Emergent Dialysis and its Impact on Quality of Life in Undocumented Patients with End-Stage Renal Disease

Abstract

Participants: 88 of 101 unfunded patients presenting to the ED during the study period consented to participate, resulting in an 87.1% response rate. 65 of these patients were undocumented immigrants. Main Outcome Measures:Quantitative scores for the 5 subscales of the KDQOL-36 were calculated for the study population. Results:Measures of physical and mental health in our study population were lower than those published for scheduled dialysis patients. 79.5% of our patients lost employment due to their dialysis requirements. At least 71.4% of the study patients were unaware that they required dialysis before immigrating to the United States.Conclusions: Quality of life scores were found to be low among our population of undocumented emergent dialysis patients. Our data also provide some evidence that availability of dialysis at no cost is not a primary driver of illegal immigration of ESRD patients to the United States. Ethn

Renal Replacement Therapy for Undocumented Immigrants: Current Models with Medical, Financial, and Physician Perspectives—a Narrative Review

“…In a national survey, most nephrologists believed undocumented immigrants with ESRD have inadequate access to Ahmed et al 18 Retrospective cohort 2016 TX 88 Undocumented immigrants with ESRD Cervantes et al 6 Cross-sectional survey 2017 CO 20 Undocumented immigrants with ESRD Cervantes et al 19 Retrospective Cohort study 2018 CO, TX, CA 211 Undocumented immigrants with ESRD Coritsidis et al 7 Retrospective cohort study and cross-sectional survey 21 Cross-sectional survey 2017 TX 88 Undocumented immigrants with ESRD Hurley et al 15 Cross-sectional survey 2009 National 990 Nephrologists Linden et al 22 Cross-sectional survey 2012 NY 45 Undocumented immigrants with ESRD Madden And Qeadan 16 Case-control study 2017 New Mexico 759 cases Emergent dialysis recipients through hospital ED McEnhill et al 23 Retrospective cohort study 2015 CA 304 Pediatric kidney transplant recipients Raghavan 24 Retrospective cohort 2012 TX 140 Undocumented immigrants with ESRD Raghavan 25 Descriptive 11 Retrospective case series 2017 IN 19 Undocumented immigrants with ESRD Weaver et al 28 Retrospective case series 2012 IN 6 Dialysis patients without a dialysis home healthcare and were frustrated by the impossibility of obtaining outpatient long-term dialysis, unavailability of transplantation, and the growing prevalence of undocumented patients with ESRD. 15 Physicians do not support the idea that undocumented immigrants coming to the USA for the purpose of medical care, or switch states for the purpose of consistent outpatient treatment; most studies support that undocumented patients are unaware of their diagnoses prior to immigration and do not relocate to other states for access to better care.…”

“…7 The USA relies on this population for work and social contributions, but inadequate dialysis impedes their productive role in society. 14,21 Many of them are contributing or have contributed substantially to the Medicare and social security system they are unable to access. 14,26 However, in one survey, 79.5% (n = 35) of undocumented dialysis patients reported their unemployment was a direct result of the burden of obtaining emergent dialysis.…”

“…23 Quality of life is significantly lower in undocumented patients undergoing emergent dialysis. 6,14,21 Undocumented immigrants undergoing emergent dialysis reported increased physical pain and a lower level of function despite having an increased satisfaction with care compared to those undergoing chronic care. 14 In one study, many patients in a center that practices emergent dialysis report the difficulties of waiting for symptom accumulation, specifically debilitating shortness of breath.…”

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

“…[6][7][8][9] Though often called compassionate dialysis, emergencyonly dialysis is associated with lower quality of life and physical stress for patients, as well as substantial psychosocial stress for both patients and clinicians compared with scheduled hemodialysis. 1,8,[10][11][12][13] Limited data from small, nonrandomized studies suggest correspondingly worse health outcomes, increased health care use, and higher costs associated with emergency-only dialysis. 10,14 Nonetheless, this treatment persists in part because providing scheduled dialysis to undocumented immigrants is perceived to be more expensive.…”

Comparisons of the Severity between the Kidney and Non-Kidney Disabled Persons by the Number of Chronic Diseases, Out-of-Pocket Expenditure, and Quality of Life: using Korea Health Panel

“…It reflected that the latter subjects required a lot of time to treat and had a quite difficult situation to sustain a job. In the previous study, it was similar that only a small percentage had economic activity in ESRD [15][16][17][18].…”