Primary care use and kidney transplant outcomes among patients on hemodialysis - a cohort study

Kidney transplantation is the optimal treatment for kidney failure, but whether primary care use among those on dialysis is associated with increased rates of kidney transplantation is unknown.

We conducted a retrospective cohort study using United States Renal Data System (USRDS) and Medicare Parts A, B, and D claims to estimate the association between any primary care use (vs none) and both kidney transplantation and "active" kidney transplant waitlisting. Primary care use was defined as ≥ 1 outpatient visit to a family, general, geriatric, or internal medicine provider from January 1^st, 2018 to December 31^st, 2018. Patients were followed January 1^st2019 until December 31^st2020.

We identified 74,028 (60%) and 48,794 (40%) Medicare beneficiaries with and without primary care use. After 2 years of follow-up, the sHR for kidney transplantation was 1.11 (95% CI 1.05-1.17; 2 year-incidence 5.3% vs 4.8%). Among patients not already waitlisted, primary care use was associated with increased "active" kidney transplant waitlisting (sHR 1.19, 95% CI 1.12-1.27; 2-year incidence: 4.3% vs 3.6%). Medical testing was also higher: mammogram sHR 1.30 (95% CI 1.25-1.35), colonoscopy sHR 1.28 (95% CI 1.22-1.33), and transthoracic echocardiography sHR 1.28 (95% CI 1.25-1.31). Among patients who ultimately underwent kidney transplantation, medical testing was similar between groups.

In US Medicare beneficiaries receiving hemodialysis, primary care use was associated with higher rates of kidney transplantation and medical testing. Because the completed medical testing was similar among all patients who ultimately received a transplant, these findings suggest that primary care use may be linked to more timely completion of transplant-related evaluation steps.