Inadequate dialysis care placing undocumented immigrants at higher risk

Undocumented immigrants in the United States with end-stage renal disease are finding refuge in hospital emergency rooms for treatment, but that care is often inadequate and inferior to standard dialysis care, according to data recently published in JAMA Internal Medicine.

Lilia Cervantes, MD, of Denver Health, and fellow researchers from the University of California San Francisco and Baylor College of Medicine, found undocumented immigrants with ESRD who received emergency care were much more likely to die and to spend more time in the hospital with medical problems vs. patients who get care in outpatient dialysis centers.

About 6,500 undocumented immigrants with ESRD live in the United States, the authors reported, but do not have access to major federally funded insurance programs. State Medicaid programs will pay for emergency care for an undocumented patient, and some states choose to reimburse outpatient clinics to provide standard dialysis to undocumented immigrants.

In the study, 211 patients with ESRD were identified who had started receiving dialysis treatments via three health centers. The treatments were observed between 2007-2014. Of this group, 169 had emergency-only dialysis at Denver Health and Harris Health, Houston, and 42 received dialysis three times a week at Zuckerberg San Francisco General Hospital. Of the study group, 199 were Hispanic.

After tracking the patients at 3- and 5-year follow-up, the researchers found the undocumented patients who had emergency-only dialysis in Denver and Houston were more likely to die and to spend more days in the hospital compared to those who received conventional treatment at the UCSF dialysis clinic.

“In this cohort study, mean 5-year mortality for patients who received emergency-only hemodialysis was more than 14-fold higher than for those who received standard hemodialysis,” the authors noted. The patients receiving standard hemodialysis were more likely to initiate treatment with an arteriovenous fistula or graft vs. the hospital-treated patients. Likewise, the patients receiving conventional treatments had higher albumin and hemoglobin levels than the patients receiving emergency-only hemodialysis,” the authors reported.

“An emergency-only hemodialysis treatment strategy to treat undocumented immigrants with ESRD is strongly associated with increased mortality and more acute hospital days compared with a treatment strategy of standard hemodialysis,” the authors concluded. “The life-and-death nature of emergency-only hemodialysis demands that we establish policies guiding care for undocumented immigrants with ESRD and balancing the many conflicting issues. States across the country providing emergency-only hemodialysis to undocumented immigrants should reconsider the substantial human and economic effect of providing less-than-standard hemodialysis care.” – by Mark E. Neumann

Reference:

Cervantes L, et al. JAMA Intern Med. 2017;doi:10.1001/jamainternmed.2017.7039.

Disclosure: Cervantes reports no relevant financial disclosures.