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Association Between Transportation and Home Dialysis Transition: Retrospective Cohort Study.

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  • 1Department of Family and Community Medicine, University of California, Davis, Sacramento, CA.

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Summary

Individuals with end-stage kidney disease (ESKD) lacking private transportation are less likely to transition to home dialysis. Addressing transportation barriers is crucial for improving home dialysis access and reducing missed treatments.

Keywords:
End-stage kidney diseasedialysishome modalitiessocial risktransportation

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Area of Science:

  • Nephrology
  • Public Health
  • Health Services Research

Background:

  • Transportation insecurity is a significant barrier for individuals with end-stage kidney disease (ESKD) requiring frequent dialysis treatments.
  • Home dialysis modalities offer potential benefits for ESKD patients facing transportation challenges by reducing travel burdens.

Purpose of the Study:

  • To investigate the association between transportation mode and the transition to home dialysis among individuals with ESKD.
  • To identify if transportation insecurity impacts access to home dialysis therapies.

Main Methods:

  • Retrospective cohort study of individuals with ESKD on in-center hemodialysis (HD).
  • Transportation modes categorized into private (self/friend/family) and non-private (Medicaid NEMT, paratransit, public transit, etc.).
  • Log-binomial regression models used to estimate incidence rate ratios for home dialysis transition.

Main Results:

  • Individuals lacking private transportation were significantly less likely to transition to home dialysis.
  • Adjusted incidence rate ratios for home dialysis transition were 47%-58% lower in non-private transportation groups compared to private.
  • This disparity was evident across various non-private transport modes, including Medicaid and paratransit.

Conclusions:

  • Transportation insecurity is a significant barrier to home dialysis adoption for ESKD patients.
  • Targeting interventions to address transportation barriers may improve home dialysis uptake and reduce missed treatments.
  • Further research should explore caregiver data and implement comprehensive transportation assessments.