Nav: Home

Illness experience of undocumented immigrants with end-stage renal failure

February 06, 2017

A small study of undocumented immigrants with kidney failure reports that not having access to scheduled hemodialysis results in physical and psychological distress that impacts them and their families, according to a new article published online by JAMA Internal Medicine.

About 11 million undocumented immigrants live and work in the United States but they are excluded from a range of public benefits, including Medicare, federally funded Medicaid and the insurance provisions of the Affordable Care Act. Hemodialysis is a life-sustaining treatment for patients with end-stage renal disease (ESRD). An estimated 6,480 undocumented immigrants in the United States have ESRD and some states use state emergency Medicaid programs to finance scheduled hemodialysis for these patients, while in most states these patients receive only emergency hemodialysis in emergency departments reimbursed by states' emergency Medicaid programs.

Lila Cervantes, M.D., of Denver Health, Colorado, and coauthors conducted an interview study with 20 undocumented immigrants (10 women and 10 men) at a Colorado safety-net hospital from July to December in 2015.

Patients described unpredictable access to emergency-only hemodialysis, the burden of symptoms (including shortness of breath as fluid builds up in the chest), and having to consume food or beverages high in potassium outside the hospital so they could meet the criteria of critical illness. Patients also reported having to miss work, anxiety over dying because of their life-threatening illness, and distress experienced by their families. Patients expressed appreciation for their care, although it was nonstandard and suboptimal, according to the article.

Limitations of the study include its small sample size from one safety-net hospital in Colorado.

"Undocumented patients with ESRD and no access to scheduled hemodialysis describe significant physical and psychological distress that affects their families and their own ability to work. This distress, coupled with higher costs for emergent dialysis, indicate that we should reconsider our professional and societal approach to ESRD care for undocumented patients. Comparing the experiences of different states and localities may aid in identifying more humane and higher-value solutions," the article concludes.
-end-
(JAMA Intern Med. Published online February 6, 2017. doi:10.1001/jamainternmed.2016.8865; available pre-embargo at the For The Media website.)

Editor's Note: The article contains funding/support disclosures. Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

Related Hemodialysis Articles:

Hospitalizations among dialysis patients are higher in areas with more black residents
Patients receiving hemodialysis at facilities located in residential areas with a high percentage of Black residents have a higher rate of hospitalization.
Survival following switch from urgent in-center hemodialysis to home dialysis
Few patients who start urgent and unplanned dialysis in clinical centers switch to home dialysis.
Community house hemodialysis offers many benefits to patients with kidney failure
Community house hemodialysis is a dialysis modality that overcomes many of the barriers to home hemodialysis.
New study evaluates transcatheter dialysis conduit procedures over 15 years
A new research study by Harvey L. Neiman Health Policy Institute found that utilization of invasive procedures on hemodialysis conduits -- artificially constructed shuts used by many individuals who require dialysis -- increased markedly from 2001 through 2015 for nephrologists and declined for radiologists.
Commentary: Modifications to Medicare rules could support care innovation for dialysis
Public health researchers suggest adjustments to recently proposed rule changes on how Medicare pays for dialysis services.
Effect of oral alfacalcidol on clinical outcomes in patients without secondary hyperparathyroidism R
''Treatment with active vitamin D did not decrease cardiovascular events in kidney patients undergoing hemodialysis''-- A research group in Japan reported their research results in the December 11 issue of JAMA.
Insurance-related disparities in timely access to gold standard dialysis procedure
In a study that compared uninsured patients starting hemodialysis with similar patients already covered by Medicare or Medicaid, patients with Medicare or Medicaid were more likely to receive dialysis through an arteriovenous fistula or graft by their fourth dialysis month.
Frequent home hemodialysis linked to lower mortality risk vs. traditional hemodialysis
Within one year after initiating dialysis, patients on more frequent home hemodialysis were 23 percent less likely to die compared with patients receiving traditional in-center hemodialysis.
Study: Online positive psychology exercises improve quality of life in hemodialysis patients
Patients with depression who used tablet computers to complete brief positive psychology exercises online several times a week scored lower on depressive symptoms and reported that they felt better able to cope with their kidney disease by the end of the five-week pilot study, led by University of Illinois social work professor Rosalba Hernandez.
Protective protein activated by vitamin K found, inactive, abundant in blacks on dialysis
High levels of a protein activated by vitamin K and associated with cardiovascular disease when it isn't, has been found in the blood of African-Americans on dialysis, investigators report.
More Hemodialysis News and Hemodialysis Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.