Surviving Kidney Dialysis in a Down-Grid Scenario, by G.C.

The power-grid goes down two hours before you are scheduled to begin your next round of hemodialysis at a clinic thirty-five miles away. Using the Ham radio, you discover through your III Percent communications network that all power is down across the southern sector. There is little hope of it being restored in the foreseeable future. The clinic should have a back-up generator in place, so (other than an inconvenience) your treatment should go ahead as planned. You lock the place down, turn on the alarms, and then you and the wife head for the clinic. As usual, when you leave you can’t shake the feeling of vulnerability, knowing that the security of the homestead rests with Macs– an eleven year-old Labrador that is racked with arthritis so bad that he seldom moves from his favorite spot under the corner of the porch.

As you maneuver your way down the hill, straddling the gullies caused by a recent downpour, you began to question the rationality of your situation. Can you really survive a down-grid scenario with renal failure? What happens if you arrive at the clinic to find they have no back-up power? What happens if the roads are blocked or the clinic is under attack by roving thugs looking to cash in on prescription drugs? Questions, one after another, began to tumble through your mind; answers, however, prove more elusive than the dust before yesterday’s rain. By the time you make it to the blacktop, you realize that what you don’t know could be just enough to kill you.

Those who suffer from kidney failure must deal with these questions every day, praying for no interruptions in their circumstances, and hoping to survive until a donor is located and a transplant successfully performed; at least that is the case for those whom transplant is even an option. According to the National Kidney Foundation, of the 99,000 Americans on the kidney transplant list, fewer than 17,000 people receive one each year. Every day, 14 people die while waiting for a kidney. Of course, there are no guarantees, especially when considering the many obstacles encountered during this trying time (and the risks inherent with dialysis). Fortunately, there are answers to many of these questions through an alternative dialysis treatment– peritoneal dialysis (PD). PD provides patients an opportunity (and the flexibility) to perform dialysis, regardless of location or the need of electricity. This can mean the difference between life and death in a down-grid scenario.

My knowledge of this treatment came about through the personal experience of a dear friend that I will refer to as Sniper1. Like me, he is retired, middle-aged, and doing everything he can to prepare his family for the eventual collapse of society. Regrettably, he was diagnosed in January 2013 with chronic renal failure. His kidneys had shut down and toxins were building up in his bloodstream. After numerous tests (which almost cost his life) Sniper1 was placed on a hemodialysis regimen three times weekly (lasting four hours, each). He would usually leave the house before sunrise to make the thirty-five mile trip to the clinic. There, he would use his walker to slowly move to the check-in desk, answer a litany of questions, fill out forms, and then spend about an hour in the waiting room before being called back for treatment. He would then be weighed and his ports connected to the hemodialysis machine. Approximately three hours later at the end of his treatment, he was usually so tired and weak that he required assistance back to the car for his return trip home. Due to the side effects of hemodialysis, such as: cramps, nausea, vomiting, and weakness, he was not able to drive himself back from treatment. This required either his wife, daughters, or close friends to chauffer him the seventy miles round trip, three times a week. He would spend roughly thirty-six hours with these painful side-effects, slowly and painfully regaining some strength, and then repeat the cycle again.

I watched as my friend’s condition deteriorated, becoming progressively worse with each passing day, but there was always hope in Sniper1’s eyes. He would force a feeble smile and say, “Red Flint, we’re gonna buy us a mountaintop in West Virginia some day when we win the lottery and I get to feeling better.” I would wholeheartedly agree, anything to keep him in good spirits. We would discuss plans for our bunker and spend hours exchanging ideas on scriptural issues and doctrines. As far as he was concerned, this kidney failure was just another bump in the road, like the rest of his life had been; he would get through it just like he had Vietnam and everything else since then. He was determined to leave this world at the last possible second, as Sniper1 is a true survivalist.

Not only is he a survivalist, he is a realist and fully understands the urgency of his situation. The side effects of the hemodialysis treatment were taking a physical toll on his body and the long drives were putting a strain on his finances in addition to causing an excessive burden on his family. Even in his frail condition, he began to research alternative methods of kidney dialysis. The last thing he wanted was to be dependent on the electrical grid. One alternative method–peritoneal dialysis– sounded promising. He spent many hours researching the pros and cons of this procedure.

Sniper1 believed he could reduce many of these additional health problems by changing from hemodialysis to peritoneal dialysis and improve his quality of life in the process. More importantly, he wanted to be able to survive without the use of electricity. His doctor agreed that he was a good candidate for peritoneal dialysis and suggested he start the new treatment. The port in his chest was removed, and a small catheter was inserted into the peritoneal cavity in his abdomen. He was required to attend classes on how to perform the procedure safely. Once he was cleared and certified as proficient, items required for the treatment and the dialysate were shipped to his residence.

Unlike hemodialysis, which requires the patient’s blood be cleansed through a machine, peritoneal dialysis involves a change of fluids by force of gravity. A single-dose flexible bag, containing dextrose solution, is hung on an IV pole, and a small tube from the solution is connected to the catheter on the patient’s abdomen. The peritoneal dialysis solution is instilled into the peritoneal cavity. Through the process of osmosis, excess water and toxins in the bloodstream are pulled into the solution through the semi-permeable membrane of the peritoneum. The length of “dwell time” of the solution in the peritoneal cavity is determined by the doctor. Afterwards, the solution is drained from the patient. Normally, the fluid is drained and solution is instilled at the same setting; this takes approximately thirty minutes for both procedures and is usually performed four times each twenty-four hour period.

Patients are encouraged to stockpile three months’ supply of dialysate. This is shipped to the patient’s home via UPS or FedEx. Some facilities will allow a far longer supply, if requested. The main concern is not to exceed shelf life. Storage is the primary problem to overcome when requesting a large order.

Though there are numerous advantages of peritoneal dialysis, there are precautions and warnings associated with this procedure. Like all medical procedures there are risks involved that could prove fatal, if proper procedures are not followed. The greatest risk with peritoneal dialysis is infection. Every facet of this procedure must be performed in an extremely sanitary environment, and all tubes, catheter, and connections must be sterilized. Even something as small as a dust mite can result in peritonitis; infection, if not treated properly, can be fatal. Infection of the peritoneum has been described as a pain worse than death. Sanitation cannot be overstated while performing this procedure.

Patients who are using peritoneal dialysis should have routine evaluations to determine if accurate hematologic factors and electrolyte blood levels are being maintained. This osmosis process can cause a significant loss of water-soluble vitamins, protein, and amino acids; replacement therapy may be required if levels are determined to be too low. It is also extremely important to maintain a proper fluid balance between treatments to prevent over- or under-hydration. Failure to maintain a proper balance can result in shock and/or heart failure.

Sniper1 has been on peritoneal dialysis now approximately a year and is enjoying a far better quality of life than he did while on hemodialysis. He still suffers from neuropathy in both feet and requires the use of a four-pronged cane sometimes to keep from losing his balance. He can perform many tasks now that were impossible while on hemodialysis, such as mowing the yard or working in his garden. He is certainly not up to pre-renal failure abilities, but he can perform roughly 70% of his normal daily routine.

It is still unclear as to why his anti-immune system failed, leading to this life-threatening condition. Sniper1 is presently on the waiting list for transplant and is being tested continually to monitor whether he is a viable candidate. He may or may not receive this operation; his white blood cell count is still too high, indicating an anti-immune deficiency reaction. If fate dictates no improvement, he will be required to continue peritoneal dialysis indefinitely.

Can Sniper1 or a reader of Survival Blog really survive a down-grid scenario with renal failure? The answer to this question is a resounding YES! There’s no need to worry about a blackout, whether the clinic has a backup power source, if the roads are blocked, or if thugs are on the prowl. This life-saving procedure can be performed in the comfort of one’s home, while reading the latest edition of Field & Stream, or The Patriot.

I write this so that other readers of SurvivalBlog know that there are alternate solutions to their health issues in a worse-case scenario. I, like everyone else in Sniper1’s family and my own, was completely unaware that peritoneal dialysis even existed. I have now seen its capabilities first hand and am duly impressed.

JWR Adds: Peritoneal dialysis at home should only be considered a “last resort” measure, when there is no other care available. In my estimation, the safest course for anyone who is on a kidney dialysis regimen is to strategically relocate to a region that already has a capable, well-established dialysis center with at least thee seats and that is in an electrical power exporting region where the local power utility already has plans in place for “islanding” their power, in the event of a grid collapse. I described one such area (Farmington, New Mexico), in my novel Survivors. There are several other such regions, mainly in the Pacific Northwest and in the Inland Northwest. For further details, see my article: Islands in the Darkness: Some Local Power Utilities Have Prepared to Go It Alone. – JWR