Starting dialysis the "wrong" way could cost patients their shot at a transplant. A new study found that patients with suboptimal dialysis starts — meaning without proper vascular access or prior nephrology care — were significantly less likely to be referred for, evaluated for, or wait-listed for a kidney transplant. Over half of U.S. patients in the Southeast fell into this suboptimal category.
Starting dialysis without the right preparation doesn't just affect immediate care — it may derail a patient's entire transplant journey. A large cohort study published in Nature Communications Medicine found that patients who began dialysis suboptimally (without arteriovenous access or prior nephrology care) had significantly lower odds of being referred for, evaluated for, and wait-listed for a kidney transplant compared to those with highly optimal starts.
The study analyzed data from nearly 50,000 adults across nine transplant centers in the Southeast U.S. between 2015 and 2019. Researchers categorized dialysis starts into four tiers — highly optimal, moderately optimal, minimally optimal, and nonoptimal — and tracked transplant pathway outcomes over time. Alarmingly, more than half of patients fell into the minimally optimal or nonoptimal categories.
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Why it matters: Kidney transplant is the gold standard treatment for kidney failure, but getting there requires navigating a complex referral and evaluation process. This study shows that how a patient enters dialysis can set the trajectory for their entire care path — making early nephrology involvement and proper vascular access planning critical levers for improving transplant access.
