Purpose of reviewAcross the United States, significant variation exists in the provision of care of undocumented immigrants with end-stage renal disease (ESRD), with some states providing standard dialysis, and other states providing emergency-only hemodialysis (EoHD).Recent findingsEoHD is associated with higher morbidity and mortality compared with standard hemodialysis. EoHD is also associated with higher healthcare utilization, resulting in more emergency department visits, more days spent in the hospital, and higher healthcare costs. Undocumented immigrants with ESRD who rely on EoHD also experience crippling and potentially fatal physical symptoms as well as psychosocial suffering, with some patients describing recurrent near-death experiences. Clinicians who provide EoHD to undocumented patients report experiencing moral distress and symptoms of professional burnout because of providing care that they perceive as unethical and far below the standard of care.SummaryUndocumented immigrants with ESRD who rely on EoHD have worse health outcomes and quality of life compared with patients who receive standard hemodialysis. EoHD is also more costly to the healthcare system. Healthcare policy reform is critical as more research demonstrates the worse clinical outcomes and higher costs of EoHD. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

healthcare policy hemodialysis emergency-only hemodialysis end stage renal disease Undocumented immigrants

patient care clinical outcome immigrant end stage renal disease hospitalization health care policy human professional burnout near-death experience priority journal morbidity emergency ward United States health care cost treatment duration undocumented immigrant hemodialysis Article health care utilization emergency care mortality rate emergency health service health care quality Kidney Transplantation practice guideline mortality