Emergency-Only Hemodialysis Linked to Worse Outcomes
MONDAY, Dec. 18, 2017 -- Emergency-only hemodialysis treatment is associated with increased mortality compared with standard hemodialysis for undocumented immigrants with end-stage renal disease, according to a study published online Dec. 18 in JAMA Internal Medicine.
Lilia Cervantes, M.D., from Denver Health, and colleagues conducted a retrospective cohort study involving undocumented immigrants with incident end-stage renal disease who initiated emergency-only hemodialysis (169 patients) or standard hemodialysis (42 patients).
The researchers found that compared with patients receiving emergency-only hemodialysis, those receiving standard hemodialysis were more likely to initiate hemodialysis with an arteriovenous fistula or graft and had higher albumin and hemoglobin levels. The mean three-year relative hazard of mortality was increased for patients receiving emergency-only versus standard hemodialysis after adjustment for propensity score (hazard ratio, 4.96; 95 percent confidence interval, 0.93 to 26.45; P = 0.06); the mean five-year relative hazard of mortality was increased more than 14-fold (hazard ratio, 14.13; 95 percent confidence interval, 1.24 to 161; P = 0.03). After adjustment for propensity score, patients who received emergency-only hemodialysis had 9.81 times the expected number of acute care days compared with patients who had standard hemodialysis. Patients who received emergency-only versus standard hemodialysis had 0.31 times fewer ambulatory care visits.
"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," the authors write.
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Posted: December 2017