When access to chronic dialysis is limited: one center's approach to emergent hemodialysis

Emergent hemodialysis is the practice of dialyzing a patient only when there is a life-threatening need for this treatment. Undocumented immigrants in many cities depend on this practice, as they are not entitled to the regularly scheduled hemodialysis treatments available to US citizens. There are several medical and ethical challenges to emergent hemodialysis. One example is defining the criteria that determine the need for an emergent treatment. Although it is lifesaving, emergent dialysis is inadequate dialysis; it results in unnecessary patient complications, is medically burdensome for the treating physician, and expensive to the providing facility. This article describes how undocumented immigrants are cared for in one county hospital system in a large city.