Achieving KDOQI Guidelines for Hematocrit in HIV-Infected Hemodialysis Patients.

The primary cause of anemia in HIV-infected patients with ESRD is diminished production of erythropoietin. Although most patients respond to recombinant erythropoietin, the response may be blunted in patients with ESRD and concomitant viral or bacterial infections. Previous studies demonstrated a response to erythropoietin by HIV-infected ESRD patients, but hematocrit levels on average were only 27-29%. We were interested in determining if KDOQI guidelines could be met in these patients. Hematocrits and epogen doses of all HIV-positive patients who were undergoing hemodialysis at the Nassau University Medical Center Dialysis Unit between September 2002 and March 2003 were compared to matched controls in our hemodialysis unit. The hematocrit levels in our population were higher than those reported in earlier papers. In our patient population, the mean hematocrit was 37.5, whereas the mean hematocrit levels in the HIV group in previous papers were 27-29%. HIV-infected patients did require higher erythropoietin dosages than controls, but similar doses were used as compared to previous studies. HIV patients on hemodialysis can achieve KDOQI target hematocrits. The difference in route of iron administration and iron stores may explain the higher hematocrit levels in our HIV patient population as compared to previous trials.

The initiation of dialysis in undocumented aliens: the impact on a public hospital system.

BACKGROUND: Health and dialysis care of undocumented aliens often falls on public hospitals because the majority of these patients are uninsured and cannot afford private medical care. With an estimate of greater than 5 million undocumented aliens, the rate of such patients with end-stage renal disease (ESRD) approaches 1,000 patients/y. Although much attention has been focused on the financial and political impact of this group, little has been published on health care issues. METHODS: Records of 55 undocumented alien patients initiating dialysis therapy from 2 public hospitals in the New York City metropolitan area were reviewed and compared with those of 223 American citizens. We interviewed patients in their native language to assess what predialysis care they had received. RESULTS: Undocumented aliens were primarily Hispanic (58%), poorly educated, and in the United States for 5.11 +/- 0.62 years before dialysis therapy. Four percent were aware of their renal disease before immigration, and fewer than one third had any pre-ESRD care. Undocumented aliens had greater creatinine levels and blood pressures and lower calculated glomerular filtration rates compared with Americans. Their admission lengths of stay and total costs for their first dialysis treatments were greater than those of American patients. Undocumented aliens were twice as likely to be employed. CONCLUSION: Undocumented aliens do not appear to migrate here for medical reasons, suggested by their greater employment rate. They are less inclined to seek pre-ESRD care and present relatively late for dialysis therapy. This study highlights the paucity of pre-ESRD care in these patients and in lower income communities in general. Providing early health care to undocumented aliens would avoid more expensive medical care later on.