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<h5 class="section-title" id="d4179312e480">Importance</h5>
<p id="d4179312e482">Undocumented immigrants with end-stage renal disease have variable
access to hemodialysis
in the United States despite evidence-based standards for frequency of dialysis care.
</p>
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<h5 class="section-title" id="d4179312e485">Objective</h5>
<p id="d4179312e487">To determine whether mortality and health care use differs among
undocumented immigrants
who receive emergency-only hemodialysis vs standard hemodialysis (3 times weekly at
a health care center).
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<h5 class="section-title" id="d4179312e490">Design, Setting, and Participants</h5>
<p id="d4179312e492">A retrospective cohort study was conducted of undocumented immigrants
with incident
end-stage renal disease who initiated emergency-only hemodialysis (Denver Health,
Denver, Colorado, and Harris Health, Houston, Texas) or standard (Zuckerberg San Francisco
General Hospital, San Francisco, California) hemodialysis between January 1, 2007,
and July 15, 2014.
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<h5 class="section-title" id="d4179312e495">Exposures</h5>
<p id="d4179312e497">Access to emergency-only hemodialysis vs standard hemodialysis.</p>
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<h5 class="section-title" id="d4179312e500">Main Outcomes and Measures</h5>
<p id="d4179312e502">The primary outcome was mortality. Secondary outcomes were health
care use (acute
care days and ambulatory care visits) and rates of bacteremia. Outcomes were adjusted
for propensity to undergo emergency hemodialysis vs standard hemodialysis.
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<h5 class="section-title" id="d4179312e505">Results</h5>
<p id="d4179312e507">A total of 211 undocumented patients (86 women and 125 men; mean
[SD] age, 46.5 [14.6]
years; 42 from the standard hemodialysis group and 169 from the emergency-only hemodialysis
group) initiated hemodialysis during the study period. Patients receiving standard
hemodialysis were more likely to initiate hemodialysis with an arteriovenous fistula
or graft and had higher albumin and hemoglobin levels than patients receiving emergency-only
hemodialysis. Adjusting for propensity score, the mean 3-year relative hazard of mortality
among patients who received emergency-only hemodialysis was nearly 5-fold (hazard
ratio, 4.96; 95% CI, 0.93-26.45;
<i>P</i> = .06) greater compared with patients who received standard hemodialysis.
Mean 5-year
relative hazard of mortality for patients who received emergency-only hemodialysis
was more than 14-fold (hazard ratio, 14.13; 95% CI, 1.24-161.00;
<i>P</i> = .03) higher than for those who received standard hemodialysis after adjustment
for propensity score. The number of acute care days for patients who received emergency-only
hemodialysis was 9.81 times (95% CI, 6.27-15.35;
<i>P</i> < .001) the expected number of days for patients who had standard hemodialysis
after
adjustment for propensity score. Ambulatory care visits for patients who received
emergency-only hemodialysis were 0.31 (95% CI, 0.21-0.46;
<i>P</i> < .001) times less than the expected number of days for patients who received
standard
hemodialysis.
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<h5 class="section-title" id="d4179312e522">Conclusions and Relevance</h5>
<p id="d4179312e524">Undocumented immigrants with end-stage renal disease treated
with emergency-only hemodialysis
have higher mortality and spend more days in the hospital than those receiving standard
hemodialysis. States and cities should consider offering standard hemodialysis to
undocumented immigrants.
</p>
</div><p class="first" id="d4179312e527">This cohort study examines whether mortality
and health care use differs among undocumented
immigrants who receive standard hemodialysis (3 times weekly at a health care center)
vs emergency-only hemodialysis.
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<h5 class="section-title" id="d4179312e534">Question</h5>
<p id="d4179312e536">Do mortality and health care use differ between undocumented
immigrants with end-stage
renal disease treated with emergency-only hemodialysis vs standard hemodialysis (3
times weekly)?
</p>
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<h5 class="section-title" id="d4179312e539">Findings</h5>
<p id="d4179312e541">In this cohort study, mean 5-year mortality for patients who
received emergency-only
hemodialysis was more than 14-fold higher than for those who received standard hemodialysis.
Patients who received emergency-only hemodialysis had more inpatient days but fewer
outpatient clinic visits than those who received standard hemodialysis.
</p>
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<h5 class="section-title" id="d4179312e544">Meaning</h5>
<p id="d4179312e546">Availability of standard hemodialysis for undocumented immigrants
could both save
lives and reduce inpatient resource use, suggesting the need for a careful examination
and potential change of existing health care policies.
</p>
</div>