The care of dialysis-dependent undocumented immigrants exemplifies a problem at the crux of 2 US national agendas: immigration and health care reform. Undocumented immigrants represent 3% of the US population and 27% of the uninsured, and an estimated 6,500 individuals are dialysis dependent. With no uniform national policy, an estimated 30% to 50% of these individuals receive treatment only in life-threatening situations (emergent dialysis). Since 2005, about 400 undocumented immigrants have received a kidney transplant (>70% living). Although the Affordable Care Act specifically excluded noncitizens, its policies have indirectly allowed more than 200 individuals to purchase insurance from a health insurance exchange and transition from emergent to thrice-weekly hemodialysis. Under the Trump administration, uncertainties with health care plans, threats of deportation, and rescinding of policies such as sanctuary city status are bound to result in unforeseen challenges for this vulnerable population. Global variation in the care accessible to migrants, refugees, undocumented immigrants, and asylum seekers argues for the need for a framework to transform advocacy into public policy to improve the lives of patients with kidney disease worldwide. Access to nonemergent dialysis is humane and cost-effective; it deserves to be espoused and advocated by leading medical organizations. © 2017 National Kidney Foundation, Inc.

Migrants renal replacement therapy (RRT) United States immigration policy US health care system kidney disease sanctuary city health care costs medical ethics end-stage renal disease (ESRD) Dialysis Undocumented immigrants Immigration

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