes or several days. Clean drinking water may be difficult to obtain. Your emergency kit should provide you and your family with the basic necessities. A basic home emergency kit should contain enough water and food for each person for at least three days, paper and plastic ware, a manual can and bottle opener, first aid supplies, a flashlight and a battery-powered radio. This kit should be stored in one place such as a lidded plastic trashcan or duffle bag, and should be easily accessible. The American Red Cross has excellent and comprehensive disaster preparedness information. They have compiled a list of items that should be in your emergency kit.

Kidney patients on dialysis should add several items to their emergency kit that will help meet their needs if an emergency happens. The kit should include the following:

  • Emergency phone numbers for your doctors and dialysis centers, as well as another nearby dialysis center
  • At least three day’s worth of any medicines you are taking as well as a list of medicines and the dosage amount
  • If you are on If you have diabetes, a week’s worth of supplies (syringes, insulin, alcohol wipes, glucose monitoring strips)
  • Food for the 3-day emergency diet and a copy of the diet (see below)

Place these items in a container or bag that can be carried easily if you need to be evacuated or moved from your home. Rotate the stock of your emergency kit to make sure supplies are not past their expiration dates.

For people who rely on automated peritoneal dialysis (APD) machine, they can perform manual exchanges until power is restored.

The 3-day emergency diet

People who rely on in-center hemodialysishome hemodialysis (HHD), automated peritoneal dialysis, also known as a cycler, may be affected during a widespread emergency. Power may not be available to work the dialysis machines or roads may be closed, blocking access to your dialysis center. Hospitals may be unable to provide dialysis right away and you may not have access to treatment for a couple of days. The 3-day emergency diet will provide you with adequate nutrition in the event of an emergency as well as limit the amount of fluid and waste your body accumulates until you can get the necessary treatment. Please note: this diet is not a substitute for dialysis or your renal diet; it is only intended to be followed for three days or fewer in an emergency situation.

The following food items will be needed for the 3-day emergency diet and should be stored in your emergency kit:

  • 3 packages of dry milk or four 8-ounce cans of evaporated milk
  • 1 to 2 gallons of distilled or bottled water
  • 2 packages of powdered fruit flavored drink or one large bottle of pre-mixed fruit flavored drink
  • 1 to 2 cans or bottles of soft drink (no dark cola due to high phosphorus)
  • A six pack of 4-ounce cans or boxes of low potassium fruit juice (apple, grape, etc.)
  • 6 boxes of single serving cereal (no raisin bran)
  • 1 box of sugar, sugar packets or artificial sweetener
  • 12 four-ounce cans of low potassium fruit or fruit bowls (peaches, pineapple, oranges, mixed fruit, applesauce or pears. No raisins.)
  • 8 small cans of unsalted tuna, salmon, chicken or turkey
  • 1 jar of peanut butter
  • 1 small jar of grape jelly
  • 1 small jar of honey
  • 3 small jars of mayonnaise (you will open a new jar each day) or 8-12 single serving foil wrapped packets
  • 1 loaf of white bread (this can be stored in the freezer and replaced every 3 months until needed for emergency)
  • 1 box of vanilla wafers or graham crackers
  • 4 to 6 bags of hard candy (jelly beans, mints, sourballs, lollipops)
  • 1 package of marshmallows

Use any fresh food items you have available for the 3-day emergency diet first, then use what you have stored in your emergency kit. Diabetics should limit their sugar intake and substitute diabetic-friendly items where appropriate. However, diabetics should have some candy available that is not sugar-free in case their blood sugar gets too low.

On the 3-day emergency diet, you will only be allowed 2 cups of fluid each day. This diet is stricter than your renal diet; it has been designed to limit the amount of waste and fluid buildup in your body if you are unable to receive dialysis.

When a widespread emergency or disaster happens, begin your 3-day emergency diet right away. Also, keep a copy of the diet with your emergency supplies to help guide you. The menu for the 3-day emergency diet is as follows:

Day 1

Breakfast

½ cup milk (made from the dry powdered milk) or mix ¼ cup evaporated milk with ¼ cup distilled or bottled water)

1 single-serving box of cereal

1 tablespoon sugar (if needed)

½ cup of drained, canned peaches     

Snack

5 vanilla wafers or 1-½ graham cracker squares

10 sourballs

Lunch

2 slices of bread

2 tablespoons peanut butter

2 tablespoons jelly

½ cup drained, canned pears

½ cup (4 ounces) powdered or pre-mixed fruit flavored drink

Snack

10 marshmallows

½ cup applesauce

Dinner

2 slices bread

½ can (2 ounces) unsalted, canned chicken*

2 tablespoons mayonnaise*

1/2 cup cranberry juice

Snack

10 jelly beans

5 vanilla wafers or 1-½ graham cracker squares

Day 2

Breakfast

½ cup milk (made from the dry powered milk) or mix ¼ cup evaporated milk with ¼ cup distilled or bottled water)

1 single-serving box of cereal

1 tablespoon sugar (if needed)

½ can drained, canned pears

Snack

5 unsalted crackers with jelly

10 jelly beans

Lunch

2 slices of bread

    ¼ cup (1 ounce) unsalted, canned turkey*

½ cup drained, canned pineapple

½ cup (4 ounces) powdered or pre-mixed fruit flavored drink

Snack

10 mints

½ cup canned applesauce

Dinner

2 slices of bread

½ can (2 ounces) unsalted, canned tuna*

2 tablespoons mayonnaise*

½ cup cranberry juice

Snack

5 vanilla wafers or 1-½ graham cracker squares

10 sourballs

Day 3

Breakfast

½ cup milk (made from the dry powdered milk) or mix ¼ cup evaporated milk with ¼ cup distilled water

1 single-serving box of cereal

1 tablespoon sugar (if needed)

½ cup drained canned pears

Snack

10 vanilla wafers or 1-½ graham cracker squares

10 hard candies

Lunch

2 slices of bread

2 tablespoons peanut butter

2 tablespoons jelly or honey

½ cup drained canned peaches

½ cup (4 ounces) cranberry juice

Snack

½ cup applesauce

10 jelly beans

Dinner

2 slices of bread

½ cup (2 ounces) unsalted, canned salmon*

1 tablespoon mayonnaise*

1/2 cup light soda (no dark cola due to high phosphorus)

Snack

5 vanilla wafers or 1-½ graham cracker squares

10 marshmallows

*PERISHABLE ITEM:  Throw away unused portion if not eaten or refrigerated within 4 hours.

Ask your renal dietitian if you have questions about the emergency diet. Do not substitute any foods on this diet without talking to your dietitian first.

When a widespread emergency occurs

If you are at home and uninjured, you should stay home unless instructed by emergency personnel. Watch television or listen to the radio for any news about your area. For weather related emergencies, you may have some time before the worst hits. Be aware of any weather watches in your area.

If you are on continuous ambulatory peritoneal dialysis (CAPD), continue to do your exchanges. PD patients who depend on a cycler can do manual exchanges. If power is unavailable and you do not know how to do a manual exchange, you should start the 3-day emergency diet. People on hemodialysis should start the 3-day diet immediately.

Phone service may be interrupted or you may be instructed to leave the phone lines open for emergency calls. Once phone service becomes available, contact your dialysis center. You should also have your current address and phone number on file at the center so they can contact you and arrange a dialysis session as soon as possible.

Evacuating to a shelter

Sometimes an emergency will require you to leave your home and evacuate to a shelter on short notice. Remember to take your emergency diet items and your necessary medicines, which should be stored in a bag or tote that can be easily carried. Once at the shelter, alert the personnel about your medical needs.

An emergency at the hemodialysis center

DaVita centers have comprehensive emergency guidelines to keep you safe. When you begin dialysis at a DaVita center, the facility administrator or other health care team member will explain what to do if an emergency situation occurs. If you would like a reminder, ask a member of your health care team what emergency procedures are in place.

If an emergency occurs, wait for instructions from health care team members. Your safety is their concern. In the rare and unlikely event health care team members are unable to provide instructions and you must disconnect your access yourself, there is an emergency disconnect pack attached to the side of your dialysis machine that should be within your reach. It contains the needed items to get off dialysis. Disconnecting your access improperly can be extremely dangerous. Ask your renal nurse to show you what to do if you must disconnect your access yourself.

Individual emergencies

Although individual emergencies are smaller in scale, they can still be as dangerous to your health. Medical-alert bracelets show emergency personnel that you have a special health condition. This is very important if you are unconscious or unable to speak.

If you are being treated for injuries, remember to protect your access. Do not allow anyone to inject medication into your access or place anything on it.

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