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Care of undocumented-uninsured immigrants in a large urban dialysis unit
Moshe Shashar; Gil Chernin; Idit F Schwartz; Doron Schwartz; Talia Weinstein; Amir Gal-Oz
BMC Nephrology,13,1(2012-09-19)



Medical, 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.


We 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.


Fifteen 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.


Undocumented-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.

关键词:Uninsured, Undocumented, Dialysis, ESRD, Immigrants

出版者:BioMed Central Ltd

推荐引用方式:Moshe Shashar,Gil Chernin,Idit F Schwartz, et al. Care of undocumented-uninsured immigrants in a large urban dialysis unit[J]. BMC Nephrology,2012,13(1)

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