Dialysis Emergency Plan for a Parent: Missed Treatment Rules

A dialysis emergency plan answers one question before anyone needs it: what happens if your parent can't get to treatment? If a session is missed or the center is closed, call the center's emergency number first, then the backup center the team named, and start the emergency diet the care team gave you. Chest pain, worse shortness of breath, a racing or pounding heartbeat or new confusion means 911, not a wait for the next chair.

Why dialysis needs its own emergency plan

Most emergency plans assume a person can ride out a storm at home. Dialysis doesn't allow that. The CMS booklet Preparing for Emergencies: A Guide for People on Dialysis (June 2026 edition, posted by the IPRO ESRD Network; we couldn't find a copy on cms.gov) says disasters can make it hard to get treatment "because of changes to water, power, sanitation, or transportation." A center may close for lost power or water, building damage, an evacuation order, or weather that keeps staff away.

The National Kidney Foundation (NKF) says missing dialysis lets fluid, potassium and phosphorus build up. High potassium can lead to heart rhythm problems, and extra fluid can collect in the lungs and cause shortness of breath. For peritoneal dialysis, MedlinePlus says on its peritoneal dialysis page that skipping exchanges "can be dangerous to your health."

So the plan has two jobs: get your parent to a chair as fast as possible, and keep things stable until then.

If a treatment is missed or the center is closed

The CMS guide's section "When Your Dialysis Facility Is Closed" gives the order:

1. Call the dialysis center or its emergency number. CMS says to call your dialysis care team "or your facility's emergency phone number to learn where and when to get treatment." Its contact form has a blank labeled "Emergency Hotline." Fill it in now, not during the storm.
2. If you can't reach them, call the backup center. The CMS form has blanks for a backup facility near home and one far from home. Ask the center which ones to use.
3. Call the ESRD Network if you're stuck. Medicare's disaster and emergency page says that with Original Medicare, the End-Stage Renal Disease (ESRD) Network can help your parent get dialysis treatments and tell you who to contact for supplies, drugs and transportation. Each region's toll-free patient line is at the back of the CMS guide. With a Medicare Advantage plan, contact the plan. 1-800-MEDICARE (1-800-633-4227) is the fallback.
4. Tell the family where your parent is going. It matters more than it sounds when three siblings are calling three different numbers.
5. Start the emergency diet and fluid limits the care team gave your parent. More on that below.
6. Line up the ride. CMS suggests practicing the route to the backup center ahead of time.

CMS adds one firm line: "You should always try to get dialysis within three days of your last treatment." That is a ceiling for disasters, not a target. Ask your parent's team what their personal limit is.

If your parent has to go to a shelter, both CMS and the National Kidney Foundation's emergency guide say to tell the person in charge that they need dialysis.

What happened to the KCER hotline?

Many older handouts list the Kidney Community Emergency Response (KCER) hotline. When we checked, the June 2026 CMS guide's version notes say "Removed KCER," and its resource page now points to Kidney Health Analytics & Responsive Emergency Support (KHARES) instead. The old KCER website now sends visitors to an IPRO ESRD Network resource archive. Some sites still print the old KCER number, but we couldn't confirm it still works, so we've left it out.

Put the numbers the current CMS guide relies on at the top of the sheet: the center's emergency line and your parent's ESRD Network. Each fall, ask the center: "Which emergency numbers should be on my parent's sheet this year?"

If your parent lives where winter closes roads, our winter storm plan for an elderly parent covers the rest of the house.

The emergency diet: ask the care team for theirs

CMS says that when treatments are missed, a "special, strict diet" limits the buildup of water, protein wastes and potassium. It doesn't replace dialysis, and CMS says to review the plan with the facility dietitian "to see if you need to make changes based on your own personal needs." NKF describes its emergency meal plan as "stricter than your usual diet," built to control potassium, phosphorus, urea and fluid.

What the sources say:

• Fluid: limit it. CMS says to ask the healthcare team how much fluid your parent can have and reminds readers that fruits and vegetables contain water.
• Potassium and phosphate: avoid high potassium foods. CMS names dried beans, potatoes and tomatoes, and rules out sports drinks and drinks with phosphate.
• Sodium: NKF says not to use salt or salt substitutes. NKF's high potassium page adds that some salt substitutes are high in potassium.
• Start early: CMS says if your parent may miss a treatment, start the emergency diet right away, and "it won't harm you to start it sooner than you need to."

One gap worth knowing: the two big guides don't agree on fluid. NKF's emergency guide lists one fixed daily cap for everyone, while CMS tells patients to ask their own team. So the plan on the fridge should be the one your parent's dietitian signed off on, with their fluid number in the dietitian's handwriting.

Bring three questions to the next dietitian visit:

1. Can you give us my parent's emergency diet plan in writing, including the fluid limit?
2. Does anything change because of diabetes? (CMS says to skip the sweets in its plan but keep hard candy for lows.)
3. How should my parent take pills if fluid is restricted? CMS suggests applesauce.

Then keep the approved shelf food together, with the plan taped to the box.

Warning signs: when to call 911

Some ESRD Networks hand out a green, yellow and red zone sheet. This example is a 2023 "How are you feeling today?" sheet from the IPRO ESRD Network, made under contract with CMS for its own regions. Your parent's center may use a different one:

NKF says sudden high potassium can bring heart palpitations, shortness of breath, chest pain, nausea or vomiting, and calls sudden or severe high potassium "a life-threatening condition" that "requires immediate medical care."

Our rule for the fridge sheet: chest pain or trouble breathing is always a 911 call. After a missed session, treat any red zone sign the same way. Don't wait for the center to call back.

If your parent also has heart failure, see our guide to heart failure warning signs.

The access: what to tell paramedics and the ER

CMS warns: "Do not let someone who does not know you touch or inject something into your access," because healthcare workers unfamiliar with dialysis "may not know what a fistula, graft, or catheter is."

For a fistula or graft, NKF's hemodialysis access page says:

• No blood pressure cuff on the access arm.
• No blood draws or IVs in the access arm unless the dialysis team says it's okay.
• No tight sleeves, watches, bracelets or jewelry over the access.
• Feel for the vibration (the "thrill") and call right away if it stops, feels much weaker or changes.

MedlinePlus's guide to caring for a vascular access adds that no one should draw blood from a tunneled central venous catheter. It says to contact the provider right away for bleeding from the site, signs of infection (redness, swelling, pain, warmth or pus), a fever of 100.3°F or higher, a weak or missing thrill, or a cold, numb or weak hand. NKF adds that bleeding that won't stop, or blood spurting from the access, means calling the center, doctor or emergency services right away. For a catheter, NKF says to call the team if the dressing gets wet, loose or dirty, or comes off.

Say it to the paramedics and again at triage: "Dialysis patient. Left arm fistula. No blood pressure, IVs or needles in that arm." CMS suggests a medical ID, but not a bracelet on the access side, where it could block blood flow.

If your parent is admitted, our guide for when an elderly parent is hospitalized covers the first days.

Peritoneal dialysis and home hemodialysis supplies

Home dialysis moves the backup plan into your parent's spare room. From the CMS guide:

• PD supplies: "As directed by your dialysis team, keep a five-to seven-day supply," check expiration dates, and replace them as needed or every six months.
• Cycler users: learn and practice manual exchanges so your parent can switch if the power goes out. NIDDK's peritoneal dialysis page says the same.
• Antibiotics: CMS lists a five-day supply of antibiotics for PD patients if the doctor recommends it.
• Utilities: register with the power and water companies for priority restoration.
• Home hemodialysis: keep a flashlight and batteries near the machine. Use flashlights, never candles, even though some emergency lists still include them.

NKF's guide suggests a two-week stock, longer than the CMS figure, so ask the home training nurse which to follow. NIDDK says to store supplies somewhere cool, clean and dry. Put the supply company's phone and account number on the binder page. NIDDK also says cloudy or unusually colored used solution is a sign of infection that needs immediate care.

For machines, batteries and generators, see our power outage plan for medical equipment.

The medication list, including phosphate binders

NIDDK's managing CKD page says to keep an up-to-date list of medicines and supplements in the wallet and use one pharmacy. For dialysis, add:

• Phosphate binders. NIDDK's mineral and bone disorder page explains that these bind phosphorus in food so it isn't absorbed. NKF's phosphorus page says they "must be taken every time you eat, including meals and snacks." Pack binders next to the emergency food.
• Dialysis-related drugs. Medicare's dialysis coverage page lists drugs such as heparin and anemia medicines among dialysis services. Ask the center for a printed list of anything given during treatment.
• A disaster supply. CMS recommends a five to seven day supply of all prescriptions in the go-kit, with expiration dates checked monthly. Medicare's disaster page says drug plans can help replace lost medicines.

Never adjust or skip a medicine to stretch a supply. If pills are running low, call the pharmacy or the doctor. Our medication list guide has a template.

If your parent has kidney disease but isn't on dialysis

Pain relievers and cold medicines. NIDDK says NSAIDs, a group that includes common pain relievers and cold medicines such as ibuprofen and naproxen, can damage the kidneys, and suggests asking a pharmacist or provider whether a medicine is safe. NKF's pain medicines page is blunter: people with CKD "should not self-treat with NSAIDs" and should talk with a healthcare professional first. Write "Kidney disease: ask before any NSAID" on the medication list.

Contrast dye. CT and MRI scans sometimes use dye. NKF's contrast dye page suggests sharing every medicine and supplement with the team before the test, asking whether a non-contrast scan could give enough information, and asking whether any medicine should be held. A "chronic kidney disease" line on the emergency sheet lets the ER weigh this.

A dialysis page for the binder

Fill this out once and update it when anything changes. CMS says to fill in its form in pencil, and it has a point.

Make one copy for the fridge, one for the go-kit and a photo on your phone. Our emergency information sheet for paramedics shows how this fits with the rest of the one-page sheet, and what to bring to the ER covers the bag.

Frequently asked questions

How long can someone go without dialysis?

It depends on the person, which is why the answer belongs to your parent's team. For disasters, the CMS guide says to always try to get dialysis within three days of the last treatment.

Can the emergency room do dialysis?

NKF says someone with fluid overload after a missed session may need to go to the hospital emergency department for dialysis. Call the center first if your parent is stable. Call 911 for chest pain, trouble breathing or other red zone signs.

Does Medicare pay for an ambulance to dialysis?

Medicare's dialysis coverage page says ambulance rides from home to the nearest dialysis facility are covered only when traveling in any other vehicle could endanger your parent's health. Plan a backup ride anyway.

What goes in a dialysis go-kit?

CMS lists bottled water, a radio, flashlights and batteries, a first-aid kit, a phone and charger, a manual can opener, measuring cups, cash, a change of clothes, the contact form and a five to seven day supply of medicines.

Getting it onto paper

You can build all of this yourself: one call to the center for the emergency numbers and backup sites, one dietitian visit for the written emergency diet, and an hour with this page. If you'd rather hand off the organizing, Emergency Binder Now turns about 25 minutes of guided questions into a printable binder with your parent's medicines, doctors and contacts, a one-page Emergency Information Sheet for paramedics and the ER, and a list of what's still missing, like the backup center nobody has named yet. You can see a sample binder first.