Social Risk Factors and Kidney Transplant Waitlisting Among Patients Receiving Dialysis: A National Cohort Study.

RATIONALE: Social risk factors (SRFs) include potentially intervenable individual-level social and economic conditions that impact health. Limited data exist on the prevalence of SRFs and their impact on transplantation among individuals receiving dialysis.

STUDY

DESIGN

A cross-sectional cohort study.

EXPOSURES: The SRF data (housing, food security, utilities, transportation & personal safety) were collected from maintenance dialysis patients at Dialysis Clinic, Inc. from May 2023 to March 2025 using questions from the Accountable Health Communities Health-Related Social Needs Screening Tool.

OUTCOME: Most recent transplant status, defined as neither being waitlisted nor having received a transplant through March 2025.

ANALYTICAL APPROACH: A total SRF burden score was assigned to each patient, categorized as screening positive for none (0), one (1), or more than one (>1) SRF. We evaluated the association of SRF burden score and transplant status using logistic regression. Models were adjusted for age, sex, race/ethnicity, dialysis vintage, modality, clinic location, financial status, insurance coverage, and comorbid conditions. Supplementary analyses examined the association between each SRF domain and the outcome.

RESULTS

Among 12,994 patients with SRF data, 1,360 (10.5%) had a score of 1 and 445 (3.4%) had a score of >1. In an adjusted model, having one or more SRF was associated with increased odds of not being transplanted or waitlisted for transplant (odds ratio 1.19 [0.99-1.43] and 1.65 [1.14-2.38] for 1 and >1 SRF). Other associated SRFs included being financially uncomfortable (1.54 [1.33-1.78]) and dialyzing in a rural clinic (1.26 [1.11-1.44]). In supplementary analyses, transportation insecurity (2.59 [1.74, 3.87]) had the strongest association with the outcome.

LIMITATIONS: Residual confounding and exposure misclassification.

CONCLUSIONS

In a national cohort of maintenance dialysis patients, more than 10% had one or more SRF; this was associated with increased odds of not being transplanted or actively waitlisted. Addressing SRFs, including transportation barriers, may improve access to kidney transplants.