Getting to Dialysis Shouldn't Be a Life-or-Death Struggle—But for 27% of Patients, It Is

Transportation to dialysis treatments can mean the difference between life and death for kidney patients. A major study examining 115,982 adults on in-center hemodialysis found that 27% of patients don't have reliable private transportation to their life-sustaining treatments, forcing them to depend on often unreliable community or medical transport services.

What Makes Transportation So Critical for Dialysis Patients?

People with end-stage kidney disease (ESKD) typically need hemodialysis three times per week, with each session lasting about four hours. Missing even one treatment can be dangerous, but transportation problems make this all too common. The EnROUTE Study, which included input from patients through a Community Advisory Board, found that those without private transportation were significantly more likely to miss scheduled treatments, experience worse overall health, and die within one year of the study period.

Bertha Dickerson, a study participant, knows this struggle firsthand. Her dialysis center is just 15 minutes away, but using paratransit—a shared-ride service for people who can't use public transportation—takes an hour and is often late. "When I arrive late, my dialysis sessions are cut short by at least 40 minutes," she explained.

How Do Transportation Barriers Impact Patient Outcomes?

The study revealed stark differences in health outcomes based on transportation access. Patients relying on community or medical transport services faced multiple challenges that directly affected their survival rates. These transportation-dependent patients experienced:

• Higher Treatment Abandonment: Significantly more missed dialysis appointments due to unreliable pickup times and scheduling conflicts
• Shortened Treatment Sessions: Late arrivals often resulted in reduced dialysis time, compromising the effectiveness of the life-sustaining treatment
• Increased Mortality Risk: A measurably higher likelihood of death within one year compared to patients with reliable private transportation

Daniel Jovan Pulido, who has been navigating kidney disease since age 8, experienced these challenges during college. "I wasn't driving at the time, so I relied on medical transport to pick me up from my community college. It was difficult coordinating my schedule around dialysis and transportation. It added a lot of stress," he shared.

Why Are Patient Voices Essential in Kidney Care Research?

The EnROUTE Study stands out because researchers created a Community Advisory Board made up of patients and care partners who helped recruit participants, create interview guides, and interpret findings. This patient-centered approach revealed insights that purely clinical data might miss. "Patients live with the day-to-day realities of these conditions and have valuable insights that can't be gained from textbooks or theories," Daniel explained.

Iris Corina, now in her 70s, joined the study after her own kidney journey that included both dialysis and transplant. She emphasized the broader impact: "Transportation matters for dialysis patients. But it's more than that—you need reliable transportation to get to grocery stores and appointments. More lives can and will be saved when transportation is no longer an issue."

The study's findings confirm what patients have long known—that getting to dialysis is often a matter of survival, not convenience. By documenting these experiences with hard data from nearly 116,000 patients, researchers have created a powerful case for addressing transportation barriers as a critical component of kidney care, not just a logistical afterthought.