When Access to Chronic Dialysis is Limited: One Center’s Approach to Emergent Hemodialysis

Raghavan, Rajeev

doi:10.1111/j.1525-139x.2012.01066.x

Cited by 26 publications

(39 citation statements)

References 11 publications

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“…Recent reports from industrialized countries have highlighted the medical as well as the ethical and financial dilemmas that arise while treating undocumented-uninsured end stage renal disease (ESRD) patients with the need for renal replacement therapy (RRT) [7-16]. Currently, there are no specific legal guidelines in Israel regarding chronic dialysis treatment for undocumented-uninsured patients with ESRD.…”

Section: Introductionmentioning

confidence: 99%

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Care of undocumented-uninsured immigrants in a large urban dialysis unit

et al. 2012

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BackgroundMedical, ethical and financial dilemmas may arise in treating undocumented-uninsured patients with end-stage renal disease (ESRD). Hereby we describe the 10-year experience of treating undocumented-uninsured ESRD patients in a large public dialysis-unit.MethodsWe evaluated the medical files of all the chronic dialysis patients treated at the Tel-Aviv Medical Center between the years 2000–2010. Data for all immigrant patients without documentation and medical insurance were obtained. Clinical data were compared with an age-matched cohort of 77 insured dialysis patients.ResultsFifteen undocumented-uninsured patients were treated with chronic scheduled dialysis therapy for a mean length of 2.3 years and a total of 4953 hemodialysis sessions, despite lack of reimbursement. All undocumented-uninsured patients presented initially with symptoms attributed to uremia and with stage 5 chronic kidney disease (CKD). In comparison, in the age-matched cohort, only 6 patients (8%) were initially evaluated by a nephrologist at stage 5 CKD. Levels of hemoglobin (8.5 ± 1.7 versus 10.8 ± 1.6 g/dL; p < 0.0001) and albumin (33.8 ± 4.8 versus 37.7 ± 3.9 g/L; p < 0.001) were lower in the undocumented-uninsured dialysis patients compared with the age-matched insured patients at initiation of hemodialysis therapy. These significant changes were persistent throughout the treatment period. Hemodialysis was performed in all the undocumented-uninsured patients via tunneled cuffed catheters (TCC) without higher rates of TCC-associated infections. The rate of skipped hemodialysis sessions was similar in the undocumented-uninsured and age-matched insured cohorts.ConclusionsUndocumented-uninsured dialysis patients presented initially in the advanced stages of CKD with lower levels of hemoglobin and worse nutritional status in comparison with age-matched insured patients. The type of vascular access for hemodialysis was less than optimal with regards to current guidelines. There is a need for the national and international nephrology communities to establish a policy concerning the treatment of undocumented-uninsured patients with CKD.

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Section: Introductionmentioning

confidence: 99%

“…This lack of policy creates a challenge for the treating nephrologists and hospitals. A primary consideration is to decide about the nature of dialysis therapy as either a chronic scheduled regimen of therapy or as an “emergent” therapy for overt symptoms attributed to ESRD [10,16,17]. …”

Section: Introductionmentioning

confidence: 99%

Care of undocumented-uninsured immigrants in a large urban dialysis unit

et al. 2012

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“…Most patients receive a standard 3 h treatment to resolve symptoms, and occasionally, some are admitted for repeat dialysis if symptoms do not resolve acutely; urea kinetic data were not recorded. This practice in our center has been described [2], and generally, the patients we studied received dialysis once a week or once every 2 weeks. We also studied a subset of patients recruited from a county sponsored chronic HD facility where patients receive regular dialysis, but in all cases after years of receiving intermittent dialysis.…”

Section: Methodsmentioning

confidence: 99%

“…The health of undocumented immigrants, specifically concerning renal disease, is a major public health concern because of the pressure patients place on the health-care systems of the city and the county, which often care for the undocumented population. An estimated 6,000 patients suffer from a particularly severe form of renal disease called end-stage renal disease (ESRD) [2]. Patients with ESRD routinely present to public safety-net hospitals for life-saving emergent dialysis treatments, often with severe symptoms or life-threatening electrolyte abnormalities and volume overload.…”

Section: Introductionmentioning

confidence: 99%

Adverse Effects of Sporadic Dialysis on Body Composition

Workeneh

Shypailo

DeCastro

et al. 2015

Nephron

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Objective: The aim of this study is to analyze the body composition of patients receiving emergent dialysis and compare their body cell mass (BCM) and fat-free mass (FFM) with those of normal subjects. The care of patients receiving sporadic, emergent dialysis treatment is a growing public health concern and the magnitude of muscle wasting that occurs in this population is not known. Design and Methods: We used a cross-sectional design with matching to determine differences in total body potassium - an indicator of both BCM and FFM - between emergent dialysis patients and healthy normal subjects. We studied 22 subjects using a ⁴⁰K counter that measures BCM and FFM and compared them to controls after matching with sex, height and weight. Results: In the matched comparison, BCM and FFM were significantly lower in subjects with end-stage renal disease (ESRD). Unadjusted BCM was 4.7 kg lower and FFM was 8.8 kg lower for those with ESRD compared to those without ESRD (p < 0.001, p < 0.001, respectively). Comparison with unmatched controls who underwent ⁴⁰K analysis also revealed significantly lower BCM (4.1 kg) and FFM (7.7 kg) in the ESRD subjects (p = 0.004). After adjusting for age, height, weight and gender, BCM and FFM were lower by 4.2 and 7.8 kg, respectively (p < 0.001). Repeated observations were available for a subset of ESRD subjects, and the rate of FFM loss over time was significant, with the ESRD subjects demonstrating 2.2 kg per year decline (p = 0.01). Conclusion: We conclude that among other consequences, muscle wasting indicated by decline in BCM and FFM is a significant concern in the growing emergent dialysis population.

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“…13,14 Emergent treatments frequently fail to meet minimum thresholds of dialysis adequacy as assessed using objective metrics such as Kt/V calculations. 8 The standard of care for ESRD consists of perpetual thrice-weekly hemodialysis.…”

Section: Quality Of Life In Emergent Dialysis -Hogan Et Almentioning

confidence: 99%

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

et al. 2017

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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

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When Access to Chronic Dialysis is Limited: One Center’s Approach to Emergent Hemodialysis

Cited by 26 publications

References 11 publications

Care of undocumented-uninsured immigrants in a large urban dialysis unit

Care of undocumented-uninsured immigrants in a large urban dialysis unit

Adverse Effects of Sporadic Dialysis on Body Composition

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

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