Comparative mortality of hemodialysis patients at for-profit and not-for-profit dialysis facilities in the United States, 1998 to 2003: a retrospective analysis

BMC Nephrol. 2008 Jun 26;9:6. doi: 10.1186/1471-2369-9-6.

Abstract

Background: Concern lingers that dialysis therapy at for-profit (versus not-for-profit) hemodialysis facilities in the United States may be associated with higher mortality, even though 4 of every 5 contemporary dialysis patients receive therapy in such a setting.

Methods: Our primary objective was to compare the mortality hazards of patients initiating hemodialysis at for-profit and not-for-profit centers in the United States between 1998 and 2003. For-profit status of dialysis facilities was determined after subjects received 6 months of dialysis therapy, and mean follow-up was 1.7 years.

Results: Of the study population (N = 205,076), 79.9% were dialyzed in for-profit facilities after 6 months of dialysis therapy. Dialysis at for-profit facilities was associated with higher urea reduction ratios, hemoglobin levels (including levels above 12 and 13 g/dL [120 and 130 g/L]), epoetin doses, and use of intravenous iron, and less use of blood transfusions and lower proportions of patients on the transplant waiting-list (P < 0.05). Patients dialyzed at for-profit and at not-for-profit facilities had similar mortality risks (adjusted hazards ratio 1.02, 95% CI 0.99-1.06, P = 0.143).

Conclusion: While hemodialysis treatment at for-profit and not-for-profit dialysis facilities is associated with different patterns of clinical benchmark achievement, mortality rates are similar.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care Facilities / statistics & numerical data*
  • Blood Transfusion / statistics & numerical data
  • Dose-Response Relationship, Drug
  • Erythropoietin / administration & dosage
  • Erythropoietin / therapeutic use
  • Female
  • Health Facilities, Proprietary / statistics & numerical data*
  • Hemoglobins / metabolism
  • Humans
  • Injections, Intravenous / statistics & numerical data
  • Iron / administration & dosage
  • Iron / therapeutic use
  • Kidney Transplantation
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Renal Dialysis / mortality*
  • Retrospective Studies
  • United States / epidemiology
  • Urea / blood
  • Waiting Lists

Substances

  • Hemoglobins
  • Erythropoietin
  • Urea
  • Iron