#6511 EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF MIGRANTS ON CHRONIC HEMODIALYSIS TREATMENT
Authors: Alfano Gaetano , Fontana Francesco , Magistroni Riccardo , Donati Gabriele 
Published: June 2023

Abstract

Background and Aims
The rate of migrants with end-stage kidney disease is rising in Italy. Migrants often present to nephrologists with advanced kidney disease, a condition that limits the choice to perform a diagnosis and prevent the progression of the disease. Low literacy, language barriers, lack of medical insurance, illiteracy and cultural diversity are the main factors limiting the referral to physicians. Data about the prevalence and clinical characteristics of migrants in dialysis units are scarce in the literature. Our study aimed to evaluate and characterize the epidemiological profile of migrants on chronic hemodialysis (HD) treatment. Data about demographics, clinical characteristics health-related quality of life (HRQoL) were compared with the Italian population.

Method
A retrospective cross-sectional observational study was conducted on patients who underwent HD at the University Hospital of Modena from December 2021 to August 2022. All patients on chronic HD treatment aged &gt; 18 years were enrolled in the study. Data were collected from electronic health databases and interviews with a selected number of patients. HRQoL was evaluated by "EQ-5D" questionary. Overall, it ranged between a score from level 5 (no problem) to 25 (extreme problems). A scale (EQ VAS), numbered from 0 (worst imaginable health) to 100 (best imaginable health) was used to assess global assessment of own health. Patients have been subdivided based on their origin into "migrants" and "non-migrants”(or Italians). According to the International Organization for Migrations (IOM), we considered migrants all patients that were born in a foreign country and came to Italy for work, family reunification, economic or political reasons.

Results
In our hemodialysis center, 302 patients underwent hemodialysis for kidney failure. Migrants accounted for 18.2% (n. 55) of the HD population. They moved to Italy from Africa (62%), Europe (20%), Asia (16%) and Latin America (2%) for seeking work (84.3%) and family reconciliation (15.7%). A consistent percentage of migrants (37.5%) crossed the national border as undocumented migrants. Migrants started hemodialysis at a younger age than non-migrants (48.1[IQR, 39.7-56.7] vs 70.7 [IQR, 70.7-78.5]) years (P = .001) (Fig. 1). Most of them were male (69%). Migrant starter HD after 12.3 (IQR 6.5-20) years from their arrival in Italy. The age of migrants varied according to the geographic area: Subsaharian Africa (44.7 years), Asia (46 years), Europe (53.9 years) and northern Africa (54.5 years), although there was no statistically significant difference between groups (P = .67). The etiology of kidney disease was unknown in 40% of patients.
Most of the patients (54.5%) started HD with a central vein catheter (CVC) and 53% of them were not referred to a nephrologist before HD. After a follow-up of 1.8 years, the rate of CVC decreased to 26.3%. Only 14.5% of the interviewed patients declared to be informed about home dialysis. Although, 87.2% of the patients were potentially eligible for kidney transplantation (age criteria) only a few of them(18.7%) was active on the waiting list.
Migrants have a better perception of health-related quality of life than non-migrants. In the migrants and non-migrant groups, median “EQ-5D" score was 5 (IQR, 5-6) and 7 (IQR, 5-10), respectively (p= p&lt;0.001). Global health assessment in migrants and non-migrant accounted for 90 (IQR, 80-91.5) and 80 (IQR, 70-90), respectively (P = .028). It is worth noting that these differences became not statistically significant when EQ-5D (P = .45) score and EQ VAS scale (P = .52) were adjusted for the age of participants.

Conclusion
Migrants were a consistent percentage of patients in our Dialysis Unit. This group of patients was formed by young people often unaware of their kidney disease. Late referral to the nephrologist had a profound implication on vascular access for HD. The language barrier and cultural diversity were the major limitations to entry into the kidney transplant waiting list.