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Hemodialysis care for undocumented immigrants with end-stage renal disease in the United States

Welles, Christine C.a,b; Cervantes, Liliaa,b

Current Opinion in Nephrology and Hypertension: November 2019 - Volume 28 - Issue 6 - p 615–620
doi: 10.1097/MNH.0000000000000543
DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker
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Purpose of review Across the United States, significant variation exists in the provision of care of undocumented immigrants with end-stage renal disease (ESRD), with some states providing standard dialysis, and other states providing emergency-only hemodialysis (EoHD).

Recent findings EoHD is associated with higher morbidity and mortality compared with standard hemodialysis. EoHD is also associated with higher healthcare utilization, resulting in more emergency department visits, more days spent in the hospital, and higher healthcare costs. Undocumented immigrants with ESRD who rely on EoHD also experience crippling and potentially fatal physical symptoms as well as psychosocial suffering, with some patients describing recurrent near-death experiences. Clinicians who provide EoHD to undocumented patients report experiencing moral distress and symptoms of professional burnout because of providing care that they perceive as unethical and far below the standard of care.

Summary Undocumented immigrants with ESRD who rely on EoHD have worse health outcomes and quality of life compared with patients who receive standard hemodialysis. EoHD is also more costly to the healthcare system. Healthcare policy reform is critical as more research demonstrates the worse clinical outcomes and higher costs of EoHD.

aDepartment of Medicine, Denver Health and Hospital Authority, Denver

bDepartment of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA

Correspondence to Lilia Cervantes, MD, Department of Medicine, Denver Health and Hospital Authority, 601 Broadway, MC 4000, Denver, CO 80204-4507, USA. Tel: +1 303 602 5075; e-mail: Lilia.Cervantes@ucdenver.edu

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