IMPORTANCE The exclusion of undocumented immigrants from Medicare coverage for hemodialysis based on a diagnosis of end-stage renal disease (ESRD) requires physicians in some states to manage chronic illness in this population using emergent-only hemodialysis. Emergent-only dialysis is expensive and burdensome for patients. OBJECTIVE To understand the illness experience of undocumented immigrants with ESRD who lack access to scheduled hemodialysis. DESIGN, SETTING, AND PARTICIPANTS A qualitative, semistructured, interview studywas conducted in a Colorado safety-net hospital from July 1 to December 31, 2015, with 20 undocumented immigrants (hereinafter referred to as undocumented patients) with ESRD and no access to scheduled hemodialysis. Demographic information was collected from the participants' medical records. The interviews were audiorecorded, translated, and then transcribed verbatim. The interviews were analyzed using inductive qualitative theme analysis by 4 research team members from March 1 to June 30, 2016. MAIN OUTCOMES AND MEASURES Themes and subthemes from semistructured interviews. RESULTS All 20 undocumented patients included in the study (10 men and 10 women; mean [SD] age, 51.4 [13.8] years) had been in the United States for at least 5 years preceding their diagnosis with ESRD. They described the following 4 main themes: (1) a distressing symptom burden and unpredictable access to emergent-only hemodialysis, (2) death anxiety associated with weekly episodes of life-threatening illness, (3) family and social consequences of accommodating emergent-only hemodialysis, and (4) perceptions of the health care system. CONCLUSIONS AND RELEVANCE Undocumented patients with ESRD experience debilitating, potentially life-threatening physical symptoms and psychosocial distress resulting from emergent-only hemodialysis. States excluding undocumented immigrants with ESRD from scheduled dialysis should reconsider their policies. © 2017 American Medical Association.

[No Keywords available]

anxiety Needs Assessment end stage renal disease economics critical illness demography health care personnel human middle aged statistics and numerical data social aspect priority journal death procedures qualitative research Undocumented Immigrants United States Humans family psychology undocumented immigrant male semi structured interview female hemodialysis Renal Dialysis cost of illness clinical article symptom standards Article Emergency Medical Services adult Kidney Failure, Chronic emergency health service health care access Kidney Transplantation patient attitude health care system chronic kidney failure potassium Health Services Accessibility health care delivery