Migrants on hemodialysis (HD): clinical characteristics, outcome and quality of life.

Abstract

Background: Migrants who live on hemodialysis (HD) face unique challenges due to social, linguistic and cultural barriers. This study aimed to describe the demographic and clinical profile of migrants on HD, and compare these findings with the national dialysis population.

Methods: A retrospective study was conducted on the HD population at the University Hospital of Modena, Italy. Migrants were defined as adults who entered the country legally or illegally for employment, family reunification and/or to seek asylum.

Results: Migrants accounted for 18.2% (55 patients) of the HD population (302 patients) at our center. This group included individuals who came from Africa (61.8%), Europe (20%), Asia (16.4%), and Latin America (1.8%). About one-third (37.5%) arrived in Italy illegally. Most of the migrants (78.1%) were unaware of their kidney condition upon arrival in Italy. Migrants began dialysis at a younger age compared to Italian HD patients (P < 0.001). A higher rate of late referral (P < 0.001) and use of temporary vascular access (P = 0.015) was observed among migrants. No differences were found in the prevalence of hypertension (P = 0.19), diabetes (P = 0.27), and cardiovascular comorbidities (P = 0.055). Only 34.7% of potentially eligible kidney transplant recipients were evaluated for transplantation. Migrants had a significantly higher total EuroQol 5-Dimension 5-Level (EQ-5D-5L) score index (P = 0.046) and reported fewer problems with anxiety/depression (-29.4%; P = 0.03).

Conclusion: Migrants started HD at a younger age and had a higher rate of late referral compared to Italian patients. Consequently, dialysis initiation often occurred with temporary vascular access. Despite these issues and limited access to the kidney transplant waiting list, migrants overall reported a better quality of life.