Primary care engagement after kidney transplantation: predictors and outcomes

Long-term outcomes for kidney transplant recipients (KTRs) are hampered by chronic cardiovascular disease mortality. Primary care providers (PCPs) are key partners in chronic disease risk management, yet their involvement in and impact on KTRs’ care have not been well characterized. In this study, we examined factors associated with PCP utilization after kidney transplantation, and assessed associations of PCP utilization with clinical outcomes and care delivery metrics. This is a single-center retrospective cohort study using the electronic health record. We evaluated clinical and socioeconomic factors associated with PCP utilization after kidney transplantation. We used time-varying survival analyses to examine associations between PCP visits and outcomes of interest. Primary outcomes were mortality, hospitalization, and graft failure; secondary outcomes were care quality metrics including LDL and A1c control and monitoring, and statin prescription. Landmark analyses beginning at one and two years after transplant were used to confirm the primary findings with exposure fixed before follow-up time was counted. Among 815 kidney transplant recipients, 39% had ≥ 1 PCP visit after transplant. Female sex, Black or Hispanic race/ethnicity, hyperlipidemia, higher Elixhauser score, and belatacept use were independently associated with PCP utilization. No statistically significant association was detected between PCP utilization and mortality, hospitalization, or graft failure. PCP utilization was associated with improved LDL control (aHR 1.95 [95% CI 1.50–2.53]) and statin prescription (aHR 1.47 [1.01–2.13]). Greater frequency of PCP visits demonstrated a dose-dependent association with more frequent LDL and A1c monitoring and improved LDL control. In one- and two-year landmark analyses, the association with LDL control persisted (aHR 2.08 [1.42–3.02]) and aHR 2.05 [1.26–3.32] respectively), while associations with statin prescription and A1c control did not. PCP utilization was associated with improved dyslipidemia management among KTRs. These associations are observational; residual confounding cannot be excluded. Our findings show the potential value of PCP partnerships in caring for this high-risk population, and may support future efforts to optimize interdisciplinary care.