Dialysis in the undocumented: The past, the present, and what lies ahead.

In many states undocumented immigrants with end stage renal disease (ESRD) do not have access to regular, thrice weekly dialysis. The term "compassionate dialysis" is used to describe dialysis that is provided on an emergent basis, when patients are in extremis from symptoms of volume overload or suffer from life-threatening electrolyte abnormalities. In this editorial, one particularly poignant anecdote is presented from the experience of one of the authors (AZF) as a nephrologist in Texas, a state where undocumented immigrants have faced difficulties in accessing regular dialysis. We then describe the legislation that allows the right to regular dialysis to be determined on a state by state basis. We offer some potential solutions to this challenging issue, and we describe the difficulties that lay ahead given the uncertain future of the Affordable Care Act.