Kidney Week

Abstract: SA-PO1077

Primary Care and Nephrology Access: Implications for Preemptive Listing and Kidney Transplantation

Session Information

• Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Li, Yiting, New York University Grossman School of Medicine, New York, New York, United States

Yiting Li, MPH

• Menon, Gayathri, New York University Grossman School of Medicine, New York, New York, United States

Gayathri Menon, MS

• Wilson, Malika, New York University Grossman School of Medicine, New York, New York, United States

Malika Wilson, MD, MBA

• Clark-Cutaia, Maya, Hunter College, New York, New York, United States

Maya Clark-Cutaia, PhD, APRN, RN

• Demarco, Mario, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Mario Demarco, MD, MPH

• Bae, Sunjae, New York University Grossman School of Medicine, New York, New York, United States

Sunjae Bae, MD, PhD, MPH

• Kim, Byoungjun, New York University Grossman School of Medicine, New York, New York, United States

Byoungjun Kim, PhD

• Orandi, Babak, New York University Grossman School of Medicine, New York, New York, United States

Babak Orandi

• Thorpe, Roland J., Johns Hopkins University, Baltimore, Maryland, United States

Roland J. Thorpe, PhD

• Segev, Dorry L., New York University Grossman School of Medicine, New York, New York, United States

Dorry L. Segev, MD, PhD

• McAdams-DeMarco, Mara, New York University Grossman School of Medicine, New York, New York, United States

Mara McAdams-DeMarco, PhD

Background

Preemptive KT (PKT) confers health advantages compared to KT after dialysis. Care coordination between primary care providers and nephrologists is crucial for preemptive KT, and residence in areas with primary care (medically underserved areas [MUAs]/Health professional shortage areas [HPSAs]) and nephrology shortages may affect access to and disparities in preemptive listing/KT.

Methods

We identified 348,466 KT candidates (age>=18 years) from the USRDS (2005-2020). Modified Poisson regression quantified adjusted prevalence ratios (aPR) of preemptive listing and cause-specific hazards models quantified adjusted hazard ratios (aHR) of preemptive KT, by MUAs/HPSAs/distance to nearest nephrologist (far:>=16km). We used interaction terms to quantify racial/ethnic disparities in the aforementioned associations.

Results

30% of candidates lived in MUAs, 8% in HPSAs, and 12% lived far from the nearest nephrologist. Candidates in MUAs had a lower prevalence of preemptive listing (aPR=0.85,95% confidence interval [CI]:0.84-0.86) and a lower likelihood of PKT (aHR=0.78,95%CI:0.76-0.80). While disparities in preemptive listing were worse for all minoritized candidates in MUAs (P_interactions<0.05), disparities in PKT were worse only for Black candidates (P_interaction<0.05). Candidates in HPSAs had a lower prevalence of preemptive listing (aPR=0.86,95%CI:0.84-0.88) and a lower likelihood of PKT (aHR=0.76,95%CI:0.73-0.80), with no differences by race/ethnicity (P_interactions>0.05). Lastly, there was no difference/disparity in preemptive listing/KT by distance to the nearest nephrologist.

Conclusion

Residence in primary care shortage areas may impede preemptive listing/KT, further perpetuating racial and ethnic disparities. Greater investment in primary care within MUAs/HPSAs and increased nephrology care coordination may increase transplant equity.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025k2p0z1y3