CKD Care Gaps for Incarcerated Patients, With Laura Maursetter, MD

Among chronic kidney disease (CKD) patients, incarcerated individuals have historically struggled to receive adequate kidney care.

Laura J. Maursetter, Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, has been providing care for incarcerated persons for her entire nephrology career.

"It has a lot of meaning for me, both in the connection with patients that I have, but also in the idea that our kidney patients in general come from socioeconomically disadvantaged groups," she told HCPLive. "This [population] is not an exception, and being able to see that we deliver care in a way that is just and good is something that I have a lot of passion for."

A Population With Few Standards and Little Oversight

While incarcerated patients with CKD are legally entitled to adequate medical care, structural problems can create barriers to access. As Maursetter points out, there is also little standardization in how that care is delivered or tracked, and the consistency of care can vary considerably depending on time served and the resources available at a given facility.

"There's not really any sort of tracking system to see what percentage of CKD patients are being seen by a nephrologist," she said. There is similarly no systematic way to confirm whether patients are receiving recommended lab work or being started on appropriate medications, she noted, making it difficult to assess what care actually looks like across the correctional system as a whole.

This absence of data is not unique to Maursetter's observations. In a paper she coauthored on kidney care in correctional settings, outcome studies in this population are described as nearly nonexistent, a gap attributed to institutional review board hurdles, the practical difficulty of recruiting and following patients who may be transferred or released, and a lack of incentive within correctional systems to track health outcomes.

Research Barriers Compound the Data Gap

Ethical concerns around research involving incarcerated people, while intended to protect a vulnerable population, have had the secondary effect of excluding that population from studies altogether, according to Maursetter. Without that data, clinicians and policymakers are left without a clear picture of how CKD affects people in custody or how well current care models are working.

The stakes of that gap are significant. Under the U.S. Constitution, incarcerated individuals retain a right to adequate medical care, a protection rooted in the Eighth Amendment's prohibition on cruel and unusual punishment and reinforced through due process protections for pretrial and civil detainees, according to a frequently asked questions resource published by the American Society of Nephrology (ASN). For patients with kidney failure specifically, adequate care has a narrow definition: consistent access to nephrologists and dialysis-trained nursing staff, uninterrupted dialysis or transplant medication schedules, and immediate response to complications. Disruptions to any of these, even short ones, can escalate quickly.

Building Accountability Into Correctional Nephrology

For Maursetter, closing these gaps starts with demanding basic quality standards, not just for care delivered during incarceration, but for the transition back into the community afterward.

"As a field, demanding some quality standards be implemented, demanding that care is provided so that post-incarceration people have the opportunity to be able to be taken care of in a way that is good, and we didn't miss the boat during the time that they were incarcerated, is a really important factor," she said.

That continuity concern echoes recommendations Maursetter and colleagues have made elsewhere: that nephrology teams build direct relationships with correctional healthcare staff, push for standardized CKD screening at intake, and treat the reentry period as a defined handoff rather than a point where care simply lapses.

Even the research needed to close these gaps faces obstacles, Maursetter noted. "Research is hard to do in the Department of Corrections because of the ethical questions — sometimes people just exclude that population, and then we miss the boat on being able to know more about what that population looks like."

References

1. Maursetter LJ. Nephrology care for incarcerated people: a call to action. Nature Reviews NephrologyPublished online July 28, 2026. doi:10.1038/s41581-026-01108-7

2. Kumar M, Stauss M, Taylor P, Maursetter L, Woywodt A. 10 tips for providing kidney care to persons in prison. Clin Kidney J. 2025;18(5):sfaf090. doi:10.1093/ckj/sfaf090

3. American Society of Nephrology. People Living with Kidney Failure in Detention Facilities: Frequently Asked Questions (FAQs). Published March 2026. Accessed August 25, 2026. https://epc.asn-online.org/wp-content/uploads/2026/02/Kidney-Failure-in-Detention-Facilities-FAQ.pdf