Undocumented Immigrants Have Higher Risk of Death with Emergency-Only Dialysis

Bottom Line: Undocumented immigrants with end-stage kidney disease were much more likely to die and to spend more time in the hospital when they could access dialysis only as an emergency once they became critically ill.
 
Why The Research Is Interesting: About 6,500 undocumented immigrants with end-stage renal disease (ESRD) live in the United States and these patients are excluded from major federally funded insurance programs. Consequently, the availability of dialysis for undocumented immigrants varies between states. Clinical guidelines recommend standard dialysis should be three sessions a week but for undocumented immigrants who rely on emergency-only dialysis this may be only one or two sessions per week. Federal Medicaid funds can pay for emergency care for an undocumented patient and some states use state funds to provide standard dialysis to undocumented immigrants.
 
Who and When: 211 undocumented patients with newly diagnosed ESRD who initiated dialysis at three health centers between 2007-2014 (169 had emergency-only dialysis in Colorado and Texas, and 42 had standard dialysis three times a week at a hospital in California); 199 of the patients were Hispanic
 
What: Emergency-only dialysis or standard dialysis (exposures); death and health care use, including acute care days (outcomes)
 
How (Study Design): This is an observational study. Because researchers are not intervening for purposes of the study they cannot control natural differences that could explain the study findings.
 
Authors: Lilia Cervantes, M.D., of Denver Health, Colorado, and coauthors
 
Results: Undocumented patients who had emergency-only dialysis were more likely to die after three and five years and to spend more days in the hospital.
 
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What The Figure Shows: The figure shows increasing mortality over time for all undocumented patients (A) and for undocumented Hispanic patients (B) when they received emergency-only dialysis compared with standard dialysis.
 
Study Limitations: Undocumented immigrant patients with ESRD from only three cities in the United States were included; comparing outcomes for these patients cannot account for other factors that could influence those outcomes.
 
Study Conclusions: States should consider the human and economic toll of providing access to less-than-standard dialysis for undocumented immigrant patients because of the association between emergency-only dialysis and increased death and days spent in the hospital.
 
Related Material: A podcast accompanies this article and it can be previewed on the For The Media website
 
For more details and to read the full study, please visit the For The Media website.
 
(doi:10.1001/jamainternmed.2017.7039)