Having a Primary Care Provider Linked to Reduced ED Visits for ESKD, With Vahakn Shahinian

In patients with end-stage kidney disease (ESKD) receiving dialysis, new research suggests that having a primary care physician (PCP) is associated with a reduced likelihood of emergency department visits, especially those that don’t ultimately result in hospitalization.1

By having access to a PCP, patients can have the continuity to address general health complications without needing to escalate treatment to the emergency department, which addresses a major cost of care in this patient population, according to study investigators.1

Overall, >70% of patients with ESKD have ≥1 significant comorbidity, with the most common being cardiovascular disease, diabetes, and hypertension. Therefore, treating patients with kidney failure often involves addressing other symptoms within the general care of other specialties.2

“PCPs might just have easier availability for any kinds of issues that might come up,” study investigator Vahakn Shahinian, MD, Co-Chief of Dow Division of Health Services Research, Professor of Internal Medicine and Urology at the University of Michigan Medical School, said in an interview with HCPLive. “If somebody has developed a cough or respiratory tract infection, it's possible that if they just have a nephrologist, it may be harder for them to be able to get a hold of somebody who might be able to prescribe them something and try to head off an emergency room visit instead. That's the concept we were trying to get at.”

To address the association between primary care involvement and emergency department utilization, Shahinian and investigators conducted a national, retrospective, cross-sectional study of patients receiving dialysis, leveraging data from the US Renal Data System (USRDS), including that of 181,520 patients with ESKD receiving maintenance hemodialysis.1

Upon analysis, investigators did not find a significant difference between the estimated risk of hospitalization among those with a 0% probability of having a PCP and those with a 100% (51.0%; 95% Confidence Interval [CI], 49.6%-52.4% vs 48.7%; 95% CI, 45.9%-51.4%). However, there was a difference in estimated risk of an emergency department visits (69.4%; 95% CI, 68.1%-70.7% vs 75.0%; 95% CI, 72.5%-77.6%; P = .003), which was pronounced among those visits not resulting in hospitalization (51.2%; 95% CI, 49.7%-52.7% vs 72.1%; 95% CI, 69.2%-74.9%; P < .001).1

“In the American medical system, not everybody has a primary care physician, and frequently, you can access specialty care without going through primary care,” said Shahinian. “A lot of patients have a primary care physician, so that's a much bigger, not specific to nephrology in any way, but a much bigger issue about access to primary care in general.”

Given these findings, Shahinian and colleagues proposed that including partnerships with primary care practices may be one method to reduce total costs of care, and suggest future models of care may benefit from explicitly incentivizing primary care involvement.

References

1. Bailoor K, Hirth RA, Guro P, Oerline MK, Hollingsworth JM, Shahinian VB. Primary Care Involvement and Health Care Utilization Among Patients With End-Stage Kidney Disease. JAMA Network Open. 2026;9(3):e260807. doi:https://doi.org/10.1001/jamanetworkopen.2026.0807

2. Cha J, Han D. Health-Related Quality of Life Based on Comorbidities Among Patients with End-Stage Renal Disease. Osong Public Health and Research Perspectives. 2020;11(4):194-200. doi:https://doi.org/10.24171/j.phrp.2020.11.4.08