MedicalResearch.com Interview with:
Oanh Kieu Nguyen, MD, MA
Division of Hospital Medicine
Zuckerberg San Francisco General Hospital
MedicalResearch.com: What is the background for this study?
Response: In U.S. citizens and permanent residents with kidney failure or end-stage renal disease (ESRD), having health insurance, Medicare, or Medicaid guarantees access to regularly scheduled hemodialysis 2-3 times per week, the evidence-based standard of care for ESRD. This treatment helps people live relatively normal lives. In 40 of 50 U.S. states, undocumented immigrants with ESRD have limited access to hemodialysis because they are not eligible for any form of federal assistance including Medicare or Medicaid, and must wait until they are life-threateningly ill to receive dialysis through a hospital emergency department, a situation called “emergency-only hemodialysis.” There are an estimated 6,500 undocumented individuals in the U.S. suffering from ESRD.
A unique opportunity made it feasible for uninsured undocumented immigrants with ESRD receiving emergency-only dialysis in Dallas, Texas, to enroll in private, commercial health insurance plans in 2015 and made it possible for researchers to compare scheduled vs. emergency-only dialysis among undocumented immigrants with ESRD. This natural experiment included 181 undocumented immigrants, 105 of whom received insurance coverage and enrolled in scheduled dialysis and 76 of whom remained uninsured.
MedicalResearch.com: What are the main findings?
Response: In this study, we found that not only was scheduled hemodialysis more effective in preventing death at one year than virtually any pharmaceutical treatment currently available with an absolute risk reduction of 14% or number needed to treat of 7 to prevent 1 death at 1 year, it also resulted in a health care cost savings of nearly $70,000 per person per year.
MedicalResearch.com: What should readers take away from your report?
Response: Given the unequivocal and considerable benefits of scheduled hemodialysis compared to emergency-only dialysis, local, state, and national health policy should provide for scheduled hemodialysis as the universal standard care for all individuals with kidney failure in the United States.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: This study provides the highest level of evidence possible supporting the health and societal benefits of providing scheduled hemodialysis to undocumented immigrants with ESRD, since a randomized clinical trial would be unethical and unfeasible. The time for action is now.
Disclosures: This study was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award numbers KL2TR001103 and UL1TR001105. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Agency for Healthcare Research and Quality.
Nguyen OK, Vazquez MA, Charles L, et al. Association of Scheduled vs Emergency-Only Dialysis With Health Outcomes and Costs in Undocumented Immigrants With End-stage Renal Disease. JAMA Intern Med. Published online December 21, 2018. doi:10.1001/jamainternmed.2018.5866
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