Assessing the impact of transitional care units on dialysis patient outcomes: A multicenter, propensity score‐matched analysis

Introduction Inadequate predialysis care and education impacts the selection of a dialysis modality and is associated with adverse clinical outcomes. Transitional care units (TCUs) aim to meet the unmet educational needs of incident dialysis patients, but their impact beyond increasing home dialysis utilization has been incompletely characterized. Methods This retrospective study included adults initiating in‐center hemodialysis at a TCU, matched to controls (1:4) with no TCU history initiating in‐center hemodialysis. Patients were followed for up to 14 months. TCUs are dedicated spaces where staff provide personalized education and as‐needed adjustments to dialysis prescriptions. For many patients, therapy was initiated with four to five weekly dialysis sessions, with at least some sessions delivered by home dialysis machines. Outcomes included survival, first hospitalization, transplant waiting‐list status, post‐TCU dialysis modality, and vascular access type. Findings The study included 724 patients initiating dialysis across 48 TCUs, with 2892 well‐matched controls. At the end of 14 months, patients initiating dialysis in a TCU were significantly more likely to be referred and/or wait‐listed for a kidney transplant than controls (57% vs. 42%; p