Format

Send to

Choose Destination
Am J Kidney Dis. 2009 Jun;53(6):940-9. doi: 10.1053/j.ajkd.2008.12.029. Epub 2009 Mar 26.

Care of undocumented individuals with ESRD: a national survey of US nephrologists.

Author information

1
Division of General Internal Medicine, Denver Health, Denver, CO 80204, USA. laura.hurley@dhha.org

Abstract

BACKGROUND:

Although Medicare covers most dialysis therapy for US citizens with end-stage renal disease (ESRD), no national standards for dialysis provision exist for undocumented (ie, immigrant) patients with ESRD.

STUDY DESIGN:

Cross-sectional survey.

SETTING & PARTICIPANTS:

Mail and internet survey from October 2006 to February 2007 of American Society of Nephrology member nephrologists.

PREDICTORS:

Region of the country, practicing in a state with a high undocumented population, inpatient and outpatient practice setting, and practice location.

OUTCOMES:

Characteristics of nephrologists who report caring for undocumented patients with ESRD and those who perceive that such patients have access to maintenance dialysis therapy.

RESULTS:

Response rate was 57% (990 of 1,723). Of nephrologists surveyed, 65%, representing 44 states, reported providing care to undocumented patients with ESRD and 61% reported increasing prevalence. Being from a state with a high undocumented population (OR, 1.67; 95% CI, 1.21 to 2.30) was associated with undocumented ESRD patient care; being from the Northeastern United States (OR, 0.55; 95% CI, 0.34 to 0.88) or a small town/rural area (OR, 0.27; 95% CI, 0.18 to 0.40) were negatively associated. Of the respondents, 91% reported that undocumented patients had access to emergent dialysis, but only 51% reported access to maintenance dialysis therapy. The characteristic associated with reporting access to maintenance dialysis was practicing in a state with a high undocumented population (OR, 1.91; 95% CI, 1.37 to 2.66), whereas practicing in the Southern United States was negatively associated (OR, 0.37; 95% CI, 0.24 to 0.57). Emergent-only dialysis for undocumented patients was reported by 28%. Of respondents knowledgeable about reimbursement, most reported inadequate compensation and 35% reported that outpatient dialysis units provide uncompensated dialysis care to undocumented patients with ESRD.

LIMITATIONS:

Selection and information biases inherent to survey methods.

CONCLUSIONS:

Dialysis for undocumented patients with ESRD is an increasing problem involving the majority of US nephrologists. Inadequately compensated or uncompensated care may limit the availability of long-term maintenance dialysis therapy for undocumented patients with ESRD. Regional variations argue for more rational and uniform national policy regarding this issue.

PMID:
19327878
DOI:
10.1053/j.ajkd.2008.12.029
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center