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Frequent outpatient visits, surgical and radiological procedures, hospitalisations and haemodialysis (HD) sessions impose a significant time burden on patients. The concept of time toxicity is widely described in oncology, and captures the disruption to patients\u2019 lives due to treatment-related demands. We aimed to quantify time- based healthcare workload during the transition onto KRT and identify patient characteristics associated with increased workload.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study including all consecutive adults initiating KRT (haemodialysis (HD), peritoneal dialysis (PD), or pre-emptive transplantation (KTx)) in the Glasgow Renal and Transplant Unit between January 2015 and December 2019. Routinely collected electronic health record data were used to estimate time spent per month on healthcare-related activities (outpatient appointments, radiology, inpatient admissions, HD sessions, and travel) from 6 months pre- to 36 months post-KRT initiation. Workload was analysed as a time-based outcome (hours\/month). Univariate analysis used Kruskal-Wallis testing; multivariate modelling employed negative binomial regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1,022 patients (58.6% male; median age 61 years) contributed over 1.1\u00a0million patient-days. Median healthcare workload peaked around KRT initiation and was highest in HD patients. Kidney transplantation was associated with markedly lower workload post-initiation (IRR 0.04). Increased workload was associated with female sex, polypharmacy (&gt;\u200915 medications), late referral, older age (in maintenance phase), and modality change or failed transplant. Socioeconomic deprivation and primary renal disease were not significantly associated with higher workload.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Healthcare workload during KRT transition is substantial and varies widely. Transplantation is associated with significantly lower workload. These findings support timely transplant planning and underscore the importance of considering the time burden of healthcare experienced by patients when discussing treatment options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12882-025-04693-0","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T11:38:59Z","timestamp":1766489939000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare workload associated with transition onto kidney replacement therapy: a retrospective cohort study"],"prefix":"10.1186","volume":"27","author":[{"given":"Catrin H.","family":"Jones","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Edgar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Thomson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie I.","family":"Gallacher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Knight","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Kingsmore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick B.","family":"Mark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Stevenson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhautesh","family":"Jani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"issue":"7","key":"4693_CR1","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1038\/s41581-024-00820-6","volume":"20","author":"A Francis","year":"2024","unstructured":"Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, et al. 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Also as a result of this study being secondary analysis of routinely collected anonymised data individual consent for participation was deemed not to be required in line with MRC guidelines \u2018Using information about people in health research\u201d.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and ethics statement"}},{"value":"Not applicable. This study used only anonymised, routinely collected data, and no identifiable individual data are presented.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"PM received grants from AstraZeneca and Boehringer Ingelheim, consulting fees from AstraZeneca, Boehringer Ingelheim, Pharmacosmos, and Vifor, honoraria for lectures from AstraZeneca, Boehringer Ingelheim, and Vifor and participates in advisory boards for Vertex and NovoNordisk. PT has received speaker fees from W.L. Gore & Associates. All other authors have no conflict of interest to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"73"}}