Abstract: SA-PO0931
Demographic Inequities and Clinical Outcomes in Patients with ESKD Lacking Outpatient Maintenance Dialysis
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
- Akutek, Martin, Penn Medicine, Philadelphia, Pennsylvania, United States
- Opare-Addo, Kwasi Asamoah, Penn Medicine, Philadelphia, Pennsylvania, United States
- Salcedo Betancourt, Juan David, Penn Medicine, Philadelphia, Pennsylvania, United States
- Reddy, Yuvaram N.V., Penn Medicine, Philadelphia, Pennsylvania, United States
Background
Some patients with end-stage renal disease (ESRD) are administratively discharged from outpatient dialysis units—or are never accepted—for various reasons. These individuals rely on emergency departments for hemodialysis ("emergency-only dialysis"). This study characterizes their demographics, reasons for discharge or non-acceptance, and clinical outcomes.
Methods
This is a retrospective cohort study across three academic centers from July 2024–December 2025. We used the electronic health record to identify ESRD patients receiving emergency-only dialysis and a random set of outpatient controls and their demographics, clinical outcomes, and laboratory markers were collected.
Results
We identified 27 patients receiving emergency-only dialysis and 50 controls. Patients without outpatient units were younger (mean 50 vs. 66.4 years, p<0.001), and relied on Medicaid (81.5% vs. 53.1%, p=0.008). 84.2% were discharged from units; 14.8% were never accepted. Non-adherence was the leading reason for discharge (59.3%). Healthcare utilization was higher (45.4 ED visits vs. 2.2; 10.4 admissions vs. 1.9; both p<0.0001). Clinical markers were worse; lower hemoglobin (8.4 vs. 11.0 g/dL) and higher PTH (954 vs. 548.8 pg/mL). Use of phosphate binders (25.9% vs. 88%) and epoetin (EPO) (55.6% vs. 90%) was lower. Four deaths (14.8%) occurred in the study group and 3 patients were eventually transferred to an outpatient unit.
Conclusion
In this study, ESRD patients without outpatient dialysis access are a high-risk group with worse outcomes and heavy healthcare use. Their lower use of phosphate binders and epoetin highlights missed opportunities to improve care even in emergency-only dialysis. System-level interventions are needed to support and reintegrate this vulnerable population.
Patient Characteristics