Colo. – 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
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.
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
and her co-authors interviewed 20 patients at Denver Health between July 2015
and December 2015 and asked them to describe their experiences.
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.
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.
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
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.
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.”
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.