Association of Scheduled vs Emergency-Only Dialysis With Health Outcomes and Costs in Undocumented Immigrants With End-stage Renal Disease

Abstract

In 40 of 50 US states, scheduled dialysis is withheld from undocumented immigrants with end-stage renal disease (ESRD); instead, they receive intermittent emergency-only dialysis to treat life-threatening manifestations of ESRD. However, the comparative effectiveness of scheduled dialysis vs emergency-only dialysis and the influence of treatment on health outcomes, utilization, and costs is uncertain. OBJECTIVE To compare the effectiveness of scheduled vs emergency-only dialysis with regard to health outcomes, utilization, and costs in undocumented immigrants with ESRD. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of 181 eligible adults with ESRD receiving emergency-only dialysis in Dallas, Texas, who became newly eligible and applied for private commercial health insurance in February 2015; 105 received coverage and were enrolled in scheduled dialysis; 76 were not enrolled in insurance for nonclinical reasons (eg, lack of capacity at a participating outpatient dialysis center) and remained uninsured, receiving emergency-only dialysis. We examined data on eligible persons during a 6-month period prior to enrollment (baseline period,

The Status of Provision of Standard Outpatient Dialysis for US Undocumented Immigrants with ESKD

“…They also spend tenfold more time in the hospital and less time in the outpatient setting compared with those receiving standard hemodialysis (4). The lower mortality and the lower health care utilization among undocumented immigrants who receive standard hemodialysis were confirmed in a follow-up study that compared undocumented immigrants who receive emergency-only hemodialysis with undocumented privately insured patients who receive standard hemodialysis (5). Emergencyonly hemodialysis is expensive from a societal perspective, although to a hospital or health care system, it may be reimbursed by emergency Medicaid.…”

Briefly Noted

“…In an observational study, undocumented immigrants with ESRD who were treated with scheduled HD (N = 105) had a lower adjusted one year mortality (3%) and adjusted costs ($4316/month lower) than patients (N = 76) receiving emergency only HD (17% mortality) …”

Insurance Status and Emergency Department Visits Associated With Hemodialysis in Texas

“…Patients with end-stage renal disease (ESRD) require regular hemodialysis (HD) treatment, which is nearly universally covered by Medicare in the United States. 1 However, Medicare coverage is not available for individuals who are not US citizens or permanent residents. For many uninsured individuals with ESRD, intermittent dialysis through the emergency department (ED) is the sole treatment option.…”

“…For many uninsured individuals with ESRD, intermittent dialysis through the emergency department (ED) is the sole treatment option. 1 The system of accessing HD in the ED presents several major system-level challenges, including adding patient volume to overcrowded EDs, taxing hospital dialysis resources, and incurring substantial health care costs. Prior studies 1,2 characterizing the health burden of ED visits for HD treatment by patients with ESRD were limited to a single region.…”