Dialysis Care for Undocumented Immigrants With Kidney Failure in the COVID-19 Era: Public Health Implications and Policy Recommendations

Rizzolo, Katherine; Novick, Tessa K.; Cervantes, Lilia

doi:10.1053/j.ajkd.2020.05.001

Cited by 17 publications

(40 citation statements)

References 11 publications

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“…In Sweden, a COVID-19 situational report found around 65% of refugees are either overweight or obese compared to 50% in the rest of the population, and around 35% are smokers, which is higher than the general population (87). In addition, hospital visits for management of co-morbidities may increase risk of exposure to COVID-19 (88). Co-infections may also play a role.…”

Section: Resultsmentioning

confidence: 99%

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review

Hayward

Deal

Cheng

et al. 2020

Preprint

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BackgroundMigrants, including refugees, asylum seekers, labour migrants, and undocumented migrants, now constitute a considerable proportion of most high-income countries’ populations, including their skilled and unskilled workforces. Migrants may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are being affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations (cases, hospitalisations, deaths), indirect health and social impacts, and to determine key risk factors.MethodsWe did a systematic review following PRISMA guidelines, registered with PROSPERO (CRD42020222135). We searched databases including PubMed, Global Health, Scopus, CINAHL, and pre-print databases (medRxiv) via the WHO Global Research on COVID-19 database to Nov 18, 2020 for peer-reviewed and grey literature pertaining to migrants (defined as foreign born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on our primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts, and risk factors, using narrative synthesis.Results3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps and labour compounds may have been especially affected. In general, migrants have higher levels of many risk factors and vulnerabilities relevant to COVID-19, including increased exposure to SARS-CoV-2 due to high-risk occupations and overcrowded accommodation, and barriers to health care including inadequate information, language barriers, and reduced entitlement to healthcare coverage related to their immigration status.ConclusionsMigrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health responses to the pandemic and should inform policymaking on strategies for reducing transmission of COVID-19 in this population. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.

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Section: Resultsmentioning

confidence: 99%

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review

Hayward

Deal

Cheng

et al. 2020

Preprint

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“…24,25,63,64 Cost considerations have entered into the decision of the optimal access primarily in the uninsured or undocumented immigrants, [50][51][52] with dialysis care of the latter group varying from state to state in the United States. 50 However, examination of cost-effectiveness reveals that the overall costs of patients with CVCs are the highest, whereas AVF costs are the lowest despite the initial higher costs of AVFs than AVGs. 3,[65][66][67] Such analyses need to be nuanced since the procedure, hospitalization, and mortality rates, which drive the overall costs of the three accesses, tend to become closer in certain subgroups, for example, older patients or women with diabetes.…”

Section: Ta B L E 2 (Continued)mentioning

confidence: 99%

“…Patients living in rural and remote areas further from nephrology specialists have less predialysis care and a higher rate of dialysis with a temporary CVC than a permanent AVF/AVG access, 47 and they have higher mortality rates from infectious causes 48 . Likewise, undocumented and uninsured immigrants usually receive little or no predialysis care, 49,50 are not considered for an AVF/AVG creation, and are dialyzed with a CVC whether or not it is the most optimal access 51 . A similar barrier to an AVF or AVG exists in the uninsured, particularly blacks and Hispanics, 40 who are more often dialyzed with a CVC whether or not it is the preferred access 52 .…”

Section: Barriers To An Optimal Access Based On the Eskd Patientmentioning

confidence: 99%

“…While nonrandomized quality of life surveys have shown better scores in AVF/AVG patients than those with CVCs, 62 increasing numbers of patients have refused an optimal AVF or AVG to avoid the operative procedures, painful needle cannulations, more frequent needle cannulations on home HD, fear of needle dislodgement on nocturnal HD, and multiple procedures to maintain permanent accesses 24,25,63,64 . Cost considerations have entered into the decision of the optimal access primarily in the uninsured or undocumented immigrants, 50‐52 with dialysis care of the latter group varying from state to state in the United States 50 . However, examination of cost‐effectiveness reveals that the overall costs of patients with CVCs are the highest, whereas AVF costs are the lowest despite the initial higher costs of AVFs than AVGs 3,65‐67 .…”

Section: Barriers To An Optimal Access Based On the Eskd Patientmentioning

confidence: 99%

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Barriers to optimal vascular access for hemodialysis

Brown

2020

Seminars in Dialysis

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Vascular access so essential for hemodialysis (HD) has been considered its Achilles heel. 1 Since the description of the Brescia-Cimino radiocephalic arteriovenous fistula (AVF) in 1966, 2 it has been considered the optimal access for HD because it was long-lasting and had generally lower rates of complications and mortality than either arteriovenous grafts (AVGs) or central venous catheters (CVCs). 3,4 This gave rise to the "Fistula First" initiative in 2003 5 that has dominated quality assessment in HD as a central factor in the Centers for Medicare and Medicaid Services (CMS) Five Star ratings and financial reimbursement of HD providers. However, the Fistula First initiative had the unintended consequences of increasing the proportion of CVCs as the percentage of AVG creation markedly decreased from 170 per 1000 patient-years in 2003 to 100 in 2007. 6 Therefore, Fistula First became "Fistula First, Catheter Last" in 2007 7 to modify this effect. But as the end-stage kidney disease (ESKD) population expanded with aging HD patients and those with comorbid conditions, individual assessment of the appropriate access for HD changed the paradigm to "Patient First: ESKD Life-Plan" by the most recent National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. 3 KDOQI now espouses that "attainment of the 'right access, in the right patient, at the right time, for the right reasons' is a more patient-centered approach to care, where population measures, such as percentage with AVF created or used, or the percentage with hemodialysis CVC, may be unhelpful and counterproductive for patient-centered goals". 3 Attaining a goal of the "right access" has proved elusive mainly because, as depicted by the characteristics desirable for the optimal vascular access shown in Table 1, 3,8,9 the optimal vascular access does not currently exist. Thus, ESKD care providers attempting to offer the right access must weigh the barriers to achieving the most optimal vascular access to suit each of their HD patients individually.

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“…For example, outpatient dialysis is defined as an emergency service in Arizona's Medicaid Policy Manual. Undocumented immigrants receiving outpatient hemodialysis in Arizona require monthly certification verifying that the lack of thrice‐weekly hemodialysis would cause life‐threatening health consequences 29 …”

Section: Types Of Immigration Status and Access To Dialysismentioning

confidence: 99%

Immigration status and end‐stage kidney disease: Role of policy and access to care

Rizzolo

Cervantes

2020

Seminars in Dialysis

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Noncitizens (ie, lawfully present and undocumented immigrants) account for 7% (or 22 million) of the population in the United States. 1 Knowing an individual's immigration status is critically important to understanding healthcare coverage and thus, the provision of dialysis. With the exception of undocumented immigrants, there is little research on dialysis healthcare coverage barriers faced by immigrants with other types of immigration status. According to estimates from 2019, there are between 5500 and 8857 undocumented immigrants with end-stage kidney disease (ESKD). 2 Undocumented immigrants are the largest uninsured group in the country, accounting for 27% of the total uninsured population. 3 Most studies support that undocumented immigrants with ESKD are unaware of their diagnosis prior to arrival in the United States, and on average have been in the United States for 5 years prior to diagnosis. 4 For undocumented and certain groups of documented immigrants with ESKD, access to nephrology and dialysis care is limited.

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Dialysis Care for Undocumented Immigrants With Kidney Failure in the COVID-19 Era: Public Health Implications and Policy Recommendations

Cited by 17 publications

References 11 publications

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review

Barriers to optimal vascular access for hemodialysis

Immigration status and end‐stage kidney disease: Role of policy and access to care

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