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

Authors

• Dustin Le
• Hatem Najar
• Zoheb Backer
• Rohanit Singh
• Byoungjun Kim
• Anna Flattau
• Morgan E Grams
• Laura Plantinga
• Bernard G Jaar

Publication/Presentation Date

9-4-2026

Abstract

BACKGROUND: 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.

METHODS: 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

RESULTS: 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.

CONCLUSIONS: 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.

Volume

27

Issue

1

ISSN

1471-2369

Published In/Presented At

Le, D., Najar, H., Backer, Z., Singh, R., Kim, B., Flattau, A., Grams, M. E., Plantinga, L., & Jaar, B. G. (2026). Primary care use and kidney transplant outcomes among patients on hemodialysis - a cohort study. BMC nephrology, 27(1), 635. https://doi.org/10.1186/s12882-026-05335-9

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

42947041

Department(s)

Administration and Leadership

Document Type

Article