Abstract: SA-PO0362
Primary Care Use and Clinical Outcomes in a Prevalent Cohort of Patients Requiring Hemodialysis
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
- 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
Use of primary care services in the general population has been associated with improved population health outcomes, but whether these benefits extend to patients requiring dialysis is unclear. We evaluated the association of primary care use in the previous year with clinical outcomes using a point prevalent cohort of patients requiring hemodialysis.
Methods
We identified and included patients receiving in-center hemodialysis on 1/01/2019, who were enrolled in Medicare Parts A, B, and D identified in the United States Renal Data System. The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular and infection mortality, first hospitalization, emergency department/urgent care use, and subsequent primary care use, and patients were followed for outcomes through 12/31/2020. We used inverse probability of treatment weighting to adjust for differences between those with and without primary care use, and we used Cox proportional hazards models to estimate the associations between primary care use and study outcomes.
Results
Among 122,496 patients (mean age, 65; 55% male; 59% White; 71% with diabetes), 60% had used primary care services in the previous year. Primary care use was associated with lower rates of all-cause mortality (HR: 0.90 [95% CI: 0.88 – 0.92]), cardiovascular mortality (HR: 0.96 [95% CI: 0.93 – 0.99]), and infection mortality (HR: 0.81 [95% CI: 0.75 – 0.88), but with higher rates of first hospitalization (HR: 1.04 [95% CI: 1.02 – 1.05]), first emergency department/urgent care use (HR 1.06 [95% CI: 1.05 – 1.08]), and subsequent primary care use (HR = 4.30 [95% CI 4.21 – 4.39]).
Conclusion
Primary care use among prevalent patients requiring hemodialysis was associated with lower mortality but slightly higher rates of hospitalization and emergency department/urgent care visits. Our results suggest that primary care use is associated with improved mortality for patients requiring in-center hemodialysis, but further studies are warranted.