Abstract: SA-PO0367
Travel Burden and Missed Dialysis Treatment: Varying Patterns by Urbanicity and Implications for Policy
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Kim, Byoungjun, New York University Grossman School of Medicine, New York, New York, United States
- Lee, Myeonggyun, New York University Grossman School of Medicine, New York, New York, United States
- Adhikari, Samrachana, New York University Grossman School of Medicine, New York, New York, United States
- Le, Dustin, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, United States
- Bae, Sunjae, New York University Grossman School of Medicine, New York, New York, United States
- Li, Yiting, New York University Grossman School of Medicine, New York, New York, United States
- Segev, Dorry L., New York University Grossman School of Medicine, New York, New York, United States
- Thorpe, Lorna, New York University Grossman School of Medicine, New York, New York, United States
- Grams, Morgan, New York University Grossman School of Medicine, New York, New York, United States
- McAdams-DeMarco, Mara, New York University Grossman School of Medicine, New York, New York, United States
Background
Among patients with ESKD, missed hemodialysis treatments are common, placing them at risk for hospitalization, emergency room visits, and mortality. The impact of travel burden and neighborhood characteristics on missed treatments has not been characterized.
Methods
We identified adult patients initiating in-center hemodialysis (2011-2020) from the national registry. Missed treatments over the 10-week period after the first 90 days of initiation were defined using Medicare claims. Travel burden was measured at the neighborhood level (travel time, traffic volume, public transit density) using residential ZipCode and log-transformed for skewness. Rate ratios (RRs) for missed treatments were estimated using Quasi-Poisson models, adjusting for demographics, insurance, employment, pre-ESKD nephrology care, functional status, and neighborhood poverty, and stratified by urbanicity.
Results
Among 215,905 patients (mean age 70 [SD: 11]; 55% male; 59% White; 36% urban; 34% suburban; 30% rural), 29% missed at least one treatment during their initial 10 maintenance weeks. Travel time was associated with higher rates of missed treatment in all urbanicity types (RR in urban:1.15, 95% CI:1.13-1.17; RR in suburban:1.17, 95% CI:1.15-1.19; RR in rural:1.12, 95% CI:1.10-1.14). Traffic volume was associated with higher rates of missed treatment only in urban (RR:1.05 95% CI:1.03-1.08) and suburban areas (RR:1.05, 95% CI:1.02-1.07). Public transit density was associated with reduced rates of missed treatments in suburban (RR:0.97, 95% CI:0.95-0.99) and rural areas (RR:0.82, 95% CI:0.70-0.95).
Conclusion
Longer travel times to dialysis facilities were associated with higher rates of missed treatments across all urbanicity types, while higher traffic volumes showed similar associations in urban and suburban areas. Greater public transit density reduced rates of missed treatment in suburban and rural areas. Transportation interventions tailored to urbanicity may reduce missed treatment of maintenance hemodialysis.
Funding
- NIDDK Support