Transportation barriers create an unexpected paradox in kidney care that affects thousands of dialysis patients nationwide. While home dialysis theoretically eliminates travel burdens, patients who already struggle with getting to treatment centers are significantly less likely to transition to home-based care—the very solution that could solve their mobility challenges.
This national cohort analysis of end-stage kidney disease patients revealed that individuals relying on Medicaid transport, paratransit, or public transit were substantially less likely to begin home dialysis compared to those with private vehicles or family drivers. The study tracked actual treatment transitions rather than patient preferences, capturing real-world barriers that prevent uptake of potentially life-improving therapies. Researchers examined transportation patterns across a major dialysis organization's network, providing robust data on how mobility constraints influence treatment decisions.
This finding illuminates a critical gap in healthcare equity that extends beyond simple access issues. Patients without reliable transportation may face compounding barriers: they often have lower socioeconomic status, less family support, and housing situations that complicate home treatment setup. The irony is striking—those who would benefit most from eliminating travel requirements are least able to access the training and support needed for home dialysis initiation. This suggests that healthcare systems must redesign home dialysis programs to actively reach transportation-insecure populations rather than assuming they will naturally gravitate toward home-based options. The implications extend to other chronic conditions requiring frequent medical visits, highlighting how transportation inequity perpetuates health disparities even when seemingly superior treatment options exist.