Abstract: SA-PO0935
Unplanned Dialysis Initiation in a Bronx Safety-Net Hospital: Effects of Social Determinants of Health and Health Care Access
Session Information
- Diversity and Equity in Kidney Health
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Aung, Htun Min, New York City Health and Hospitals Jacobi, New York, New York, United States
- Rodriguez, Marcos Alejandro, New York City Health and Hospitals Jacobi, New York, New York, United States
- Bhandari, Sanjeev, New York City Health and Hospitals Jacobi, New York, New York, United States
- Jim, Belinda, New York City Health and Hospitals Jacobi, New York, New York, United States
- Acharya, Anjali, New York City Health and Hospitals Jacobi, New York, New York, United States
Background
Unplanned dialysis initiation via central venous catheter (CVC) is associated with increased infection, rehospitalization, and mortality. We evaluated social determinants of health (SDOH), healthcare access, and outcomes among patients initiating dialysis in a Bronx safety-net hospital.
Methods
We conducted a retrospective cohort study of adults with CKD stage 5 hospitalized between April 2023 and March 2025 who initiated dialysis during hospitalization. Demographic, SDOH, healthcare utilization, and 1-year outcomes were collected by chart review.
Results
Seventy-seven patients initiated hemodialysis using tunneled or non-tunneled CVCs, while only 3 initiated dialysis via arteriovenous fistula or graft. No patients initiated peritoneal dialysis. Patients were predominantly Black (58%) and Hispanic/Latinx (44%), with 38% non-English speakers. Many patients had limited prior nephrology follow-up, 39% missed at least 1 clinic visit and 31% had documented dialysis refusal. Most patients relied on Medicaid or emergency Medicaid. Clinical characteristics, SDOH, healthcare access, and 1-year outcomes are shown in Table 1. Within 1 year, 60% required rehospitalization, 13% developed bacteremia, and survival was 91%.
Conclusion
Unplanned CVC-dependent dialysis initiation was nearly universal and no patients initiated peritoneal dialysis despite limited prior nephrology visits. Language barriers, missed clinic visits, dialysis refusal, and socioeconomic vulnerability may contribute to unsuccessful CKD transition planning and absent home dialysis uptake with no difference between the 2 groups. These findings support the need for consistent SDOH-targeted interventions focused on culturally appropriate dialysis education, vascular access planning, and improved home dialysis access.
Acknowledgment
We would like to sincerely thank Ms. Cheryl Moore for her assistance in obtaining the patient list for this study.