ArticleBMC nephrology2012
Care of undocumented-uninsured immigrants in a large urban dialysis unit.
Article in BMC nephrology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Article
- Urgent care centres for reducing the demand on emergency departments: a scoping review of published quantitative and qualitative studies.The Medical journal of Australia · 2025Article
- Emergency department visits for hemodialysis by insurance status in the United States.Journal of the American College of Emergency Physicians open · 2022Article
- Canadian Senior Renal Leaders Community of Practice: Vulnerable Populations With Chronic Kidney Disease-Evidence to Inform Policy.Canadian journal of kidney health and disease · 2020Article
- A Scoping Review of Undocumented Immigrants and Palliative Care: Implications for the Canadian Context.Journal of immigrant and minority health · 2019Article
- Medical Care for Undocumented Immigrants: National and International Issues.Physician assistant clinics · 2019Review
- Healthcare outcomes in undocumented immigrants undergoing two emergency dialysis approaches .Clinical nephrology · 2017Article
- Medical Care for Undocumented Immigrants: National and International Issues.Primary care · 2017Review
- Barriers to health care for undocumented immigrants: a literature review.Risk management and healthcare policy · 2015Review
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMedical, ethical and financial dilemmas may arise in treating undocumented-uninsured patients with end-stage renal disease (ESRD). Hereby we describe the 10-year experience of treating undocumented-uninsured ESRD patients in a large public dialysis-unit.
methodsWe evaluated the medical files of all the chronic dialysis patients treated at the Tel-Aviv Medical Center between the years 2000-2010. Data for all immigrant patients without documentation and medical insurance were obtained. Clinical data were compared with an age-matched cohort of 77 insured dialysis patients.
resultsFifteen undocumented-uninsured patients were treated with chronic scheduled dialysis therapy for a mean length of 2.3 years and a total of 4953 hemodialysis sessions, despite lack of reimbursement. All undocumented-uninsured patients presented initially with symptoms attributed to uremia and with stage 5 chronic kidney disease (CKD). In comparison, in the age-matched cohort, only 6 patients (8%) were initially evaluated by a nephrologist at stage 5 CKD. Levels of hemoglobin (8.5 ± 1.7 versus 10.8 ± 1.6 g/dL; p < 0.0001) and albumin (33.8 ± 4.8 versus 37.7 ± 3.9 g/L; p < 0.001) were lower in the undocumented-uninsured dialysis patients compared with the age-matched insured patients at initiation of hemodialysis therapy. These significant changes were persistent throughout the treatment period. Hemodialysis was performed in all the undocumented-uninsured patients via tunneled cuffed catheters (TCC) without higher rates of TCC-associated infections. The rate of skipped hemodialysis sessions was similar in the undocumented-uninsured and age-matched insured cohorts.
conclusionsUndocumented-uninsured dialysis patients presented initially in the advanced stages of CKD with lower levels of hemoglobin and worse nutritional status in comparison with age-matched insured patients. The type of vascular access for hemodialysis was less than optimal with regards to current guidelines. There is a need for the national and international nephrology communities to establish a policy concerning the treatment of undocumented-uninsured patients with CKD.
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