Emergency Preparedness for People with Kidney Disease

It is a good idea to plan ahead and be prepared in the case of an emergency, such as a natural disaster (earthquake, hurricane, tornado, snow storm) or even a pandemic like COVID-19. Regardless of its nature, an emergency can have a direct impact on you and your family. In some emergencies you may not have access to your regular dialysis treatments. In other situations, you may receive your scheduled dialysis treatments but may have issues with access to the foods you usually eat.

It’s normal to feel uncertain or worried during emergencies that impact daily life. However, there are actions you can take to be prepared and ensure you can receive the treatment you need or lessen the impact of having to miss a dialysis session. Let’s explore these actions together.

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 basic necessities. A basic home emergency kit contains 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. It is important to put everything together in one place such as a lidded plastic trashcan or duffle bag, and store your emergency kit somewhere easily accessible. For a complete list of items to put in your emergency kit, check out the American Red Cross.

Patients on dialysis should add several items to their emergency kit. These include:

• 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 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 hemodialysis, home 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 kidney 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:

• 4 small cans of evaporated milk or 3 containers of brick pack milk. 1 to 2 gallons of distilled or bottled water.
• Powdered drink mix (lemonade, grape drink).
• Small cans or brick packs of cranberry juice. Small cans of lemon-lime soda.
• Small boxes of single-serving cereal (no raisin bran).
• 1 box of sugar, sugar packets or preferred sugar-free sweetener.
• Canned pears, peaches, pineapple, mixed fruit and applesauce in 4-ounce single-serving containers.
• 8 small cans or pouches of unsalted tuna, salmon, chicken or turkey.
• 1 jar of peanut butter.
• 1 small jar of 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.
• 2 loaves of bread (consider storing a loaf in the freezer and replace every 3 months until needed for emergency).
• 1 box of vanilla wafers, graham crackers, animal crackers or unsalted crackers.
• 4 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. People with diabetes should limit their sugar intake and substitute lower-carbohydrate items where appropriate. However, they 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
1/2 cup milk, or mix 1/4 cup evaporated milk with 1/4 cup distilled or bottled water
1 box of cereal (single-serving)
Sugar or other sweetener (if needed)
1/2 cup canned peaches, drained

Snack
5 vanilla wafers or 4 graham cracker squares
10 sourballs (if additional calories are needed)

Lunch
2 bread slices
2 tablespoons peanut butter
2 tablespoons jelly
1/2 cup canned pears, drained
1/2 cup (4 ounces) pre-made powdered fruit drink

Snack
1/2 cup applesauce
10 marshmallows (if additional calories are needed)

Dinner
2 bread slices
1/2 can (2 ounces) unsalted, canned chicken*
2 tablespoons mayonnaise*
1/2 cup cranberry juice

Snack
5 vanilla wafers or 4 graham cracker squares
10 jelly beans (if additional calories are needed)

Day 2

Breakfast
1/2 cup milk or mix 1/4 cup evaporated milk with 1/4 cup distilled or bottled water)
1 box of cereal (single-serving)
1 tablespoon sugar or other sweetener (if needed)
1/2 cup canned pears, drained

Snack
5 unsalted crackers with jelly
10 jelly beans (if additional calories are needed)

Lunch
2 slices of bread
1/4 cup (1 ounce) unsalted, canned turkey*
1/2 cup canned pineapple, drained,
1/2 cup (4 ounces) pre-made powdered fruit drink

Snack
10 mints (if additional calories are needed)
1/2 cup applesauce

Dinner
2 bread slices
1/2 can (2 ounces) unsalted, canned tuna*
2 tablespoons mayonnaise*
1/2 cup cranberry juice

Snack
5 vanilla wafers or 4 graham cracker squares
10 sourballs (if additional calories are needed)

Day 3

Breakfast
1/2 cup milk or mix 1/4 cup evaporated milk with 1/4 cup distilled water
1 box of cereal, single-serving
1 tablespoon sugar or other sweetener (if needed)
1/2 cup canned pears, drained

Snack
10 vanilla wafers or 4 graham cracker squares
10 hard candies (if additional calories are needed)

Lunch
2 bread slices
2 tablespoons peanut butter
2 tablespoons jelly or honey
1/2 cup canned peaches, drained
1/2 cup (4 ounces) cranberry juice

Snack
1/2 cup applesauce
10 jelly beans (if additional calories are needed)

Dinner
2 bread slices
1/2 cup (2 ounces) unsalted, canned salmon*
1 tablespoon mayonnaise*
1/2 cup clear soda (no dark cola due to high phosphorus)

Snack
5 vanilla wafers or 4 graham cracker squares
10 marshmallows (if additional calories are needed)

When a widespread emergency occurs, here are some helpful tips:

• If you are at home and uninjured, 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 sometime to prepare. Stay tuned in to 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 are not sure how to do a manual exchange, start the 3-day emergency diet.
• If you are a hemodialysis patient, 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, please reach out to your dialysis center team. It is important to ensure your current address and phone number is 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) with you. Once at the shelter, notify the shelter personnel about your medical needs.

An emergency at the hemodialysis center

Your safety is our top priority! DaVita centers have comprehensive emergency guidelines to keep you safe. When you begin dialysis at a DaVita center, the facility administrator or a center care team member will share what to do if an emergency situation occurs. If you would like a reminder, ask a member of your center care team what emergency procedures are in place.

If an emergency occurs, please wait for instructions from center care team members. They have been trained to provide support during times like these. In the rare and unlikely event the center 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. Properly disconnecting your access is extremely important – ask your renal nurse to show you what to do if you must disconnect your access yourself.

Individual emergencies

It is also a good idea to be prepared for individual emergencies. Medical-alert bracelets show emergency personnel that you have a special health condition and can be life-saving in instances where you may be temporarily unconscious or unable to speak.

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

Additional DaVita.com emergency articles

• Diabetes Emergency Plan
• Diet and Safety Tips from DaVita Dietitians 
• Pantry Tips for Extended Home Stays