American journal of kidney diseases : the official journal of the National Kidney Foundation
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The Centers for Medicare & Medicaid Services require that dialysis patients' health-related quality of life be assessed annually. The primary instrument used for this purpose is the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36), which includes the SF-12 as its generic core and 3 kidney disease-targeted scales: Burden of Kidney Disease, Symptoms and Problems of Kidney Disease, and Effects of Kidney Disease. Despite its broad use, there has been limited evaluation of KDQOL-36's psychometric properties. ⋯ The study provides support for the reliability and construct validity of the KDQOL-36 scales for assessment of health-related quality of life among dialysis patients.
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The care of dialysis-dependent undocumented immigrants exemplifies a problem at the crux of 2 US national agendas: immigration and health care reform. Undocumented immigrants represent 3% of the US population and 27% of the uninsured, and an estimated 6,500 individuals are dialysis dependent. With no uniform national policy, an estimated 30% to 50% of these individuals receive treatment only in life-threatening situations (emergent dialysis). ⋯ Under the Trump administration, uncertainties with health care plans, threats of deportation, and rescinding of policies such as sanctuary city status are bound to result in unforeseen challenges for this vulnerable population. Global variation in the care accessible to migrants, refugees, undocumented immigrants, and asylum seekers argues for the need for a framework to transform advocacy into public policy to improve the lives of patients with kidney disease worldwide. Access to nonemergent dialysis is humane and cost-effective; it deserves to be espoused and advocated by leading medical organizations.