Outcomes 1. Understand the patterns of physician care in the community for patients with KF-D, including the various care provider, and the timing of their involvement. 2. Analyze how continuity of primary care, or a team of providers, influences health care outcomes and its potential prioritization in EoL care policies and models. Key Message Patients with KF-D predominantly see nephrologists in their last year of life. Research from Ontario, Canada, found that when palliative care was included, fewer patients died in acute care settings. This study helps understand end of life care for these patients, suggesting the importance of palliative care involvement. Importance Patients with kidney failure on dialysis (KF-D) experience a high mortality rate and patients may see many different specialties in the last year of life. Continuity of care (CoC) is generally associated with improved outcomes(1-8), but its measurement for end-of-life (EoL) care in KF-D patients needs investigating and refinement. Objective(s) To identify patterns of outpatient physician care in the last year of life for patients with KF-D, report CoC at the EoL, and understand the impact of CoC on healthcare outcomes. Scientific Methods Utilized Retrospective cohort study of patients with KF-D who died between 2017-2019 in Ontario, Canada, using linked health administrative data. Physician care patterns were identified and evaluated against healthcare outcomes, including place of death and inpatient utilization in last 30 days of life. Results Patients (N = 6,866) median age at death was 73 years, 64% were male, and 12% resided in rural regions. 26% of patients had a general practitioner (GP), palliative care physician, and nephrology pattern, 59% had a GP and nephrology pattern, and 15% lacked GP involvement. Nephrologists maintained consistent involvement and palliative care became involved in the last 90 days of life, while involvement was consistent but low. The GP, nephrology, and palliative care pattern had the fewest patients (66%) dying in acute settings, but also spent the most days in hospital in their 30 days of life. Conclusion(s) Continuity for nephrology is inherently high for patients with KF-D due to the dialysis treatment. Multiple specialties are involved, suggesting that other illnesses are being cared for. Involving palliative care reduces the number of patients dying in acute settings. Impact This research is part of a broader mixed-methods study aimed at determining a comprehensive understanding of EoL CoC. Study results provide insights on CoC and approaches to EoL care for patients with KF-D.