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Study: Cardiac arrest major cause of death among immigrants with limited access to ESKD care
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A study among immigrants with ESKD living in Colorado and relying on emergency-only hemodialysis – equating to about six dialysis treatments a month – showed that most died of a cardiac arrest/arrythmia or other acute unexpected event.
Researchers looked at cause of death among 35 undocumented patients with ESKD who were treated by Denver Health between January 2005 and March 2017 and received emergency-only hemodialysis (EOHD) care. Since these patients were not legal U.S. residents, the criteria for receiving limited dialysis care like EOHD requires that a patient be critically ill from ESKD complications.
“It is not uncommon for patients on EOHD to report frequent near-death experiences because of this requirement,” wrote lead author Lilia Cervantes, MD, and colleagues from the department of medicine at Denver Health, University of Colorado and University of Washington School of Medicine in Seattle. “A retrospective cohort multisite study showed that the adjusted 5-year relative hazard of mortality among undocumented patients receiving EOHD is 14-fold that for undocumented patients receiving standard hemodialysis.”
Half of the deaths (18) were attributed to cardiac arrest; six of the patients died after withdrawing from dialysis, the authors wrote. Help for immigrants who decided to end EOHD is not often provided.
“How best to foster end-of-life planning for undocumented patients with ESKD receiving EOHD exposes the fundamental contradictions inherent in current approaches to caring for these patients,” the authors wrote. “Few of the patients who died in the hospital had documentation of an advance directive, and most received cardiopulmonary resuscitation and intubation during the terminal admission. At the same time, lack of access to health care means that undocumented immigrants also have limited access to hospice services.
“Hospice improves health-related quality of life and reduces health care costs, which should be considered given the higher mortality as well as physical and psychosocial distress described by patients who rely on EOHD.” – by Mark E. Neumann
Disclosures: The work was supported by the Harold Amos Medical Faculty Development Award from the Robert Wood Johnson Foundation and grant 2015212 from the Doris Duke Charitable Foundation (University of Colorado School of Medicine fund to retain clinical scientist). One of the paper’s co-authors, Michel Chonchol, MD, is a deputy editor of the Clinical Journal of the American Society of Nephrology and was not involved in the peer review process for this manuscript.
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