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. 2025 Jun;38(5):1313-1327.
doi: 10.1007/s40620-025-02290-w. Epub 2025 Apr 15.

Kidney failure care for migrants: a European survey

Cédric Rafat  1   2 , Ewa Pawlowicz-Szlarska  3 , Gaetano Alfano  4 , Alice Doreille  5 , Amaryllis H Van Craenenbroeck  6   7 , Liz Lightstone  8   9 , Valérie Luyckx  10   11   12   13   14 , Silvia Salaro  10 , Maria Jose Soler  15   16 , Dominique Tudor  10 , Andreas Kronbichler  17   18 , Safak Mirioglu  19   20   21
Affiliations

Kidney failure care for migrants: a European survey

Cédric Rafat et al. J Nephrol. 2025 Jun.

Abstract

Background: The management of migrants with kidney failure and no medical insurance raises complex medical, social, financial, and ethical issues. The survey aimed to investigate (i) current practices in managing these patients, and (ii) the perspective of European nephrologists on ethical dilemmas and optimal care.

Methods: The survey was piloted by the ISN Western Europe Regional Board, with members of the Young Nephrologists' Platform (YNP) of the European Renal Association (ERA), and disseminated to European nephrologists in the ISN and YNP networks. Responses were collected anonymously via SurveyMonkey.

Results: A total of 378 responses were collected from 29 European countries. Most (57%) managed fewer than 3 migrant patients with kidney failure per week, while 10% managed more than 11. Most respondents indicated that access to dialysis was unrestricted (59%), although only 25% said migrant patients were systematically eligible for kidney transplantation. Many nephrologists (38%) were unaware of the directives of governmental bodies or hospital protocols regarding migrant patients. The most common obstacles to patient management included language non concordance (64%), uncertainty about the future (56%), and lack of knowledge of medical history (49%). Two-thirds felt managing migrant patients was a moral duty, though 52% reported stress within the clinical caregiving team.

Conclusion: Despite strong commitment from European nephrologists, a fragmented legal framework, remaining barriers, and uneven case distribution hinder optimal care for migrant patients with kidney disease.

Keywords: End-stage kidney disease; Hemodialysis; Kidney transplantation; Migrant patients; Peritoneal dialysis.

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Conflict of interest statement

Declarations. Conflict of interest: CR received lecture grants from Alexion, consulting fees from Vifor, and travel grants form Sanofi-aventis, outside the submitted work. AK received research grants from CSL Vifor and Otsuka, consultancy fees from Amgen, AstraZeneca, Boehringer Ingelheim, CSL Vifor, Delta4, GlaxoSmithKline, Novartis, Novo Nordisk, Otsuka, Roche, Sobi and Walden Biosciences, and speaking fees from CSL Vifor and Otsuka, all outside the submitted work. SM received support for meeting registration and travel from Amgen and Sanofi Genzyme outside the submitted work. LL received consulting fees from Alexion, AstraZeneca, Biogen, BMS, GSK, Kezar, Novartis, Otsuka, Pfizer, and Sanofi; has participated in speaker bureau for Alexion, GSK and Roche and is a scientific advisor for Carna Health. All outside the submitted work. M.J.S. received honoraria as a speaker and consulting fees from Novo Nordisk, Jansen, Mundipharma, AstraZeneca, Esteve, Fresenius, Eli Lilly, Boehringer-Ingelheim, Vifor, ICU, Pfizer, Bayer, Travere Therapeutics, GE Healthcare, GSK, MEDICE and Otsuka. She is also one of the former Editors-in-Chief of CKJ. Current editorial board of American Society of Nephrology (ASN)journals. All outside of the submitted work. Ethical approval: The survey was anonymous. Ethics approval was waived by the ethical committee of the Modena Academic Hospital, as the data were collected anonymously and processed in aggregate. Informed consent: Not applicable.

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