Climate Shocks to Dialysis Fluid Supply Necessitate a Paradigm Shift in Production: Point-of-Care Fluid Generation as a Sustainable Solution

Authors

• Akash Karopadi, Management Consulting Division, Alira Health Boston LLC, MA, US
• Davide Targa, Management Consulting Division, Alira Health, Barcelona, Spain
• Priyanka Arya, Vivance Pte Ltd, Singapore
• Suresha Belur Venkataraya, Vivance Pte Ltd, Singapore
• Mandar Gori, Vivance Inc, Los Angeles, California, United States

Background

In 2024, Hurricane Helene flooded Baxter’s North Cove plant in North Carolina, halting operations and cutting ~60% of U.S. PD fluid supply, causing nationwide shortages. In 2025, wildfires forced dialysis clinic evacuations, disrupting patient care. These climate events underscore the urgent need for decentralized solutions across dialysis supply chain and care delivery. Point-of-care (POC) dialysis fluid generation offers a resilient alternative, reducing dependence on centralized manufacturing and vulnerable supply chains, ensuring care continuity during climate disruptions.

Methods

We reviewed reports from FDA, CDC, CMS, ASN, and ISPD detailing health advisories, emergency protocols and conservation strategies for PD fluid use following Hurricane Helene. These reports were analyzed to assess the reported clinical outcomes and provider testimonies.
Additionally, qualitative interviews with 12 stakeholders from large and medium dialysis organizations (LDO/MDOs) and independent clinics assessed the crisis impact and perceived value of a POC PD fluid generation system which reduces fluid logistics and storage need by 89%, by producing dialysate on-demand using tap water.

Results

Shortages led to bag-sparing regimens, delayed PD initiations, and in some cases, transition to in-center dialysis. Among interviewed stakeholders, 66.7% strongly agreed with adoption of POC fluid generation as a solution to supply chain limitations and clinical disruptions (Figure 1).

Conclusion

Climate events expose the vulnerability of a concentrated PD fluid supply chain, triggering shortages that threaten home dialysis expansion and investment. Decentralized innovations, like Vivance’s POC fluid generation system, offer a promising approach to enhance sustainability and scalability of home dialysis, strengthening resilience and supporting the continued expansion of home dialysis.

Figure 1. Expert Insights on PD Fluid Shortage Crisis and Vivance’s POC Dialysis Fluid Generation System

Presented at ASN Kidney Week 2025, Houston, TX, Nov 5 – Nov 9, 2025
Copyright © 2025 by the American Society of Nephrology

Published abstract available at: doi: 10.1681/ASN.2025vy98h0bj