Undocumented Patients

History of Present Illness


The plight of undocumented immigrants with ESRD has received significant attention in the popular press, partly because of increased concern over healthcare utilization and so-called “super-utilizers”, and because the physical and emotional toll associated with perpetually teetering on the “brink of death” is so striking. Debate over the ethical and financial implications of providing scheduled hemodialysis to this patient population has been contentious, and has raised questions about the role of dialysis as a bridge to kidney transplantation in this group.

The JAMA Internal Medicine articles by Cervantes et al and Nguyen et al stand out for their methodological approaches and impacts on policy and public discourse. The former is a qualitative study focused on the illness experience of undocumented patients with ESRD; it illustrates the significant illness and death anxiety related to frequent, unplanned hospitalization. The latter examined this population through an observational cohort study of undocumented patients with ESRD receiving scheduled versus emergency-only dialysis. It demonstrated three key benefits to scheduled dialysis: decreased one-year mortality, decreased healthcare utilization, and decreased cost when compared to emergency-only dialysis access. Margarita, an undocumented woman, shares her experience with ESRD in a short podcast.

Extra: To listen to a discussion between Dr. Oanh Nguyen and the co-founders of Equal Treatment, click here.