Beyond Medical Eligibility: Functional and Social Dimensions of Transplant Access in Patients on Hemodialysis

Background: Eligibility for kidney transplantation in patients on hemodialysis (HD) does not depend exclusively on clinical criteria, but also on functional, social, and attitudinal factors. Knowing the differential profile of this population according to their transplant status (TxS) allows for the development of strategies that reduce inequalities and promote personalized care in outpatient units. To describe the clinical, functional, and social profile of patients on outpatient hemodialysis (HD) according to their transplant status at the end of the care period. Methods: Cross-sectional study of a national database of 4,565 HD patients. Patients were categorized according to TxS: included, excluded by medical decision, by patient decision, for other reasons, or due to temporary contraindication. Clinical variables (age, comorbidity index, BMI, months on dialysis), functional variables (educational level, employment status, type of housing, and income), and expanded social variables such as family support network, autonomy, frequency of medical visits, and access to transportation or caregivers were analyzed. Comparisons were made between groups. Results: Patients on the active list were younger (57.5 years), had a lower comorbidity index (4.8), and a lower BMI (26.0). Those excluded by medical decision were older (76.2 years) and had higher comorbidity index (7.9), while those who refused transplantation had been on dialysis for longer (68.8 months). Significant social differences were identified: the excluded groups had a higher prevalence of basic education, unemployment, non-independent housing, lower self-care, dependence on transportation, and less regular medical follow-up. Conclusion: Transplant status is associated with significant differences in age, comorbidity, social factors, and level of support. The inclusion of expanded social variables allows for a better characterization of vulnerability in hemodialysis patients and justifies comprehensive assessment models that guide more equitable, patient-centered clinical decisions aligned with quality and healthcare accessibility objectives.