OBJECTIVE: Hemodialysis (HD) care in the United States for undocumented immigrants remains a challenging issue. The objective of this study is to evaluate the timeliness of nephrology and vascular surgery care provided to undocumented immigrants with end-stage renal disease compared with their documented counterparts. Additionally, we evaluate catheter-related complications in undocumented patients on HD. METHODS: A retrospective chart analysis was performed of patients undergoing first-time arteriovenous access (AVA) creation at a single center from 2012 to 2018 to compare outcomes between documented and undocumented patients. Additionally, within the undocumented group, we compared outcomes between patients dependent on a central venous catheter (CVC group) to patients with a CVC and transition to an AVA (CAV group). The primary outcomes were time to initial evaluation by nephrology, vascular surgery, and AVA creation, as well as complications associated with long-term CVC use within the undocumented patients. RESULTS: A total of 290 patients underwent first-time AVA creation (62 undocumented
228 documented). Undocumented patients were younger at the time of surgery and, more commonly, Hispanic. Undocumented patients were more likely to receive their first nephrology evaluation upon HD initiation (59.7% vs 25.4%
P <
.001). Regarding vascular access surgery initial evaluation for AVA creation, undocumented patients were more likely to be evaluated after initiating HD (74.2% vs 38.6%
P <
.001). After being evaluated for AVA creation, there was no difference in time from vascular surgery evaluation to surgery (25 days vs 20 days
P = .95) or from surgery to AVA maturation (77 days vs 57 days
P = .31). As a result, undocumented patients were more likely to start dialysis with a CVC (90.3% vs 66.7%
P = .0004). Undocumented patients in the CVC group were more likely to experience catheter-related complications compared with their undocumented counterparts in the CAV group (CVC 72.5% vs CAV 45.9%
P = .032). The CAV patients were found to have an earlier occurrence of their first catheter-related complications, driving an earlier evaluation for AVA creation and subsequent CVC removal. CONCLUSIONS: Due to limited access to health care, undocumented immigrants with end-stage renal disease had a significant delay in evaluation by nephrologists and vascular access surgeons for AVA creation with a higher use of CVC for dialysis initiation. CVC-related complications are highly frequent and avoidable in undocumented patients with an earlier referral for creation of appropriate AVA.