Evaluation of demographic, clinical characteristics and cost of immigrant patients with end-stage renal failure
Öz
Purpose: Due to wars and disasters, people migrate forcibly due to their need for safe housing and health care. In our study, we aimed to the demographic and clinical typical of immigrants with end-stage renal disease and to make a cost analysis.
Materials and Methods: Our study is single-center and retrospective. Migrant patients who have end-stage renal disease who met the study criteria were included in the study. Demographic data, clinical data, laboratory data and treatment cost data of the cases were added to the previously created form.
Results: Our study was conducted with 696 patients. 64.2% of the cases were female and the median age was 67 years. 65.5% of the cases were of Syrian nationality. Hemodialysis was applied to all of the cases, of which 47% were urgently. 55.2% of these cases were hospitalized and mortality was observed in 13.2% of all cases. Age was statistically higher in cases with mortality. Urea and creatinine in patients with mortality were significantly higher; pH, HCO3 and GFR were statistically lower. Mortality was statistically higher in cases requiring urgent hemodialysis and hospitalized in the ICU. The cost of health was statistically higher in surviving cases. Again, in patients who were hospitalized, both the time allocated for care and the cost of health were statistically higher than in outpatients.
Conclusion: Establishing routine dialysis programs by identifying immigrant cases with end-stage renal disease will both reduce mortality and morbidity for patients, reduce health costs in countries, and reduce emergency department densities.
Anahtar Kelimeler
Destekleyen Kurum
YOK
Teşekkür
We would like to thank the staff of the Emergency Medicine Clinic and Nephrology Clinic of our hospital for their support to our study.
Kaynakça
- United Nations High Commissioner for Refugees (UNHCR). Global forced displacement hits record high 2017. https://www.unhcr.org/globaltrends2017/#:~:text=In%202017%2016.2%20million%20people,new%20high%20of%2068.5%20million.html. (Accessed February 2023).
- United Nations High Commissioner for Refugees (UNHCR). Regional Refugee and Migrant Response Plan for Europe - 2017. https://www.unhcr.org/partners/donors/589497d07/2017-regional-refugee-migrant-response-plan-europe-january-december-2017.html. (Accessed February 2023).
- İçişleri Bakanlığı, Göç İdarisi Daire Başkanlığı. 2015 yılı Türkiye Göç Raporu. https://www.goc.gov.tr/kurumlar/goc.gov.tr/YillikGocRaporlari/2015_yillik_goc_raporu.pdf (Accessed February 2023).
- İçişleri Bakanlığı, Göç İdarisi Daire Başkanlığı. 2016 yılı Türkiye Göç Raporu. https://www.goc.gov.tr/kurumlar/goc.gov.tr/YillikGocRaporlari/2016_yiik_goc_raporu_haziran.pdf (Accessed February 2023).
- Van Biesen W, Vanholder R, Vanderhaegen B, Lameire N, Wanner C, Wiecek A et al. Renal replacement therapy for refugees with end-stage kidney disease: an international survey of the nephrological community. Kidney Int Suppl 2016; 6:35-41.
- Van Biesen W, Vanholder R, Ernandez T, Drewniak D, Luyckx V. Caring for migrants and refugees with end-stage kidney disease in Europe. Am J Kidney Dis 2018; 71:701-9.
- Lameire NH, Levin A, Kellum JA, Cheung M, Jadoul M, Winkelmayer WC et al; Conference Participants. Harmonizing acute and chronic kidney disease definition and classification: report of a kidney disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int 2021; 100:516-26.
- United Nations High Commissioner for Refugees (UNHCR). Figures at a glance, global trends 2015. Available at: http://www.unhcr.org/en-us/figures-at-a-glance.html. (Accessed February 2023).
- United Nations High Commissioner for Refugees (UNHCR). Total number of Syrian refugees exceeds four million for first time 9 July 2015. Available at: http://www.unhcr.org/en-us/news/press/2015/7/559d67d46/unhcr-total-number-syrian-refugees-exceeds-four-million-first-time.html. (Accessed February 2023).
- United Nations High Commissioner for Refugees (UNHCR). Report shows health services for Syrian refugees increasingly overstretched 26 April 2013. Available at: http://www.unhcr.org/en-us/news/briefing/2013/4/517a58af9/unhcr-report-shows-health-services-syrian-refugees-increasingly-overstretched.html. (Accessed February 2023).
- Isreb MA, Rifai AO, Murad LB, Al-Makki A, Al-Saghir F, Sekkarie MA. Care and outcomes of end-stage kidney disease patients in times of armed conflict: recommendations for action. Clin Nephrol 2016; 85:281-8.
- Isreb MA, Kaysi S, Rifai AO, Al Kukhun H, Al-Adwan SAS, Kass-Hout TA et al. the effect of war on syrian refugees with end-stage renal disease. Kidney Int Rep 2017; 2:960-3.
- Prasad N, Jha V. Hemodialysis in Asia. Kidney Dis (Basel) 2015; 1:165-77.
- Raghavan R, Nuila R. Survivors-dialysis, immigration, and U.S. law. N Engl J Med 2011; 364:2183-5.
- Cervantes L, Tuot D, Raghavan R, Linas S, Zoucha J, Sweeney L et al. Association of emergency-only vs standard hemodialysis with mortality and health care use among undocumented immigrants with end-stage renal disease. JAMA Intern Med 2018; 178:188-95.
- Wu BS, Wei CH, Yang CY, Lin MH, Hsu CC, Hsu YJ, et al. Mortality rate of end-stage kidney disease patients in Taiwan. J Formos Med Assoc 2022; 121:12-9.
Son dönem böbrek yetmezliği olan göçmen hastalarin demografik ve klinik özellikleri ile maliyetinin değerlendirilmesi
Öz
Amaç: Savaşlar ve afetler nedeniyle insanlar güvenli barınma ve sağlık hizmetlerine olan ihtiyaçlarından dolayı zorunlu olarak göç etmektedirler. Çalışmamızda son dönem böbrek hastalığı olan göçmenlerin demografik ve klinik özelliklerini ve maliyet analizini incelemeyi amaçladık.
Gereç ve Yöntem: Çalışmamız tek merkezli ve retrospektif bir çalışmadır. Acil servise son dönem böbrek hastalığı semptomları ile başvuran ve çalışma kriterlerini karşılayan hastalar çalışmaya dahil edildi. Olguların demografik, klinik, laboratuvar ve tedavi maliyeti verileri önceden oluşturulan bir forma eklendi.
Bulgular: Çalışmamız 696 hasta ile yapılmıştır. Vakaların %64,2'si kadındı ve ortanca yaş 67 idi. Olguların tamamına hemodiyaliz uygulandı, bunların %47'si acil olarak gerçekleştirildi. Bu vakaların %55,2'si hastaneye yatırıldı ve tüm vakaların %13,2'sinde ölüm görüldü. Mortalite olan olgularda yaş istatistiksel olarak daha yüksekti. Mortal seyreden hastalarda üre ve kreatinin düzeyleri anlamlı olarak daha yüksekken, pH, HCO3 ve GFR düzeyleri istatistiksel olarak daha düşüktü. Acil hemodiyaliz ve yoğun bakım gerektiren olgularda mortalite oranı istatistiksel olarak daha yüksekti. Hayatta kalan olgularda sağlık maliyetleri istatistiksel olarak daha yüksekti. Ayrıca, hastanede yatan olgularda yatış süresi ve sağlık maliyetleri ayaktan hastalara göre istatistiksel olarak daha yüksekti.
Sonuç: Son dönem böbrek hastalığı olan göçmen vakaların belirlenerek rutin diyaliz programlarının oluşturulması, hastalar için hem mortalite ve morbiditeyi azaltacak hem de ülkelerdeki sağlık maliyetlerini azaltacak ve acil servisler üzerindeki yükü hafifletecektir
Anahtar Kelimeler
Göçmenler son dönem böbrek yetmezliği maliyet sağlık politikası
Kaynakça
- United Nations High Commissioner for Refugees (UNHCR). Global forced displacement hits record high 2017. https://www.unhcr.org/globaltrends2017/#:~:text=In%202017%2016.2%20million%20people,new%20high%20of%2068.5%20million.html. (Accessed February 2023).
- United Nations High Commissioner for Refugees (UNHCR). Regional Refugee and Migrant Response Plan for Europe - 2017. https://www.unhcr.org/partners/donors/589497d07/2017-regional-refugee-migrant-response-plan-europe-january-december-2017.html. (Accessed February 2023).
- İçişleri Bakanlığı, Göç İdarisi Daire Başkanlığı. 2015 yılı Türkiye Göç Raporu. https://www.goc.gov.tr/kurumlar/goc.gov.tr/YillikGocRaporlari/2015_yillik_goc_raporu.pdf (Accessed February 2023).
- İçişleri Bakanlığı, Göç İdarisi Daire Başkanlığı. 2016 yılı Türkiye Göç Raporu. https://www.goc.gov.tr/kurumlar/goc.gov.tr/YillikGocRaporlari/2016_yiik_goc_raporu_haziran.pdf (Accessed February 2023).
- Van Biesen W, Vanholder R, Vanderhaegen B, Lameire N, Wanner C, Wiecek A et al. Renal replacement therapy for refugees with end-stage kidney disease: an international survey of the nephrological community. Kidney Int Suppl 2016; 6:35-41.
- Van Biesen W, Vanholder R, Ernandez T, Drewniak D, Luyckx V. Caring for migrants and refugees with end-stage kidney disease in Europe. Am J Kidney Dis 2018; 71:701-9.
- Lameire NH, Levin A, Kellum JA, Cheung M, Jadoul M, Winkelmayer WC et al; Conference Participants. Harmonizing acute and chronic kidney disease definition and classification: report of a kidney disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int 2021; 100:516-26.
- United Nations High Commissioner for Refugees (UNHCR). Figures at a glance, global trends 2015. Available at: http://www.unhcr.org/en-us/figures-at-a-glance.html. (Accessed February 2023).
- United Nations High Commissioner for Refugees (UNHCR). Total number of Syrian refugees exceeds four million for first time 9 July 2015. Available at: http://www.unhcr.org/en-us/news/press/2015/7/559d67d46/unhcr-total-number-syrian-refugees-exceeds-four-million-first-time.html. (Accessed February 2023).
- United Nations High Commissioner for Refugees (UNHCR). Report shows health services for Syrian refugees increasingly overstretched 26 April 2013. Available at: http://www.unhcr.org/en-us/news/briefing/2013/4/517a58af9/unhcr-report-shows-health-services-syrian-refugees-increasingly-overstretched.html. (Accessed February 2023).
- Isreb MA, Rifai AO, Murad LB, Al-Makki A, Al-Saghir F, Sekkarie MA. Care and outcomes of end-stage kidney disease patients in times of armed conflict: recommendations for action. Clin Nephrol 2016; 85:281-8.
- Isreb MA, Kaysi S, Rifai AO, Al Kukhun H, Al-Adwan SAS, Kass-Hout TA et al. the effect of war on syrian refugees with end-stage renal disease. Kidney Int Rep 2017; 2:960-3.
- Prasad N, Jha V. Hemodialysis in Asia. Kidney Dis (Basel) 2015; 1:165-77.
- Raghavan R, Nuila R. Survivors-dialysis, immigration, and U.S. law. N Engl J Med 2011; 364:2183-5.
- Cervantes L, Tuot D, Raghavan R, Linas S, Zoucha J, Sweeney L et al. Association of emergency-only vs standard hemodialysis with mortality and health care use among undocumented immigrants with end-stage renal disease. JAMA Intern Med 2018; 178:188-95.
- Wu BS, Wei CH, Yang CY, Lin MH, Hsu CC, Hsu YJ, et al. Mortality rate of end-stage kidney disease patients in Taiwan. J Formos Med Assoc 2022; 121:12-9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Erken Görünüm Tarihi | 10 Temmuz 2023 |
| Yayımlanma Tarihi | 2 Temmuz 2023 |
| Kabul Tarihi | 23 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 48 Sayı: 2 |
