Abstract: SA-PO1099
Transportation Reliability, Missed Hemodialysis Treatments, and Mortality Among US Patients on Hemodialysis
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Shieu, Monica, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Li, Nien Chen, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Harford, Antonia, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Manley, Harold, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Babroudi, Seda, Tufts Medical Center, Boston, Massachusetts, United States
- Hamdan, Hiba, UC Davis Medical Center, Sacramento, California, United States
- Majchrzak, Karen M., Dialysis Clinic Inc, Nashville, Tennessee, United States
- Johnson, Doug, 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
Hemodialysis (HD) patients face numerous challenges including transportation that may affect their health outcomes. We examined the association among transportation reliability, missed hemodialysis treatments, and mortality.
Methods
Adult maintenance in-center HD patients at Dialysis Clinic, Inc. between 05/2023 to 03/2025 who completed health-related social needs questions were followed for outcomes up to one year. Patients reported transportation reliability during care plans. Missed HD treatments were defined as missed sessions that were not rescheduled and were not due to hospitalization. Four-way decomposition mediation analysis evaluated relationships among transportation reliability and missed treatments (Poisson regression), missed treatments and mortality (Cox regression), and transportation reliability and mortality (Cox regression). Models were adjusted for age, sex, race/ethnicity, vintage, comorbidities, education, clinic rurality, insurance, and financial comfort.
Results
Among 15,317 patients, 492 (3.2%) described unreliable transportation. Patients with unreliable transportation missed more treatments [10.0±14.4 vs 5.3 ±10.4 treatments; adjusted rate ratio=1.83 (1.56-2.14)] and experienced higher mortality [adjusted hazard ratio=1.52 (1.37-1.68)] than patients with reliable transportation. A five percent increase in missed treatments associated with a higher rate of mortality [adjusted hazard ratio=1.13, (1.12-1.15)]. In mediation analysis, unreliable transportation accounted for ~60% of the association with mortality, with ~40% mediated through missed treatments.
Conclusion
Unreliable transportation is associated with more missed HD treatments and higher mortality, with missed treatments mediating ~40% of the association between unreliable transportation and mortality. Improving both transportation reliability and subsequently reducing missed treatments may improve survival among HD patients.