Pre-dialysis medical social worker support and survival in patients with kidney failure: impact on unplanned dialysis, hospitalization, and prognosis

The role of medical social workers (MSWs) in managing patients with end-stage kidney disease (ESKD) undergoing hemodialysis remains unknown. This study evaluated the prognostic impact of pre-dialysis MSW support in patients undergoing renal replacement therapy. This retrospective analysis included 257 patients who started hemodialysis at the Nagasaki Harbor Medical Center between 2016 and 2023. Patients were divided into MSW (+) and MSW (-) groups based on whether they received pre-dialysis MSW support. Outcomes were assessed, including unplanned dialysis initiation, length of hospital stay, and post-hemodialysis survival. The MSW (+) group showed a lower rate of unplanned dialysis initiation, shorter hospital stays and improved post-hemodialysis prognosis compared with the MSW (-) group. In the multivariable Cox regression analysis, pre-dialysis MSW support (hazard ratio 0.58, 95% confidence interval 0.34-0.98, <i>p</i> = 0.04) was associated with lower patient mortality in addition to age, male sex, serum albumin levels 1 month before hemodialysis initiation, and serum creatinine levels 1 month before hemodialysis initiation. Stratified analyses showed a marked positive impact of MSW support in patients aged ≥70 years, male sex, living with family, and malnutrition. MSW support facilitated smoother transitions to maintenance hemodialysis centers through pre-settlement dialysis centers, alleviated patient anxiety, and ensured transportation arrangements. This study highlights the critical role of MSWs in improving clinical outcomes for patients with ESKD who are at higher social risks. Future multicenter studies are warranted to validate these findings and enhance their generalizability.