Renal replacement therapy for refugees with end-stage kidney disease: an international survey of the nephrological community.

Provision of health care for refugees poses many political, economical, and ethical questions. Data on the prevalence and management of refugees with end-stage kidney disease (ESKD) are scant. Nevertheless, the impact of refugees in need for renal replacement can be as high for the patient as for the receiving centers. The International Society of Nephrology and the European Renal Association/European Dialysis and Transplant Association surveyed their membership through Survey Monkey questionnaires to obtain data on epidemiology and management practices of refugees with ESKD. Refugees represent 1.5% of the dialysis population, but their geographic distribution is very skewed: ±60% of centers treat 0, 15% treat 1, and a limited number of centers treat >20 refugees. Knowledge on financial and legal management of these patients is low. There is a lack of a structured approach by the government. Most respondents stated we have a moral duty to treat refugee patients with ESKD. Cultural rather than linguistic differences were perceived as a barrier for optimal care. Provision of dialysis for refugees with ESKD seems sustainable and logistically feasible, as they are only 1.5% of the regular dialysis population, but the skewed distribution potentially threatens optimal care. There is a need for education on financial and legal aspects of management of refugees with ESKD. Clear guidance from governing bodies should avoid unacceptable ethical dilemmas for the individual physician. Such strategies should balance access to care for all with equity and solidarity without jeopardizing the health care of the local population.