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Researchers study care for undocumented immigrants with kidney failure

February 06, 2017

DENVER, Colo. (Feb. 3, 2017) - By failing to provide scheduled dialysis treatments to undocumented immigrants with kidney failure, states pay higher costs for care and the patients face greater pain and psychological distress, according to a new study appearing in the latest issue of the journal JAMA Internal Medicine.

"The Illness Experience of Undocumented Immigrants Receiving Emergent-Only Hemodialysis," was conducted over a 12-month period by researchers from Denver Health Medical Center, University of Colorado Anschutz Medical Campus, University of Denver and The Hastings Center.

"Undocumented patients with ESRD (end-stage renal disease) and no access to regular, scheduled hemodialysis describe significant physical and psychological distress that not only affects them, but their families as well," said the study's principal investigator Dr. Lilia Cervantes, a physician at Denver Health and assistant professor of medicine at the CU School of Medicine. "This suffering, coupled with higher costs for emergent dialysis, indicates that we should reconsider our professional and societal approach to ESRD for undocumented patients." Cervantes and her co-authors interviewed 20 patients at Denver Health between July 2015 and December 2015 and asked them to describe their experiences.

The patients in the study do not receive regular dialysis because the special Medicare benefit covering scheduled dialysis for patients with ESRD excludes undocumented immigrants. In Colorado, only "emergent hemodialysis" is covered by emergency Medicaid, which reimburses hospitals for certain emergency treatments when a patient lacks coverage. Emergent hemodialysis is only provided when a patient becomes critically ill.

The urgent symptoms that alert the patients they've become critically ill are a sensation of drowning as fluid builds up in their chests or nausea and vomiting as blood urea levels rise.

One patient described the experience: "It's happened to me twice, not being able to breathe...They saw me vomiting blood and that is when I was taken to the intensive care unit and after that I was unaware of anything around me for two days."

The study recommends an analysis of state policies to clarify whether health care professionals can define the emergency threshold so that scheduled outpatient dialysis treatment can be covered by Medicaid after a single, emergent event. Some states already take this approach, which is consistent with professional guidance on the management of ESRD as a chronic condition.

"Prior studies comparing scheduled versus emergent dialysis show that scheduled dialysis is more cost effective, because it prevents the need for interventions under emergency and critical care conditions," said Nancy Berlinger, PhD, Research Scholar with The Hastings Center and a co-author on the study. "Our research shows the experience of emergent dialysis from the patient's perspective, drawing attention to the level of suffering these patients experience before receiving treatment."
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In addition to Cervantes and Berlinger, the authors of the article are Stacy Fischer, MD, of the University of Colorado School of Medicine and Denver Health; Maria Zabalaga, BA, of Denver Health; Claudia Comacho, BA, of Denver Health; Stuart Linas, MD, of Denver Health; and Debora Ortega, PhD, of the Graduate School of Social Work at the University of Denver.

About the University of Colorado School of Medicine

Faculty at the University of Colorado School of Medicine work to advance science and improve care. These faculty members include physicians, educators and scientists at University of Colorado Health, Children's Hospital Colorado, Denver Health, National Jewish Health, and the Denver Veterans Affairs Medical Center. The school is located on the Anschutz Medical Campus, one of four campuses in the University of Colorado system. To learn more about the medical school's care, education, research and community engagement, visit its web site.

About Denver Health

Denver Health is the Rocky Mountain Region's Level I academic trauma center, and the safety net hospital for the Denver area. The Denver Health system, which integrates acute and emergency care with public and community health, includes the Rocky Mountain Regional Trauma Center, Denver's 911 emergency medical response system, Denver Health Paramedic Division, nine family health centers, 17 school-based health centers, the Rocky Mountain Poison and Drug Center, NurseLine, Denver CARES, Denver Public Health, the Denver Health Foundation and the Rocky Mountain Center for Medical Response to Terrorism, Mass Casualties and Epidemics.

About The Hastings Center

The Hastings Center is a nonpartisan bioethics research institution dedicated to bioethics and the public interest since 1969. The Center is a pioneer in collaborative interdisciplinary research and dialogue on the ethical and social impact of advances in health care and the life sciences. The Center draws on a worldwide network of experts to frame and examine issues that inform professional practice, public conversation, and social policy.

About the University of Denver Graduate School of Social Work

Faculty at the Graduate School of Social Work (GSSW) at the University of Denver are committed to excellence in teaching, community leadership and service. GSSW's mission is to foster social responsibility regarding social and economic justice, quality of life and multicultural communities, based on equality for all people. As a center for the creation and dissemination of knowledge, the School provides graduate social work education in order to alleviate and prevent social problems of individuals, families and communities.

University of Colorado Anschutz Medical Campus

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