December 20, 2017 / 10:14 PM / 4 months ago

Emergency dialysis for undocumented immigrants tied to more deaths

(Reuters Health) - - Undocumented immigrants with kidney failure who can only get emergency dialysis have worse survival odds than patients who get routine dialysis three times a week, a U.S. study suggests.  

About 6,500 undocumented immigrants in the U.S. have end-stage renal disease (ESRD), when the kidneys stop working well enough for patients to survive without dialysis or a transplant.

While Medicaid, the federal and state health program for the poor, may cover emergency dialysis for undocumented immigrants, this typically gets them just one or two sessions a week, not the standard three sessions recommended by doctors.

For the study, researchers compared outcomes for 42 undocumented immigrants in California, which uses state funds to provide three weekly dialysis treatments, to 169 undocumented immigrants in Texas and Colorado who received only emergency dialysis.

Patients in the study were 47 years old on average. People who received standard dialysis tended to be sicker when they started this treatment than the patients who only got emergency dialysis.

But emergency dialysis patients were almost five times more likely to die within three years than the patients who received standard dialysis, the study found. After five years, emergency dialysis patients were more than 14 times more likely to die, according to the report in JAMA Internal Medicine.

“To receive emergency-only hemodialysis, undocumented patients with kidney failure must be near death,” said lead study author Dr. Lilia Cervantes of the University of Colorado School of Medicine, Anshutz Medical Campus in Denver.

When people with ESRD can’t get dialysis, “fluid builds up in their lungs making them feel like they are drowning and the waste will cause nausea,” Cervantes said by email. “In addition to the fluid and waste, potassium reaches dangerously high levels causing abnormal heart rhythms leading to cardiac arrest.”

During a typical 30-day period, patients receiving standard dialysis had an average of at least 10 treatment sessions, compared with about 6 sessions for people on emergency dialysis.

Beyond worse survival odds, undocumented immigrants who lacked access to standard dialysis also spent almost 10 times as many days in the hospital and had less access to doctors in the community, compared to patients who got standard care, the study found.

“Availability of standard hemodialysis for undocumented immigrants could both save lives and reduce inpatient resource use,” the researchers wrote.

The study wasn’t a controlled experiment designed to prove whether or how the number of dialysis sessions influenced survival outcomes. It was also done in just three U.S. cities, and results might be different elsewhere in the country.

“There is significant state-to-state variability in what funding or support is available for undocumented immigrants with end-stage kidney disease,” said Rachel Patzer, a researcher at Emory School of Medicine in Atlanta who wasn’t involved in the study.

“Some states have policies that help fund regular dialysis or care for undocumented immigrants, perhaps recognizing what was found in this study – that delaying access to dialysis will likely lead to emergency care that is not in the patient’s best interest and is also more costly to the health system and to the state,” Patzer said by email.

With limited options for treating kidney failure, patients should do the best they can to focus on prevention, advised Dr. Jenny Shen, a kidney specialist at the Los Angeles Biomedical Institute at Harbor-UCLA Medical Center.

“Exercising, eating a balanced diet and maintaining a healthy weight will help stave off diabetes and high blood pressure,” Shen said by email.

“Controlling diabetes and high blood pressure if they already have these diseases will prevent or delay the development of kidney disease,” Shen added. “If patients don’t have access to care, for diabetes, eating a low carbohydrate diet will help and a low sodium diet helps control blood pressure.”

SOURCE: bit.ly/2oYOBq6 JAMA Internal Medicine, online December 18, 2017.

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