Challenges surrounding hemodialysis initiation faced by undocumented immigrants.

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.