Benefits of a Dedicated Dialysis Program for Uninsured Patients with ESKD in Texas

Background: In the state of Texas, there is no safety net for patients who require dialysis but do not have insurance. The cost of emergency only dialysis is estimated to be 8-times that of in center dialysis. The city of Austin implemented a transitional dialysis program to provide outpatient dialysis for patients who lacked insurance coverage. In this study we report on the outcomes of this program. Methods: We reviewed the charts of all patients enrolled in the transitional dialysis program from its inception in November of 2022 until December 31, 2024. Demographic data, social determinates of health data (SDOH), outcomes on dialysis, and data on transplant referrals were reviewed. Results: Of the enrolled patients (n=101), 95% were Hispanic, 32% were women and 84% were non citizen/non US residents. The average age was 50.1±14.8. The most common causes of ESKD were Diabetes (62%), Glomerular disease (15%) and HTN (11%). SDOH data found that 66% of patients had financial resources strain, 50% had food insecurity, and 20% had inadequate health literacy. Although only 12% of patients had permanent dialysis access (PDA) prior to their first dialysis treatment, currently 97% of the patients enrolled in 2022 have PDA, 90% of the patients enrolled in 2023 have PDA, and 44% of the pateints enrolled in 2024 have PDA thus far. Median time from first emergency inpatient dialysis to outpatient dialysis center placement decreased from 105 days in 2022 to 27 days in 2024 (Figure 1, p<0.0001). Since enrollment in the program, 5 patients have died and 38 have been referred for kidney transplant evaluation. Of those referred for transplant, 47% have been listed for transplant and 2 patients received living kidney donor transplant. Conclusion: The transitional dialysis program piloted in Austin has resulted in a significant decrease in the use of emergency dialysis by facilitating outpatient dialysis placement of patients who lack insurance. Additionally it has allowed for permanent dialysis access placement and provided an opportunity for transplant evaluation.