Uninsured Patients Under Dialysis in Greece: A Case-Control Study

Treating uninsured patients with end-stage renal disease (ESRD) undergoing dialysis is a challenge for every country. Greece has adopted a three-week scheduled outpatient over emergency dialysis for uninsured patients with ESRD from the pandemic until now. In this observational study, we describe the experience of treating uninsured ESRD patients in a private dialysis unit in Greece.

A total of 50 patients who underwent dialysis at Frontis Dialysis Center, Piraeus, Greece, were analyzed. Clinical and laboratory data were prospectively collected from 25 uninsured consecutive patients and compared with 25 age- and sex-matched insured dialysis patients who served as controls.

The uninsured population was treated with three-week scheduled dialysis session. The mean age of the study population was 44.4 years (SD=13.5), and 68% were male. At presentation, 60% of uninsured patients were treated with hemodialysis via central venous catheter, and hemodiafiltration dialysis was applied only in 20% of them (p-value <0.001). Initially, the median hemoglobin (9.8 g/dL (min-max: 8-12.1) versus 11 g/dL (min-max: 9-14), p-value=0.04) and albumin (3.6 g/dL (min-max: 2-4) versus 4 g/dL (min-max: 3.3-4.6), p-value=0.008) levels were significantly lower, while the median ferritin (518 ng/mL (min-max: 104-2,149) versus 208 ng/mL (min-max: 16-1,333), p-value <0.001) and parathormone (iPTH) levels (799 pg/dL (min-max: 168-2,811) versus 410 pg/dL (min-max: 13-923), p-value <0.001) were significantly higher for the uninsured patients. After three months, uninsured patients improved their anemia and nutritional status, but ferritin and iPTH levels were still significantly higher. At the end of follow-up, there were no differences between the two groups. Rates of hospitalization (40% versus 32%, p-value=0.5) and infections (24% versus 12%, p-value=0.2) did not differ between groups. During the study, there was only one cardiovascular event in the control group, and none in the uninsured group of patients. None of the patients died during the study.

Uninsured patients who received three-week scheduled dialysis sessions improved all their laboratory values and had zero mortality. Healthcare policy has to take into account that scheduled dialysis sessions result in favorable outcome for uninsured patients.