Incarcerated patients with chronic kidney disease (CKD) face a system with few tracking mechanisms, inconsistent access to medications and specialists, and steep barriers that don't disappear at release.

Laura Maursetter, MD, of the Division of Nephrology at the University of Wisconsin School of Medicine and Public Health, has spent her nephrology career caring for incarcerated patients and is calling for standardized screening, treatment, and transplant access across the carceral system. In an interview with HCPLive, Maursetter discussed the gaps she's observed, why early identification matters so much in this population, and what she'd like to see change.

Q&A: For Incarcerated Patients, Kidney Care Can't Wait, With Laura Maursetter, MD

HCPLive: What prompted you to write this call to action on nephrology care for incarcerated people?

Maursetter: I have been fortunate to take care of incarcerated persons for my whole nephrology career. At first it seemed like an add-on, but it has turned into something that has a lot of meaning for me, both in the connection with patients that I have, and in the idea that our kidney patients in general come from socioeconomically disadvantaged groups, and this is not an exception. Being able to see that we deliver care in a way that's just and good is something I have a lot of passion for, and there's a lot of room for improvement in this area. A lot of clinicians who see maybe one or two patients don't have the opportunity that I've had to deliver a more holistic view of care. In doing so, it's been really fun to dive in and see what kind of changes we can make. As a field, demanding some quality standards be implemented, so that post-incarceration, people have the opportunity to be taken care of in a way that is good, and we didn't miss the boat during the time they were incarcerated, is a really important factor.

HCPLive: What are some of the biggest challenges patients who are incarcerated with chronic kidney disease (CKD) face in accessing care?

Maursetter: There aren't a lot of standards implemented in the Department of Corrections. They have access to most medicines and the care that's needed, but depending on the time they're serving, the delivery of care may be a little more variable. They have a tough situation, and I don't want to discount that at all. It is really hard to have a limited amount of resources to spend on a large population, just like we see in most other health care systems. That same challenge happens, and it's maybe more enhanced in the Department of Corrections. There's not really any sort of tracking system to see what percentage of CKD patients are being seen by a nephrologist, whether people are getting all the labs done that they should, or whether we're starting people on all the medicines they need to be started on. That kind of tracking system isn't implemented, which makes it really hard to know what the holistic picture looks like. Research is hard to do in the Department of Corrections because of ethical questions, and sometimes people just exclude that population, and then we miss the boat on being able to know more about what that population looks like.

HCPLive: A lot of the risk factors for incarceration also increase the risk of CKD. What should clinicians understand about the kidney health disparities that affect this population?

Maursetter: We have so much room to impact the outcome of someone's life if we start earlier. Being able to pick these things up at an earlier stage makes more of a difference down the road than if we find them much later in the course of disease. It's unfortunate because primary care doctors have so much on their plates, but looking for these things earlier, especially in high-risk populations, is cost-effective, and that's been shown, as well as outcome-effective. We've got medicines in the last 2 years in the kidney field that have really made an impact on longevity, so being able to make that happen for folks is such an exciting time.

HCPLive: Many clinicians treating this population aren't as ingrained in the process. What should those clinicians be aware of when treating this patient population?

Maursetter It's a particularly challenging group. During incarceration, I had no idea what the structure looked like and what people go through, or what it means to have different types of holdings, where sometimes people are put into different structures within the correctional facility, and that may change access to medicines. There are differences in the diets available, and each institution can be different. It's difficult to know exactly whether they take their medicines themselves or are given them, and who's watching that. Medicines can run out and not be refilled, and those types of things can be a challenge while they're in the facility. When people leave the incarcerated situation, there are so many challenges that we impose on them. I think of the correctional facility as a time where you're serving your time for the things you were convicted for, but afterward, there's so much that follows those patients: getting their medicines, having space to be seen in clinic in a more rapid fashion because they hadn't been able to schedule. I think we as a community can make a little bit of accommodation to help these folks out, have some space in clinic, realize that they may have unstable housing or difficulty with transportation. How can we build a structure to allow for some of those nuances that may not be the same for the rest of our patients? Granted, there are lots of folks that go through challenges, but these are particularly difficult.

HCPLive: What changes would you most like to see in the carceral health system to improve kidney care for incarcerated patients?

Maursetter: Some changes that can be really impactful are identification and education, for both the primary care doctors and the patients, to know how important this is. I am so lucky to have the chance to talk to some people even early in their kidney disease, where they may not even have to follow up with me, but I can share information about how important it is for them to control their blood pressure or change the way they're eating. Who knows if they can continue that outside of their correctional facility situation, but at least they've been told. I would love for us to implement standards so that, just as it's common for people to have their cholesterol checked, why not their kidney function and protein? At what point can we get nephrologists involved, and we should have some guidance to make that as easy as possible for people. And there should be standards with regard to transplant. It shouldn't be variable across different states and institutions; it should be consistent as to what kinds of opportunities we're providing to people. Your sentence duration shouldn't impact your outcomes later, so can we figure out ways to standardize what happens so a person doesn't have to wait and be on the transplant list much later than they would if they were not incarcerated?

HCPLive: Was there anything you felt was important to add?

Maursetter: One interesting part is that our medical school is doing a much better job of creating curriculum around educating our learners about the Department of Corrections. This has been run through the inpatient services, the outpatient services, and then they spend time rotating in some of the specialty services as well, so they have more comfort with what happens in those situations and could potentially be better caregivers in the future. I'm not sure how standard that is in many medical schools, but being able to do something like that would be an advantage in how we care for a different type of population, just as you might think about pregnant women or other specific populations.

The kidney community also has a lot of challenges with disadvantaged groups. We have a smaller community compared with GI or cardiology, so it makes us spread quite thin as to the advocacy needed in different populations, especially when those populations are really limited in what they can do for themselves. I think this is a group that hasn't often been recognized. I've been thankful that I've gotten a chance to speak on it at the American Society of Nephrology, and there was a lot of interest shown, but I wonder if there are more opportunities that can happen if we can highlight some of these things, so this is seen as a population that deserves some of our attention as well.

References

1. Maursetter LJ. Nephrology care for incarcerated people: a call to action. Nat Rev Nephrol. Published online July 28, 2026. https://www.nature.com/articles/s41581-026-01108-7

2. CKD Care Gaps for Incarcerated Patients, With Laura Maursetter, MD. HCPLive. Published August 25, 2026. https://www.hcplive.com/view/ckd-care-gaps-for-incarcerated-patients-with-laura-maursetter-md

3. Closing the Gaps in CKD Screening, Transplant Access, and Education for Incarcerated Patients. HCPLive. Published August 29, 2026. https://www.hcplive.com/view/closing-the-gaps-in-ckd-screening-transplant-access-and-education-for-incarcerated-patients