A new international study published in Kidney International Reports sheds light on the disproportionately high rates of chronic kidney disease among migrant populations, a growing public health concern as more than one billion people worldwide are currently living outside their country of origin. The research underscores that migration-encompassing pre-departure conditions, transit hardships, and post-arrival challenges-is a significant risk factor for kidney disease, ranging from acute injury to chronic conditions like Mesoamerican Nephropathy. The study calls for a shift away from emergency-based care toward preventative strategies tailored to the unique health profiles of migrants, and highlights how systemic barriers to care create ethical dilemmas for healthcare providers and increased costs for health systems.
Chronic Kidney Disease in Migrant Populations: A Global Health Challenge
A new international study highlights the unique vulnerabilities faced by migrants in developing chronic kidney disease (CKD), urging a more nuanced and preventative approach to healthcare for this growing population. The research, published in Kidney International Reports, emphasizes that migration itself is a key factor impacting health outcomes.
Dr. Karen Courville, a nephrologist at the Gustavo N. Collado Hospital in Chitré, Panama, contributed to the research. She completed her medical training at the University of Panama and pursued further studies in Internal Medicine and Nephrology at the Dr. Arnulfo A. Madrid Complex. Dr. Courville also completed a research fellowship at the Mario Negri Institute in Bergamo, Italy, and is currently an investigator at the Las Tablas Medical Sciences Institute and a member of the National Research System (SNI).
With over one billion people living outside their place of origin – 258 million international migrants and 763 million internal migrants – the health of migrant populations is increasingly a global public health priority. The study underscores that the migration process itself significantly impacts an individual’s health, creating unique risks at every stage: before departure, during transit, and after arrival in the destination country.
Risk Factors and Kidney Vulnerability
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Migrants are disproportionately vulnerable to both acute and chronic kidney disease. Factors such as severe dehydration, physical trauma, and untreated infections during travel can lead to acute kidney injury (AKI), which, if not properly managed, can progress to chronic kidney disease.
Once settled, migrants often face socioeconomic challenges including language barriers, lack of legal status, and precarious working conditions. Many are employed in high-risk sectors like agriculture and construction, where exposure to extreme heat and insufficient hydration contribute to the development of environmental and occupational nephropathies.
Barriers to Treatment and Specialized Care
A significant challenge for healthcare systems is ensuring access to life-sustaining treatments like dialysis and kidney transplantation for migrants, particularly those without legal documentation. In many countries, undocumented migrants are excluded from routine chronic dialysis programs and only receive “emergency dialysis” when their condition becomes critical. This practice raises ethical concerns and leads to poorer health outcomes and increased mortality compared to regular, preventative treatment.
Researchers emphasize that kidney disease in migrant populations is not solely about end-stage organ failure, but is deeply connected to specific conditions based on geographic origin and environmental exposures. This understanding is crucial for health authorities to move away from a “disaster medicine” model – responding only to emergencies – towards one of prevention and early detection tailored to each migrant’s profile.
Regional Diseases
In Central America and parts of Southeast Asia, Mesoamerican Nephropathy, also known as Chronic Kidney Disease of Unknown Causes (CKDu), is prevalent. This condition primarily affects young agricultural workers who migrate for work due to climate and economic pressures, often carrying pre-existing kidney damage with them.
Unlike traditional CKD caused by diabetes, this variant is linked to heat stress, severe dehydration, and exposure to agrochemicals. When these individuals migrate to developed countries, diagnosis is often delayed because they don’t fit the typical kidney patient profile (they are not usually obese or hypertensive), highlighting the need for healthcare providers to obtain detailed occupational and geographic histories.
Migrants from sub-Saharan Africa and South Asia have a high incidence of kidney damage resulting from endemic infectious diseases. Conditions like malaria, schistosomiasis, leptospirosis, and tuberculosis can cause acute kidney injury that, if untreated during migration, can lead to chronic kidney disease. Furthermore, genetic factors, such as the APOL1 gene variant common in people of African ancestry, predispose individuals to faster kidney disease progression when exposed to environmental stressors or infections like HIV, requiring closer monitoring.
Upon arrival in destination countries, these populations are exposed to Westernized diets and sedentary lifestyles, adding risk factors like obesity and type 2 diabetes to their existing vulnerabilities.
This means screening programs must be comprehensive, considering both infectious and environmental diseases from countries of origin and metabolic diseases common in destination countries, to prevent migrants from ending up needing dialysis.
| Phase of Migration | Risk Factors for Kidney Disease |
| Pre-migration (Country of Origin) | Exposure to infectious diseases (malaria, HIV, hepatitis), malnutrition, lack of access to safe water, exposure to environmental toxins/agrochemicals, genetic factors (e.g., APOL1), and inadequate healthcare infrastructure. |
| Transit (During the Journey) | Severe dehydration, physical trauma, violence, lack of medication for pre-existing conditions, poor sanitation, and untreated acute infections. |
| Post-migration (Destination Country) | Language and cultural barriers, uncertain legal status, lack of health insurance, physically demanding jobs, overcrowding, psychological stress, and adoption of unhealthy diets (diabetes/hypertension). |
| Systemic / Political | Exclusionary health policies, discrimination, lack of continuity of medical care, and high costs of specialized treatments (dialysis/transplant). |
Economic and Ethical Implications for Healthcare Systems
From a health management and administration perspective, excluding migrants from preventative services generates significantly higher costs in the long run.
Emergency dialysis, often performed in intensive care units with prolonged hospitalizations, places a much greater financial burden on the state than providing regular outpatient treatment or kidney transplantation. This situation also presents healthcare professionals with profound ethical dilemmas when having to deny essential care, highlighting the need for legal frameworks that protect the fundamental right to health regardless of immigration status.
Recent international data shows that people with refugee status represent approximately 1.5% of the total dialysis patient population in Europe. More information is available at:
https://www.kireports.org/article/S2468-0249(25)00744-2/fulltext
Recommendations and Towards Universal Health Coverage
To address this challenge, health authorities must move towards Universal Health Coverage (UHC), ensuring that preventative and treatment services for kidney disease are inclusive and accessible to all. This requires implementing policies that eliminate legal barriers to healthcare access, promoting safe working environments for migrant workers, and training healthcare personnel in cultural sensitivity.
International cooperation and the collection of specific data on kidney health in migrants are essential steps in designing evidence-based interventions that improve individual lives and strengthen health systems worldwide.
Research Authorship: Karen Courville 1 8,Vicente Sánchez-Polo 2 8 ,Roberta Arena 3 ∙Greta Borelli4 Lilio Hu4 , 5∙ Miriam Di Nunzio4 Gianluigi Zaza3 Gaetano La Manna 4 , 6∙ Luca De Nicola 7 , 9∙ Michele Provenzano 3 ,
9
Affiliations and Notes:
1Department of Nephrology, Gustavo N. Collado Hospital, Chitré, Panama
2Nephrology and Kidney Transplant Service, Guatemalan Social Security Institute, Guatemala City, Guatemala
3Nephrology, Dialysis and Kidney Transplant Unit, Department of Pharmacy, Health Sciences and Nutrition, University of Calabria, Cosenza Hospital “SS. Annunziata”, Cosenza, Italy
4Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy
5Nephrology and Dialysis Unit, Santa Maria Delle Croci Hospital, Ravenna, Italy
6Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
7Department of Advanced Medical and Surgical Sciences, Division of Nephrology, University of Campania “Luigi Vanvitelli”, Naples, Italy
8KC and VSP share first authorship
9LDN and MP share joint senior authorship
