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

RATIONALE &

OBJECTIVE

Transportation insecurity is a social risk factor of particular importance to individuals with end-stage kidney disease (ESKD), as most individuals need to travel multiple times a week to dialysis treatment. Advancing home modalities for individuals with ESKD experiencing transportation insecurity may be beneficial by reducing travel burden and improving access.

STUDY

DESIGN

Retrospective cohort study.

SETTING &

PARTICIPANTS

Individuals with ESKD treated with in-center hemodialysis (HD) at a large, national dialysis organization.

EXPOSURES: The main transportation mode to HD is categorized into private transportation (individuals who drive themselves or have a family member/friend drive) or those who lack private transportation (Medicaid non-emergency medical transportation, paratransit, public transportation, private pay non-emergency medical transportation, and other).

OUTCOMES: Transition to home dialysis is defined as an individual who has completed at least 1 training treatment for home therapies or at least 1 dialysis treatment at home.

ANALYTIC APPROACH: Log-binomial multivariate regression models to estimate adjusted incidence rate ratios of home dialysis transition by transportation mode.

RESULTS

Individuals who lacked private transportation were significantly less likely to transition to home dialysis compared with those who drove themselves or had a family member/friend drive them to HD. Adjusted incidence rate ratios for home dialysis transition were 47%-58% lower in nonprivate transportation groups compared with those with private transportation, ranging from 0.42 in individuals relying on Medicaid transportation benefits (95% confidence interval, 0.35-0.50; P < 0.001) to 0.53 (95% confidence interval, 0.41-0.67; P < 0.001) among paratransit users.

LIMITATIONS: Single transportation assessment, exclusion of individuals already on home dialysis, and absence of caregiver data.

CONCLUSIONS

Individuals with ESKD receiving in-center HD who lack private transportation may have reduced access to home dialysis, even though this group may benefit from home modalities. Better identifying transportation barriers and targeting home modalities for those with transportation insecurity may reduce the adverse consequences of missed dialysis related to transportation barriers and be an additional opportunity to increase home dialysis uptake.