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Social Risk Factors and Kidney Transplant Waitlisting Among Patients Receiving Dialysis: A National Cohort Study
Hiba Hamdan1, Monica Shieu2, Nien-Chen Li2
1Division Of Nephrology, UC Davis Health, Sacramento, CA.
Kidney Medicine
|March 30, 2026
Summary
Social risk factors (SRFs) negatively impact kidney transplant access for dialysis patients. Addressing barriers like transportation insecurity can improve transplant waitlisting and outcomes.
Area of Science:
- Nephrology
- Public Health
- Health Services Research
Background:
- Social risk factors (SRFs) are individual-level social and economic conditions impacting health.
- Limited data exist on SRF prevalence and their association with kidney transplantation in dialysis patients.
- Understanding SRFs is crucial for improving equitable access to transplantation.
Purpose of the Study:
- To determine the prevalence of SRFs among maintenance dialysis patients.
- To evaluate the association between SRF burden and kidney transplant waitlisting status.
- To identify specific SRFs that impact transplant access.
Main Methods:
- A cross-sectional cohort study of 12,994 maintenance dialysis patients.
- SRF data collected using the Accountable Health Communities Health-Related Social Needs Screening Tool.
- Logistic regression models adjusted for demographic, clinical, and socioeconomic factors.
Main Results:
- Over 10% of patients screened positive for at least one SRF.
- Increased SRF burden was associated with higher odds of not being transplanted or waitlisted (OR 1.19-1.65).
- Transportation insecurity showed the strongest association with reduced transplant access (OR 2.59).
Conclusions:
- A significant proportion of dialysis patients experience SRFs, hindering transplant access.
- Addressing SRFs, particularly transportation barriers, is essential for improving transplant equity.
- Interventions targeting social needs may enhance kidney transplant outcomes.
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