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Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
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Challenges surrounding hemodialysis initiation faced by undocumented immigrants.

Cynthia A Ramazani1, Emma Rooney2, Katherine Bombly3

  • 1Emory University School of Medicine, Atlanta, GA.

Journal of Vascular Surgery
|February 1, 2025
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Summary

Undocumented immigrants with end-stage renal disease face delayed nephrology and vascular access care, leading to increased central venous catheter (CVC) use and complications. Earlier referral for arteriovenous access (AVA) creation can prevent these avoidable issues.

Keywords:
Catheter complicationsEnd-stage renal diseaseHealth care accessHemodialysisHemodialysis vascular accessUndocumented immigrants

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Public Health

Background:

  • Hemodialysis (HD) care for undocumented immigrants presents significant challenges in the US.
  • Access to timely medical evaluations and surgical procedures is crucial for end-stage renal disease (ESRD) patients.

Purpose of the Study:

  • To compare the timeliness of nephrology and vascular surgery care for undocumented immigrants with ESRD versus documented patients.
  • To evaluate catheter-related complications in undocumented patients undergoing HD.

Main Methods:

  • Retrospective chart analysis of patients undergoing first-time arteriovenous access (AVA) creation from 2012-2018.
  • Comparison of outcomes between documented and undocumented patients.
  • Subgroup analysis within the undocumented group comparing central venous catheter (CVC) dependence versus transition to AVA (CAV group).

Main Results:

  • Undocumented patients had delayed evaluations by nephrology and vascular surgery for AVA creation compared to documented patients.
  • A higher proportion of undocumented patients initiated HD with a CVC (90.3% vs 66.7%).
  • Undocumented patients reliant on CVCs experienced more catheter-related complications (72.5%) than those transitioning to AVA (45.9%).

Conclusions:

  • Limited healthcare access causes significant delays in care for undocumented immigrants with ESRD, increasing reliance on CVCs for dialysis initiation.
  • High rates of CVC-related complications in this population are avoidable with earlier referral for appropriate AVA creation.
  • Timely vascular access intervention is essential for improving outcomes in undocumented ESRD patients.