{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:17:02Z","timestamp":1788913022107,"version":"build-2803163510"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"crossref","award":["KL2TR001859, TR001860"],"award-info":[{"award-number":["KL2TR001859, TR001860"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["K23DK140602"],"award-info":[{"award-number":["K23DK140602"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Transportation insecurity is a potentially modifiable social risk that can negatively impact individuals with ESKD treated with in-center dialysis.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Adults with ESKD who lacked private transportation to dialysis were more likely to miss dialysis treatments and had higher mortality.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Identifying transportation insecurity and developing novel transportation interventions has potential to improve dialysis adherence and outcomes.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transportation insecurity for people with ESKD treated with in-center hemodialysis may be a modifiable social risk that if addressed could improve access to dialysis treatments and lower mortality and complications associated with ESKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective, national cohort study between April 1, 2022, and March 31, 2023. The study included all adults with ESKD receiving in-center hemodialysis within a large dialysis organization for at least 90 days before April 1, 2022, and having completed at least one transportation assessment. Primary outcomes were missed dialysis treatments and mortality. Primary exposure was the mode of transportation to dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In this study, 115,982 individuals (mean age 63 years, 43% female, 74% residing in urban setting) met the inclusion criteria. Nearly one third (27%) did not have private transportation, defined as driving themselves or having a friend or family member drive them to dialysis. All individuals who lacked private transportation had higher mortality at 1-year follow-up compared with those with private transportation: adjusted incidence rate ratio (aIRRs) (95% confidence intervals [CIs]), 1.25 (1.19 to 1.30), 1.21 (1.15 to 1.28), 1.70 (1.55 to 1.86), and 1.09 (1.02 to 1.17) for Medicaid, paratransit (available for individuals with a disability or a disabling health condition), private pay nonemergency medical transportation, and public transit, respectively. Medicaid, paratransit, and public transportation users were more likely to miss dialysis treatments compared with those with a private ride: aIRRs (95% CIs), 1.31 (1.27 to 1.35), 1.15 (1.11 to 1.20), and 1.24 (1.18 to 1.30), respectively. All nonprivate transportation users had higher likelihood of missed dialysis treatments attributed to transportation: aIRRs (95% CIs), 2.78 (2.62 to 2.94), 2.55 (2.35 to 2.76), 1.83 (1.58 to 2.12), and 2.73 (2.47 to 3.01) for Medicaid, paratransit, private pay nonemergency medical transportation, and public transit, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A lack of private transportation was associated with higher risk of missed dialysis treatments and mortality in adults with ESKD treated with in-center hemodialysis.<\/jats:p>\n                  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