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

CKD in Native Hawaiians and Pacific Islanders

“…Many come to the United States for treatment. If they are not lawfully present or are uninsured, the receipt of standard, thrice-weekly dialysis depends on local policies and practices (12). Consequently, many only receive emergent dialysis.…”

Dialysis Care for Undocumented Immigrants With Kidney Failure in the COVID-19 Era: Public Health Implications and Policy Recommendations

“…The Emergency Medical Treatment and Active Labor Act requires hospitals to treat anyone who enters with an emergency medical condition, enabling undocumented immigrants to receive dialysis when they present to hospitals with emergency indications. 4 Emergency-only dialysis is associated with lower quality of life, high symptom burden, and significant anxiety about death. 3 Compared with people receiving standard dialysis, this population's 5-year mortality is 14-fold higher and they spend more time in the hospital and less time in the outpatient setting.…”

“…Studies show that their providers experience emotional exhaustion and burnout from the perception of propagating unjust, unethical, and substandard medical care. 4 It is also extremely costly: emergency-only dialysis costs $285,000 to $400,000 per person per year, 6 compared with $76,177 to $90,971 per person per year for standard dialysis. 7 Switching from emergency-only dialysis to outpatient dialysis is associated with a cost reduction of $5,768 per person per month.…”

“…Inclusion of outpatient dialysis in the state's definition of an emergency medical condition allows the same funds to cover outpatient dialysis instead of inpatient admissions for emergency-only dialysis. 4 In states in which Emergency Medicaid does not cover outpatient dialysis, outpatient dialysis may be procured by acquiring private insurance (sometimes paid for by nonprofit entities that provide charitable support) or through county-funded and safety net hospital-funded outpatient dialysis centers. 4 However, due to restrictions on these programs and limitations of charitable support, there are always individuals who rely on hospitals for emergency-only dialysis.…”

“…2,3 In many states, these patients do not have funding for standard outpatient dialysis care. 4,5 They rely on emergency-only dialysis (dialysis only after presenting critically ill to an emergency department), which happens on average 6 times per month. 3 This population is potentially at increased risk for complications and death if infected with COVID-19, but they risk potential exposure for themselves and their families every time they present for dialysis and occupy much needed emergency and inpatient resources.…”