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Kidney Week

Abstract: FR-PO808

Healthcare Provider Experiences in Emergent Dialysis of Undocumented Immigrants

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD


  • Jawed, Areeba, Wayne State University, Grosse Pointe Woods, Michigan, United States
  • Torke, Alexia, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Wocial, Lucia, Indiana University Health, Indianapolis, Indiana, United States

No national standards exist for chronic dialysis in undocumented (UD) immigrants posing a unique ethical dilemma for providers. The purpose of this survey was to explore provider perspectives.


Cross Sectional Internet Survey in April 2016 of Nephrology, ICU, ER, IM, Palliative Care nurses and physicians at a safety-net hospital. The last 4 open ended survey questions were included in this analysis (table 1). All authors individually explored the textual data inductively using an approach based on grounded theory to generate codes and broader themes. Coders then developed a shared code list. All responses were assigned ≥ 1 theme. We then calculated the number of participants with each of the codes.


299/765 participants completed the survey of which 185 included free texted comments. Nurses comprised 47% of the respondents. 483 responses were coded. The predominant coping mechanisms to moral distress were venting and team approach to patient care. We found that responses to the last 3 questions had overlapping themes. So, these items were coded using the same list of codes. Many participants spoke to the negative consequences of emergency dialysis for UD immigrants. This was noted to have a negative effect on providers, UD patients, other patients and the health system. Emotional and psychological distress was common (73.5%) along with concerns for emergent dialysis causing harm to UD immigrants (38.9%). Although far less common, some providers did note positive consequences of their experience caring for UD patients, most common being taking pride in provider role (13%). Attitudes about the right approach to this issue varied widely with both support (36.2%) for and opposition (7.6%) to dialysis for UD patients. Importantly emotions ran very high among those who supported regularly scheduled 3x\week dialysis and those who opposed dialysis altogether.


Provision of inadequate dialysis causes significant emotional distress in providers with varying attitudes towards the current practice of emergent dialysis. Policies need to be balanced with the strong ethical and moral commitments of providers.

How do you cope with the the Moral Distress that you encounter?
What do you perceive to be consequences of moral distress on you?
What Impact does providing care to UD immigrants have on you?
Please provide any other comments about the care of ESRD patients who are UD immigrants