Evidence on the association between dialysis facility accessibility and mortality in small countries is limited. This study evaluated the association between travel distance and one- and two-year mortality among Israeli end-stage renal disease (ESRD) patients. Data were obtained from the National Renal Replacement Therapy Registry, encompassing all Israeli ESRD patients aged ≥ 45 years who initiated hemodialysis in 2010–2021. Sociodemographic (age, sex, population group), treatment-related (hospital/community treatment, primary renal disease, incident-year cohort), and geographic (residency socioeconomic and peripherality indices) data were collected. Travel distances from the most recent address to the initial treating facility were categorized into three groups based on the 50th and 90th percentiles, excluding outliers (> 100 km). Adjusted Cox regressions assessed associations between travel distances and mortality, with incident-year cohort-specific models evaluating temporal hazard variations. Analyses included 15,606 patients. The long-distance group (> 26.39 km) was characterized by younger age, Arab ethnicity, peripheral residence, and lower socioeconomic status. Compared to the short-distance group (≤ 6.80 km), the hazard ratios (HRs) in the intermediate-distance group (> 6.80 and ≤ 26.39 km) were 1.216 (1.106–1.337) for one-year and 1.181 (1.093–1.275) for two-year mortality. In the long-distance group, the HRs were 1.718 (1.460–2.021) for one-year and 1.554 (1.351–1.787) for two-year mortality ( P-for-trend between travel distances <.001). Sensitivity and temporal analyses confirmed consistent associations across incident-year cohorts, alternative cut-offs, and outlier inclusion. The association between travel distance and mortality highlights the need to improve geographic accessibility to healthcare to reduce inequities, especially for life-sustaining chronic treatments such as hemodialysis.

Background/Objectives: Evidence on mortality after dialysis modality switch is inconsistent and may vary by timing and type of switch. This study examined associations between modality switch and short- and long-term mortality and compared cause-of-death patterns across groups. Methods: This matched historical cohort study used the Israeli National Renal Replacement Therapy Registry (2010–2022). Adult dialysis patients with a modality switch were matched 1:1 to non-switchers by age, initial modality, and survival to switch time. Follow-up started at the switch date or matched index date. Outcomes were all-cause mortality at 3 months, 6 months, 1 year, and 2 years. Conditional Cox models estimated adjusted hazard ratios overall, by initial modality, and by early (≤180 days) or late switch. Among 2-year decedents, logistic regressions compared primary and multiple cause-of-death distributions. Results: The cohort included 892 switchers and 892 non-switchers (median age 65.0 years; 66.1% males; 64.2% peritoneal dialysis [PD]-first). Among PD-first late switchers, mortality hazards were lower across follow-up landmarks, with the greatest reduction at 2 years (HR 0.421; 95%CI: 0.306–0.579), whereas hemodialysis (HD)-first early switchers had higher mortality, with borderline significance (HR 1.614; 95%CI: 0.951–2.740). Among 591 deaths within 2 years, primary cause-of-death distributions were similar; for multiple causes, early switchers showed higher adjusted odds of heart disease, whereas late HD-initiated switchers had higher adjusted odds of renal disease. Conclusions: Mortality after modality switch varies by transition direction and timing. Specifically, a late PD-to-HD transition was associated with lower long-term mortality. Further studies are needed to clarify the roles of clinical/transition-related factors.

Israel and the United States are both high-income nations committed to providing universal access to KRT for patients with ESKD. Despite this shared principle, the clinical and economic burden of ESKD is substantial, and each country has developed distinct strategies to deliver and finance care. This manuscript presents a comparative analysis of epidemiology, treatment modalities, and health system approaches to ESKD management in Israel and the United States, reviewing trends in dialysis prevalence, modality utilization, and kidney transplantation between 2012 and 2022, alongside differences in health policy, reimbursement structures, and cost-containment strategies. The United States, which maintains the largest ESKD population worldwide, is characterized by high dialysis prevalence and extensive federal funding through Medicare. Israel, while smaller in scale, demonstrates unique patterns of care shaped by universal health coverage and cost-regulation mechanisms. Marked differences are evident in dialysis prevalence, transplantation rates, and per-patient expenditures. Comparative evaluation of these two health systems illustrates how countries with similar commitments to universal access have developed divergent models for financing and delivering KRT, offering important insights into the impact of health system design on patient care, cost management, cultural differences, and the opportunity to learn from each other.