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American Journal of Kidney Diseases

Caring for Migrants and Refugees With End-Stage Kidney Disease in Europe

Published:December 20, 2017DOI:https://doi.org/10.1053/j.ajkd.2017.10.015
      With the number of migrants and refugees increasing globally, the nephrology community is increasingly confronted with issues relating to the management of end-stage kidney disease in this population, including medical, logistical, financial, and moral-ethical questions. Beginning with data for the state of affairs regarding refugees in Europe and grounded in moral reasoning theory, this Policy Forum Perspective contends that to improve care for this specific population, there is a need for: (1) clear demarcations of responsibilities across the societal (macro), local (meso), and individual (micro) levels, such that individual providers are aware of available resources and able to provide essential medical care while societies and local communities determine the general approach to dialysis care for refugees; (2) additional data and evidence to facilitate decision making based on facts rather than emotions; and (3) better information and education in a broad sense (cultural sensitivity, legal rights and obligations, and medical knowledge) to address specific needs in this population. Although the nephrology community cannot leverage a change in the geopolitical framework, we are in a position to generate accurate data describing the dimensions of care of refugee or migrant patients with end-stage kidney disease to advocate for a holistic approach to treatment for this unique patient population.

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      References

      1. UNHCR. Global forced displacement hits record high 2017. http://www.unhcr.org/news/latest/2016/6/5763b65a4/global-forced-displacement-hits-record-high.html. Accessed December 12, 2017.

      2. UNHCR. Regional Refugee and Migrant Response Plan for Europe - 2017. http://reporting.unhcr.org/node/17167. Accessed December 12, 2017.

        • Van Biesen W.
        • Vanholder R.
        • Vanderhaegen B.
        • et al.
        Renal replacement therapy for refugees with end-stage kidney disease: an international survey of the nephrological community.
        Kidney Int Suppl. 2016; 2: 35-41
        • Singer P. Famine
        affluence and morality.
        Philospohy and public affairs. 1972; 1: 229-243
        • Suphanchaimat R.
        • Kantamaturapoj K.
        • Putthasri W.
        • Prakongsai P.
        Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens.
        BMC Health Services Res. 2015; 15: 390
        • Dauvrin M.
        • Lorant V.
        • Sandhu S.
        • et al.
        Health care for irregular migrants: pragmatism across Europe: a qualitative study.
        BMC Res Notes. 2012; 5: 99
        • Suurmond J.
        • Rupp I.
        • Seeleman C.
        • Goosen S.
        • Stronks K.
        The first contacts between healthcare providers and newly-arrived asylum seekers: a qualitative study about which issues need to be addressed.
        Public Health. 2013; 127: 668-673
        • van Ryn M.
        • Burgess D.
        • Malat J.
        • Griffin J.
        Physicians' perceptions of patients' social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease.
        Am J Public Health. 2006; 96: 351-357
        • van Ryn M.
        Research on the provider contribution to race/ethnicity disparities in medical care.
        Med Care. 2002; 40: 1140-1151
        • Drewniak D.
        • Krones T.
        • Sauer C.
        • Wild V.
        The influence of patients' immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland.
        Soc Sci Med. 2016; 161: 64-73
        • Ernandez T.F.A.
        • Martin P.
        • Saudan P.
        Characteristics and outcome of migrant patients without a stable resident status starting hemodialysis in a Swiss university hospital.
        Nephrol Dial Transplant. 2017; 32: iii355
        • Slim H.
        Doing the right thing: relief agencies, moral dilemmas and responsibility in political emergencies and war.
        Disasters. 1997; 21: 244-257
        • Clarinval C.
        • Biller-Andorno N.
        Challenging operations: an ethical framework to assist humanitarian aid workers in their decision-making processes.
        PLoS Currents. 2014; 6 (https://doi.org/10.1371/currents.dis.96bec99f13800a8059bb5b5a82028bbf)
        • Malik K.
        The Quest for a Moral Compass: A Global History of Ethics.
        Atlantic Books, Brooklyn, NY2014
        • Blanchet K.
        • Ramesh A.
        • Frison S.
        • et al.
        Evidence on public health interventions in humanitarian crises.
        Lancet. 2017; 390: 2287-2296
        • Cervantes L.
        • Fischer S.
        • Berlinger N.
        • et al.
        The illness experience of undocumented immigrants with end-stage renal Disease.
        JAMA Intern Med. 2017; 177: 529-535
        • Kahneman D.
        • Slovic P.
        • Tversky A.
        Judgment Under Uncertainty: Heuristics and Biases.
        Cambridge University Press, Cambridge1982
        • Seeleman C.
        • Suurmond J.
        • Stronks K.
        Cultural competence: a conceptual framework for teaching and learning.
        Med Educ. 2009; 43: 229-237
        • Beach M.C.
        • Price E.G.
        • Gary T.L.
        • et al.
        Cultural competence: a systematic review of health care provider educational interventions.
        Med Care. 2005; 43: 356-373
        • Stone J.
        • Moskowitz G.B.
        Non-conscious bias in medical decision making: what can be done to reduce it?.
        Med Educ. 2011; 45: 768-776
        • Luyckx V.A.
        • Miljeteig I.
        • Ejigu A.M.
        • Moosa M.R.
        Ethical challenges in the provision of dialysis in resource-constrained environments.
        Semin Nephrol. 2017; 37: 273-286
        • Einollahi B.
        • Noorbala M.H.
        • Kardavani B.
        • et al.
        Kidney transplantation: is there any place for refugees?.
        Transplant Proc. 2007; 39: 895-897
        • Manirankunda L.
        • Loos J.
        • Debackaere P.
        • Nostlinger C.
        “It is not easy”: challenges for provider-initiated HIV testing and counseling in Flanders, Belgium.
        AIDS Educ Prevent. 2012; 24: 456-468
        • Angeletti S.
        • Ceccarelli G.
        • Vita S.
        • et al.
        Unusual microorganisms and antimicrobial resistances in a group of Syrian migrants: sentinel surveillance data from an asylum seekers centre in Italy.
        Travel Med Infect Dis. 2016; 14: 115-122
        • Antinori S.
        • Mediannikov O.
        • Corbellino M.
        • Raoult D.
        Louse-borne relapsing fever among East African refugees in Europe.
        Travel Med Infect Dis. 2016; 14: 110-114
        • Greenaway C.
        • Thu Ma A.
        • Kloda L.A.
        • et al.
        The seroprevalence of hepatitis C antibodies in immigrants and refugees from intermediate and high endemic countries: a systematic review and meta-analysis.
        PloS One. 2015; 10: e0141715
        • Kimbrough W.
        • Saliba V.
        • Dahab M.
        • Haskew C.
        • Checchi F.
        The burden of tuberculosis in crisis-affected populations: a systematic review.
        Lancet Infect Dis. 2012; 12: 950-965
        • Cutler S.J.
        Refugee crisis and re-emergence of forgotten infections in Europe.
        Clin Microbiol Infect. 2016; 22: 8-9
        • White J.S.
        • Hamad R.
        • Li X.
        • et al.
        Long-term effects of neighbourhood deprivation on diabetes risk: quasi-experimental evidence from a refugee dispersal policy in Sweden.
        Lancet Diabetes Endocrinol. 2016; 4: 517-524
        • Doocy S.
        • Lyles E.
        • Roberton T.
        • Akhu-Zaheya L.
        • Oweis A.
        • Burnham G.
        Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan.
        BMC Public Health. 2015; 15: 1097
        • Khader A.
        • Farajallah L.
        • Shahin Y.
        • et al.
        Hypertension and treatment outcomes in Palestine refugees in United Nations Relief and Works Agency primary health care clinics in Jordan.
        Trop Med Int Health. 2014; 19: 1276-1283
        • Babitsch B.
        • Braun T.
        • Borde T.
        • David M.
        Doctor's perception of doctor-patient relationships in emergency departments: what roles do gender and ethnicity play?.
        BMC Health Serv Res. 2008; 8: 82
        • Suurmond J.
        • Seeleman C.
        • Rupp I.
        • Goosen S.
        • Stronks K.
        Cultural competence among nurse practitioners working with asylum seekers.
        Nurs Educ Today. 2010; 30: 821-826
        • Koehn P.H.
        • Sainola-Rodriguez K.
        Clinician/patient connections in ethnoculturally nonconcordant encounters with political-asylum seekers: a comparison of physicians and nurses.
        J Transcultural Nurs. 2005; 16: 298-311
        • Alpak G.
        • Unal A.
        • Bulbul F.
        • et al.
        Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study.
        Int J Psychiatry Clin Pract. 2015; 19: 45-50
      3. Bundes Psychotherapeuten Kammer. Mindestens die Hälfte der Flüchtlinge ist psychisch krank. http://www.bptk.de/aktuell/einzelseite/artikel/mindestens-d.html. Accessed December 12, 2017.

        • Faden R.R.
        • Powers M.
        Health inequities and social justice. The moral foundations of public health.
        Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008; 51: 151-157
        • Sekkarie M.A.
        • Zanabli A.R.
        • Rifai A.O.
        • Murad L.B.
        • Al-Makki A.A.
        The Syrian conflict: assessment of the ESRD system and response to hemodialysis needs during a humanitarian and medical crisis.
        Kidney Int. 2015; 87: 262-265
        • Hynes M.
        • Sheik M.
        • Wilson H.G.
        • Spiegel P.
        Reproductive health indicators and outcomes among refugee and internally displaced persons in postemergency phase camps.
        JAMA. 2002; 288: 595-603
        • Blanchet K.
        • Fouad F.M.
        • Pherali T.
        Syrian refugees in Lebanon: the search for universal health coverage.
        Conflict Health. 2016; 10: 12
        • Majd A.
        • Isreb S.K.
        • Ahmad Oussama Rifai
        • et al.
        The effect of war on Syrian refugees with end-stage renal disease.
        Kidney Int Rep. 2017; 2: 960-963