Primary Care May Improve Access to Kidney Transplantation in Hemodialysis Patients: Study
USA: Among US Medicare beneficiaries receiving hemodialysis, greater use of primary care was associated with higher kidney transplantation rates and increased medical testing. As patients who ultimately received transplants underwent similar amounts of testing regardless of primary care use, the findings, published in BMC Nephrology, suggest that regular primary care may help patients complete transplant evaluation requirements more promptly and improve access to transplantation.
Kidney transplantation is considered the preferred treatment for eligible patients with kidney failure, offering improved survival and quality of life compared with long-term dialysis. However, many patients receiving hemodialysis do not progress to transplantation, and factors that may facilitate access to transplant evaluation and waitlisting remain an important area of study.
To examine whether engagement with primary care was associated with transplantation outcomes, Dustin Le from the Division of Nephrology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA, and colleagues conducted a retrospective cohort study using data from the United States Renal Data System (USRDS) and Medicare Parts A, B, and D claims.
The analysis included Medicare beneficiaries receiving hemodialysis who were assessed for primary care use during 2018. Primary care use was defined as at least one outpatient visit with a family medicine, general internal medicine, geriatric medicine, or internal medicine provider between January 1 and December 31, 2018. Patients were subsequently followed from January 1, 2019, through December 31, 2020, for kidney transplantation and active placement on the kidney transplant waiting list.
A total of 122,822 beneficiaries were included, with 74,028 (60%) having at least one primary care visit and 48,794 (40%) having no primary care use.
The study revealed the following findings:
- Kidney transplantation: Primary care use was associated with a higher likelihood of transplantation over 2 years (sHR 1.11), with incidence of 5.3% vs 4.8%.
- Active waitlisting: Among patients not already waitlisted, primary care use increased the likelihood of active kidney transplant waitlisting (sHR 1.19), with incidence of 4.3% vs 3.6%.
- Medical testing: Primary care users had higher rates of mammography (sHR 1.30), colonoscopy (sHR 1.28), and transthoracic echocardiography (sHR 1.28).
- Testing among transplant recipients: Patients who ultimately received a kidney transplant underwent similar amounts of medical testing, regardless of primary care use, suggesting that primary care may facilitate more timely completion of transplant evaluation.
The researchers concluded that primary care engagement may play an important role in improving access to kidney transplantation among people receiving hemodialysis. Integrating primary care more effectively into the transplant pathway could potentially help eligible patients progress through required evaluations and reach transplantation sooner.
Reference:
Le, D., Najar, H., Backer, Z. et al. Primary care use and kidney transplant outcomes among patients on hemodialysis – a cohort study. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-05335-9
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