**7. Special situations; floods and droughts**

substance. An artificial substrate added to the lysate is also proteolytically cleaved and the liberated protein can be measured by its ability to absorb light, which is the basis of the chromogenic test kits. The test can also be quantified by its ability to form a clot or produce turbidity. It is important to note that the LAL assay does not detect endotoxin < 8000 Da.

Home dialysis has resulted in a multitude of benefits for patients. Most importantly with convenience, independence and improvement in biochemical and likely mortality figures. The availability of electricity and running water should not disparage patient's eligibility for dialysis. In Australia the possibility of solar powered dialysis has been shown to be a feasible option, if not completely then to significantly offset the power costs of dialysis [17]. Similarly the lack of running water should also not be a limiting factor. Illustrated below is an example of how home dialysis became a possibility for a patient living on a farm over 200km from the

**Figure 12.** An Example of a rural home water treatment setup: (A) The borehole is approximately 2 km from the pa‐ tient's residence and is determined by the geology of the area. (B) An intermediate pumping station operated using air pressure. (C) Storage tanks are continually replenished from the bore to ensure an uninterrupted water supply. (D) A basic pre filtration cartridge filter (located in the silver casing) and two micron filters pre treat the water (E) A second pump located approximately 100m from the patients residence (F) A second set of micron filters and carbon tanks. This

is located underneath the patients home and feeds directly to dialysis machine inside the bedroom.

**6. Unique environments eg rural home setup**

nearest major city.

236 Updates in Hemodialysis

Floods are often devastating natural disasters that result in extensive disruption of transport, communication and power supply networks, as well as industrial, farming, business and personal property damage. Table 4 summarises some of the important implications for haemodialysis patients. Experience from previous natural disasters has highlighted the importance of dialysis units having a practiced disaster management plan to manage these situations. During the 2005 Hurricane Katrina disaster, 94 dialysis centres closed for at least one week affecting close to 6000 patients [30, 31]. The national kidney foundation provides a useful guide for disaster planning for people with chronic kidney disease. It includes useful information for patients such as fluid and dietary advice, including salt, potassium and water restriction, medical record management, dialysis rationing and medication supply [32].


**Table 4.** Problems associated with flooding

Water is clearly a precious resource. Unfortunately large volumes of reject water are created for the provision of dialysis. (See **Water disposal and saving-green dialysis**). Drought prone areas should consider water recycling, water saving WRO's and rainwater collection tanks to conserve water. Close liaison with the local water authority regarding supply rationing and trucked water is imperative.
