A transitional dialysis program demonstrated a significant decrease in the use of emergency dialysis for uninsured patients with end-stage kidney disease (ESKD), according to the findings of a pilot study presented at the American Society of Nephrology Kidney Week 2025.
Researchers from Dell Seton Medical Center at the University of Texas in Austin implemented the program to provide outpatient dialysis for uninsured individuals who lived in Travis County.
The pilot program launched in November 2022 and enrolled 101 patients. Patient data, including demographics, social determinants of health data, dialysis outcomes, and transplant referrals were reviewed by the researchers through December 2024.
Most patients were Hispanic (95%), 84% were not US citizens, and 32% were women. The average age was 50.1 years. Health data revealed that diabetes (62%), glomerular disease (15%), and hypertension (11%) were the most common causes of ESKD. Social determinants of health data showed that two-thirds of patients had strained financial resources, half experienced food insecurity, and 20% had inadequate health literacy.
“The cost of emergency-only dialysis is estimated to be 8 times that of in-center dialysis,” according to a press release from the American Society of Nephrology.
The researchers observed a significant decline in the number of days patients used emergency dialysis in the hospital before finding an outpatient facility. The median time from first emergency inpatient dialysis to outpatient dialysis center placement decreased from 105 days in 2022 to 27 days in 2024.
At baseline, only 12% of patients had permanent dialysis access (PDA). Within 1 year of program implementation, PDA was obtained with either an arteriovenous fistula or a peritoneal dialysis catheter (2022, 97%; 2023, 90%; 2024, 44%).
“Since Texas has no safety-net plan for patients who do not qualify for Medicare or Medicaid, the program has the potential to provide a cost-effective solution and decrease in utilization of healthcare resources for those without medical coverage who develop kidney failure,” said lead author Michelle L. Lubetzky, MD, in the press release. “It can be a model for other states and cities that also lack safety net plans.”
The program, piloted by Central Health, a taxpayer-funded organization that provides health and wellness services for uninsured patients in Travis County, provided insurance coverage for outpatient dialysis and transplantation. Since enrollment, five patients died, 18 patients were listed for kidney transplant, and two patients received living donor transplants.
