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Widespread power outages and water supply issues have created a dialysis crisis in Texas, following an onslaught of snow, ice, and sub-freezing temperatures.

"To say we're stressed is an understatement. Almost all outpatient dialysis units closed due to power outages. Trying desperately to do as many as we can inpatient. To make matters worse some of our hospitals lost water today (so no HD [hemodialysis]). Truly a nightmare," Tessa Novick, MD, a nephrologist at the University of Texas at Austin, Wednesday evening.

Half of dialysis centers across Texas -- more than 750, serving some 54,000 patients -- are affected by power outages and water issues, according to Tiffany Jones-Smith, CEO of the Texas Kidney Foundation.

"For some of our patients, we're talking about the fourth day, the fifth day without dialysis and that's unacceptable," she said in an .

Stretching those extra days puts patients at risk of potassium and fluid problems that can be life-threatening, noted Holly Kramer, MD, MPH, of Loyola University in Chicago and immediate past president of the National Kidney Foundation.

The large storm system, unofficially dubbed Winter Storm Uri, swept across much of the country but created the greatest disruptions in Texas, where it dropped snow and ice Feb. 14 and 15. Failure of the power grid has left millions across the state without electricity, and frozen pipes are causing widespread water supply problems as well.

While power has been restored for many, water remains problematic. Dialysis requires access to clean water to prepare concentrates and dialysate and to reprocess the machines for the next patient.

Most outpatient clinics don't have generators, Samaya Anumudu, MD, of Baylor College of Medicine in Houston. "Even pd [peritoneal dialysis] pts struggling without power and heat and they aren't able to warm their bags even for manuals."

Baylor and all its outpatient clinics remained Thursday due to "ongoing water pressure issues."

Fresenius Kidney Care said about half of its Houston area centers have been impacted by a lack of water, "with the other centers either fully operational or operating on generators." A spokesperson said that many more dialysis centers are expected to restore services today due to arrival of water trucks.

"Fresenius Kidney Care activated its disaster response team in an effort to restore service as quickly as possible to those locations impacted by the extreme weather," said Brad Puffer, spokesperson for Fresenius Kidney Care. "Our care teams are reaching out to patients to ensure their safety and evaluate those patients in need of immediate treatment."

DaVita indicated similar strategies.

Where centers closed intermittently as power and water comes and goes, "we are coordinating with other health care providers, including hospitals, to help ensure that patients have continued access to care," according to a statement from Chakilla Robinson White, DaVita's group vice president overseeing its Texas clinics. "We are also working to bring water tankers, generators and supplies to affected areas."

By the end of Thursday, all but 8% of U.S. Renal Care's dialysis units in the state, about 100, were back to normal operations, said Joseph Brunink, MBA, who oversees operations in Texas.

Houston is the main area that remains impacted as it has been slower to deliver water supply, he said. "That's changed over the last 24 hours, but there have been improvements across the state." He said he expected patients to be back to their normal dialysis schedules in the next day or so despite the disruptions.

Jones-Smith pointed to some bright spots, like the group of eight clinics in San Antonio that brought water in and have been running around the clock to dialyze patients from any closed clinic regardless of affiliation.

Other clinics too, are stepping up, she said, with some providing coupons for Lyft and Uber to get patients transportation to dialysis clinics. "We're just kind of banding together and figuring out what needs to be done."

That's not uncommon, said U.S. Renal Care Chief Operating Officer Andy Johnston, as the CMOs of the largest dialysis companies stay in close contact on disasters and it's routine for them to open up their clinics for patients from other sites in such circumstances.

"It's not just our staff; it's the whole industry -- the whole healthcare industry, but particularly the dialysis industry," he told 麻豆传媒. "It's really been an extraordinary 4 days. We're not out of it, there's still much to do, but it does feel like we're on the back side of it and things are getting better."

Kramer pointed to the lessons on emergency preparedness from the scramble for dialysis care when facilities closed due to loss of power and flooding from Hurricane Katrina in 2005.

"Patients receiving dialysis did not know how to adequately prepare for the storm, many hospitals and dialysis centers had insufficient disaster plans, and public health and emergency management agencies did not know how many people in their community were dialysis dependent and likely to need assistance in the wake of the storm," a noted.

While it cited improvements in the years that followed, Jones-Smith indicated that such preparations failed in Texas. "The thought that weather could impact us in this way and that our leadership wouldn't have been prepared didn't even enter anybody's mind, obviously," she told KENS5.

Some centers said they had been told there would be water supply problems, she said, "but the way that electricity was presented to everyone was that it was going to be rolling brownouts and it wouldn't be hours. ... That is not what actually happened. It's really been catastrophic."

However, Johnston was less critical and argued it was more a problem with the utilities and governance than preparedness by the industry: "I feel like we were prepared from a process standpoint but just surprised by how long this lasted, and then the water and power issues that we had to overcome and are still overcoming."

When this crisis is over, Jones-Smith said, "We can't let this go, because we need to be prepared for the next time, not just reacting to chaos, which is what we're doing right now. ... There's no getting around we've had an epic failure."

Kramer noted that the lesson isn't just for Texas -- because global warming is intensifying and shifting the usual weather-related concerns.

"We all need to have disaster planning for dialysis moving forward," she told 麻豆传媒. "This just shows it's not just hurricanes. It could be disasters from severe weather in places that are not used to it. We're seeing such huge fluctuations in weather patterns across the entire United States. Disaster planning is something we should think about all the time now."

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