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Abstract: FR-PO870

The Status of Provision of Kidney Replacement Therapy for Undocumented Immigrants in the United States

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health


  • Rizzolo, Katherine M., University of Colorado, Denver, Colorado, United States
  • Dubey, Manisha, University of Colorado, Denver, Colorado, United States
  • Feldman, Katherine E., University of Colorado, Denver, Colorado, United States
  • Cervantes, Lilia, University of Colorado, Denver, Colorado, United States

There are 6000-8000 undocumented immigrants with kidney failure living in the US. As undocumented immigrants are barred from receiving federal insurance, access to kidney replacement therapies (KRT) is decided at the state, city, or institutional level. In states where maintenance hemodialysis is not available, undocumented immigrants with kidney failure are resigned to emergency hemodialysis, or dialysis when critically ill.

In 2019, 12 states were found to cover maintenance hemodialysis for undocumented immigrants at the state level. Since 2019, a wave of advocacy for improved access to kidney care for undocumented immigrants has received greater traction. We investigate the current status of kidney replacement therapies (including maintenance dialysis, home dialysis, and transplantation) available to undocumented immigrants throughout the US.


Identifying state by state policy was conducted via interviews with nephrology providers caring for undocumented immigrants and reviewing state Medicaid policy handbooks.


At the time of this submission, 27 states have been reviewed. The results expect to be finished by August 2022.
Out of 27 states, 21 offer outpatient dialysis (Figure 1), 14 have state-wide coverage for outpatient dialysis. 5 states changed their laws to cover outpatient dialysis since 2019. 5 states have state-wide access to transplantation.


Availability of kidney replacement therapy for undocumented immigrants with kidney failure remains variable by geography in terms of state and institutional policies. Overall, the degree of access by state appears to be expanding, with greater access to maintenance dialysis and transplantation than has been noted previously. This work may be utilized for advocacy efforts to inform state and national policy change.

Figure 1. Coverage of outpatient dialysis for undocumented immigrants by state.


  • NIDDK Support