Demographics and Quality of Life in Unfunded Patients Receiving Regular Emergent Dialysis

INTRODUCTION: Patients with End Stage Renal Disease (ESRD) must undergo hemodialysis several times per week for renal dysfunction. Chronic dialysis drastically affects the lifestyles of ESRD patients, as it is time-consuming and uncomfortable. A high number of unfunded ESRD patients present to the Emergency Department (ED) at Parkland Hospital for dialysis. These patients accounted for over 7300 ED visits in 2009. Providing emergent dialysis via the ED has been shown to be more costly than providing scheduled dialysis. To date, all psychometric analyses of demographics and quality of life in chronic dialysis patients focus on insured patients in traditional dialysis centers. This study attempts to acquire and analyze such data on the emergent dialysis population at Parkland Hospital. Data will ultimately be compared to control patients from the Parkland system. METHODS: A demographic survey developed at UT Southwestern and the established "Kidney Disease Quality Of Life (KDQOL(TM)) Instrument" were presented to ESRD patients seeking dialysis in the Parkland ED. A comprehensive list of 165 suitable patients was obtained from Parkland Nephrology. With a goal of 80% recruitment of those identified, patients were recruited upon presentation 24 hours a day, 7 days a week for a 4-week period beginning on July 8, 2013. In total, 55 data points from each patient were aggregated. RESULTS: Of 101 chronic dialysis patients approached during the initial 4 weeks, 88 completed the survey. Although 39% of listed patients were not surveyed by the end of the 4 weeks, raw data collection has recently been completed. Demographic data reveal a predominantly male, Hispanic, middle-aged, undocumented, and uninsured ESRD patient population seeking dialysis in the Parkland ED. The KDQOL data indicate a majority of surveyed patients rate their current health negatively, while only 9% do so positively. Additional data quantifying the impact of chronic dialysis on patient lifestyles await analysis. DISCUSSION: The demographic data reveal that 68% of the chronic dialysis patients thus surveyed have lived in the USA for more than 5 years, yet only 15% received a diagnosis requiring dialysis over 5 years ago. This finding seems to contradict the currently accepted idea that the need for dialysis is the primary motivating factor bringing most of these patients to the USA. Quality of life data remains to be compared between the unfunded emergent population and the Nephrology clinic population. Descriptors for the emergent patients are expected to be more negative, or at best equivalent to those for the scheduled patients. Considering the higher cost of emergent dialysis, the results of this comparison are expected to support an argument for providing scheduled dialysis for unfunded ESRD patients.