Undocumented Immigrants Receiving Emergency HD More Likely to Die

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The 5-year relative risk for mortality was 14-fold higher for undocumented immigrants receiving emergency-only versus standard hemodialysis.
The 5-year relative risk for mortality was 14-fold higher for undocumented immigrants receiving emergency-only versus standard hemodialysis.

Undocumented immigrants have a higher mortality risk when they are forced to rely on emergency-only rather than standard hemodialysis (HD), a new study finds.

“States and cities should consider offering standard hemodialysis to undocumented immigrants,” Lilia Cervantes, MD, of Denver Health and colleagues stated in a paper published online in JAMA Internal Medicine.

In a study of undocumented immigrants with end-stage renal disease (ESRD), the team compared 169 emergency-only HD (from Denver and Houston) and 42 standard thrice-weekly HD (from San Francisco) patients treated from 2007 to 2014. The average age was 46.5 years.

Patients receiving emergency-only HD had a significant 14 times higher relative risk of death at 5 years compared with patients who received standard HD, after propensity score adjustment. Patients who received emergency-only HD spent nearly 10 times the number of acute care days than the expected number of days for patients who received standard HD after propensity score adjustment.

They were also 69% less likely to have typical outpatient care. The poorer mortality was consistent with that of patients who miss their standard HD sessions or who had longer interdialytic periods. Quality of care across sites did not account for the differences.

Standard HD patients in the current study were more likely to start with an arteriovenous fistula or graft and commonly had higher albumin and hemoglobin levels.

About 6500 undocumented immigrants with ESRD live in the United States, according to a study cited by the authors.

Reference

Cervantes L, Tuot D, Raghavan R, et al. Association of emergency-only vs standard hemodialysis with mortality and health care use among undocumented immigrants with end-stage renal disease. JAMA Intern Med. doi:10.1001/jamainternmed.2017.7039

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