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Peer-reviewedCC BY-NC-ND 4.0BMC Nephrology

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

  • Dustin Le1
  • Hatem Najar1
  • Zoheb Backer1
  • Rohanit Singh2
  • Byoungjun Kim3
  • Anna Flattau4
  • Morgan E. Grams5
  • Laura Plantinga6
  • Bernard G. Jaar7,8
8 affiliations
  1. 1Division of Nephrology, Thomas Jefferson University, Philadelphia, PA USA
  2. 2Division of Nephrology, Baylor College of Medicine, Houston, TX USA
  3. 3Department of Surgery, New York University, New York University, New York, NY USA
  4. 4Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA USA
  5. 5Division of Precision Medicine, New York University, New York, NY USA
  6. 6Department of Medicine, University of California San Francisco, San Francisco, CA USA
  7. 7Division of Nephrology, Johns Hopkins University, Baltimore, MD USA
  8. 8Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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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 1st, 2018 to December 31st, 2018. Patients were followed January 1st2019 until December 31st2020.

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.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12882-026-05335-9.

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Cite

BibTeXRIS
BibTeX
@article{le2026primary,
  title = {{Primary care use and kidney transplant outcomes among patients on hemodialysis – a cohort study}},
  author = {Dustin Le and Hatem Najar and Zoheb Backer and Rohanit Singh and Byoungjun Kim and Anna Flattau and Morgan E. Grams and Laura Plantinga and Bernard G. Jaar},
  journal = {BMC Nephrology},
  year = {2026},
  month = sep,
  doi = {10.1186/s12882-026-05335-9},
  url = {https://doi.org/10.1186/s12882-026-05335-9},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Primary care use and kidney transplant outcomes among patients on hemodialysis – a cohort study
AU  - Dustin Le
AU  - Hatem Najar
AU  - Zoheb Backer
AU  - Rohanit Singh
AU  - Byoungjun Kim
AU  - Anna Flattau
AU  - Morgan E. Grams
AU  - Laura Plantinga
AU  - Bernard G. Jaar
PY  - 2026
DA  - 2026/09/04
JO  - BMC Nephrology
DO  - 10.1186/s12882-026-05335-9
UR  - https://doi.org/10.1186/s12882-026-05335-9
AB  - 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 1st, 2018 to December 31st, 2018. Patients were followed January 1st2019 until December 31st2020.  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.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12882-026-05335-9.
SN  - 1471-2369
ER  -