Dialysis Management during Flooding Disasters: Operational Strategies and Lessons Learned from Songklanagarind Hospital

Flooding disasters are a major threat to the continuity of dialysis services, leading to disruptions in infrastructure, transportation, water supply, electricity, and the healthcare workforce. Dialysis care is particularly vulnerable because kidney replacement therapy is time-sensitive and dependent on complex technical systems and trained personnel. Previous disaster experiences have demonstrated increased healthcare utilization and adverse outcomes when maintenance hemodialysis is interrupted. This narrative review summarizes key principles for dialysis management during flooding disasters across preparedness, response, and recovery phases, with primary emphasis on maintenance hemodialysis and hospital-based kidney replacement therapy, and a focused discussion of peritoneal dialysis. We also present an operational case experience from Songklanagarind Hospital during regional flooding in November 2025, where services were reorganized into a dual-track model consisting of acute inpatient kidney replacement therapy and triage-based outpatient maintenance hemodialysis. Nephrologists and dialysis nurses coordinated clinical prioritization and operational continuity in order to support dialysis delivery under severe logistical constraints.