Abstract: FR-PO0970
Social Risk Factors and Kidney Transplant Wait-Listing Among Patients on Dialysis: A National Cohort Study
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Hamdan, Hiba, UC Davis Health, Sacramento, California, United States
- Shieu, Monica, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Li, Nien Chen, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Babroudi, Seda, Tufts University School of Medicine, Boston, Massachusetts, United States
- Harford, Antonia, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Majchrzak, Karen M., Dialysis Clinic Inc, Nashville, Tennessee, United States
- Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States
- Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
Background
Social risk factors (SRF) include potentially intervenable individual-level social and economic conditions that may impact health. Limited data exist on the prevalence of SRFs and their impact on transplantation among individuals receiving dialysis.
Methods
SRF data (housing, food security, utilities, transportation and personal safety) were collected from maintenance dialysis patients nationally at Dialysis Clinic, Inc. from May 2023 onward using questions derived from the Accountable Health Communities Health-Related Social Needs Screening Tool, with additional questions regarding wealth and income. A cumulative SRF score was assigned to each patient, categorized as screening positive for none (0), one (1), or more than one (>1) SRF domain. We evaluated the association between the most recent SRF score and most recent transplant status, defined as neither being waitlisted nor having received a transplant through March 2025. Logistic regression models were adjusted for age, sex, race/ethnicity, dialysis vintage, modality, clinic location, financial status, insurance coverage, and comorbid conditions. Supplementary analyses examined the association of each individual SRF domain with the outcome.
Results
Among 13,009 patients with SRF data, 1362 (10.5%) had a score of 1 and 444 (3.4%) had a score of >1. In a fully adjusted model, having one or more SRF was associated with increased odds of not being transplanted or waitlisted for transplant [OR 1.31 (1.09-1.58) and 1.73 (1.2-2.49) for 1 and >1 SRF, respectively. Other associated SRFs included being financially uncomfortable [1.58 (1.37-1.82)] and dialyzing in a rural clinic [1.28 (1.13-1.45)]. In supplementary analyses, transportation insecurity [2.59 (1.75-3.84)] had the strongest association with a decreased likelihood of transplant/waitlisting.
Conclusion
In a large national cohort of maintenance dialysis patients, more than 10% had one or more SRF, and this was associated with significantly increased odds of not being transplanted or waitlisted. Addressing SRFs, particularly transportation barriers, may improve access to kidney transplant among maintenance dialysis patients.