Association of Emergency-Only versus Standard Hemodialysis with Mortality and Health Care Use.


eMediNexus    26 December 2017

The goal of a new study published in the JAMA Internal Medicine was to determine whether mortality and health care use differs among undocumented immigrants who receive emergency-only hemodialysis versus standard hemodialysis, three times a week, at a health care center. This retrospective cohort study was conducted on undocumented immigrants with incident end-stage renal disease who initiated emergency-only hemodialysis or standard hemodialysis between January 1, 2007, and July 15, 2014. The primary outcome was mortality; secondary outcomes were health care use and rates of bacteremia. It was observed that 211 undocumented patients (86 women and 125 men) with a mean age of 46.5 years – 42 from the standard hemodialysis group and 169 from the emergency-only hemodialysis group, initiated hemodialysis during the study period. Patients receiving standard hemodialysis had higher predisposition to initiate hemodialysis with an arteriovenous fistula or graft and had higher albumin and hemoglobin levels than patients receiving emergency-only hemodialysis. Adjusting for propensity score, the mean 3-year relative hazard of mortality among patients who received emergency-only hemodialysis was approximately 5-fold greater when compared to patients who received standard hemodialysis. Additionally, the mean 5-year relative hazard of mortality for patients who received emergency-only hemodialysis was more than 14-fold higher than for those who received standard hemodialysis. On the other hand, the number of acute care days for patients who received emergency-only hemodialysis was 9.81 times the expected number of days for patients who had standard hemodialysis. Furthermore, ambulatory care visits for patients who received emergency-only hemodialysis were 0.31 times less than the expected number of days for patients who received standard hemodialysis. Therefore, it was concluded that undocumented immigrants with end-stage renal disease treated with emergency-only hemodialysis have higher mortality and spend more days in the hospital than those receiving standard hemodialysis. Hence, it was suggested that states and cities should consider offering standard hemodialysis to undocumented immigrants.

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