Impact of a Transitional Care Unit on Clinical and Psychosocial Outcomes in Unplanned Dialysis Initiation: A Mixed-Methods Study

Background: Up to 60% of patients with end-stage kidney disease initiate dialysis unexpectedly, often without preparation or education, resulting in suboptimal decisions, higher complications, and poor psychosocial adaptation. Transitional Care Units (TCUs) offer structured support, education, and counseling during this period. We evaluated the feasibility and impact of a pilot TCU in a single academic center at Mayo Clinic,MN. Methods: We conducted a mixed-methods, retrospective cohort study of a TCU within a dialysis unit. We conducted analysis of 12 patients initiating dialysis in the TCU between Jan-April and compared with 24 historical controls matched 2:1 by age, sex, and comorbidities. The TCU intervention included 1) four weeks of in-center dialysis four times per week on home dialysis machines; 2) multidisciplinary education; 3) capacity coaching; 4) frequent nurse practitioner and nephrologist support; and 5) shared decision making regarding dialysis modalities. Quantitative data on healthcare utilization and clinical outcomes were extracted from the electronic health record and analyzed using generalized estimating equations. Qualitative data from the EHR for patients in the TCU were thematically analyzed to explore patient well-being and treatment adaptation at three timepoints: pre-TCU, during TCU, and post-TCU. Results: 36 participants were included (12 TCU, 24 controls), with a mean age of 67.4 yrs; most were male (61.1%) and white (97.2%). TCU participants had significantly lower mean interdialytic weight gain (1.2 kg vs. 3.1 kg, p=0.0392), suggesting improved fluid management. No significant differences were found in hospitalizations, emergency department visits, or mortality. Qualitative analysis revealed evolving psychosocial challenges: heightened anxiety, altered identity, and functional difficulties were common during TCU. While depression and activity concerns improved post-TCU, long-term adaptation challenges persisted, reflecting unmet psychosocial needs. Conclusion: TCUs may improve early fluid management and provide short-term psychosocial support for patients starting dialysis unexpectedly. However, persistent challenges post-discharge highlight the need for extended multidisciplinary care during dialysis transition.