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Comment & Response
May 2019

Comparison of Scheduled vs Emergency-Only Dialysis in Undocumented Immigrants With End-stage Renal Disease

Author Affiliations
  • 1Centre de Néphrologie et Transplantation Rénale, Assistance Publique Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
  • 2Service Epidémiologie et économie de la santé, Assistance Publique Hôpitaux de Marseille, Marseille, France
JAMA Intern Med. 2019;179(5):728. doi:10.1001/jamainternmed.2019.0540

To the Editor We read with great interest the recent Original Investigation by Nguyen and colleagues.1 Emergency-only dialysis strategy is used to treat life-threatening manifestations of end-stage renal disease (ESRD) in undocumented immigrants with no access to scheduled dialysis without health insurance and is only used in France for the duration of a tourist visa (maximum, 90 days). This situation represents ethical dilemmas for clinicians and is common in Europe where immigrants represent about 1.5% of the dialysis population.2 This important study contributes to the management of undocumented immigrants with ESRD by reporting significant differences in health and economic outcomes in favor of a scheduled dialysis strategy. We further comment on the study design and method for the costs analysis, as well as their potential influence on the findings.

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