Abstract: FR-PO0984
Association of Primary Care Use with Kidney Transplantation Among US Patients Already on Hemodialysis
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
- Le, Dustin, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Najar, Hatem, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Backer, Zoheb, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Singh, Rohanit, Yale School of Medicine, New Haven, Connecticut, United States
- Kim, Byoungjun, 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
- Plantinga, Laura, University of California San Francisco School of Medicine, San Francisco, California, United States
- Jaar, Bernard G., Johns Hopkins Medicine, Baltimore, Maryland, United States
Background
Among individuals requiring in-center hemodialysis (HD), the association of primary care use and kidney transplantation is unknown. Primary care use may facilitate transplantation workup and increase time on the waitlist.
Methods
Using the United States Renal Data System and Medicare Parts A, B, and D claims data, we identified patients aged ≥18 and on in-center hemodialysis on 1/01/2019 (ie point prevalent cohort), and we used Fine-Gray models (to account for the competing risk of death) to estimate the sub-distribution hazard ratio of transplantation by primary care use. We used inverse probability of treatment weighting to adjust for over 40+ baseline characteristics, including United Network for Organ Sharing (UNOS) listing status.
Results
We identified 74,028 and 48,794 individuals requiring hemodialysis with and without primary care use in the previous year. The average age in the weighted population was 65, and 59% were white. After a median (interquartile interval) follow-up of 2.0 (1.18 – 2.0) years, 5.5% of patients with primary care use underwent kidney transplantation vs 5.0% of those without primary care use (HR 1.10, 95% CI: 1.04 – 1.16). Results were consistent across subgroups by age, sex, race, urbanicity classification, and baseline UNOS status.
Conclusion
Among a prevalent cohort of US Medicare beneficiaries requiring hemodialysis, primary care use was associated with increased rates of kidney transplantation. Whether there is a causal relationship between primary care use and kidney transplantation is unclear and warrants further investigation.