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


CONCLUSIONS
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.
Foley
Robert N
RN
United States Renal Data System, 914 South 8th Street, Suite S-406, Minneapolis, Minnesota, USA. RFoley@usrds.org
Fan
Qiao
Q
Liu
Jiannong
J
Gilbertson
David T
DT
Weinhandl
Eric D
ED
Chen
Shu-Cheng
SC
Collins
Allan J
AJ
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006269:Health Facilities, Proprietary / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007275:Injections, Intravenous / Q000706:statistics & numerical data; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014508:Urea / Q000097:blood; D014850:Waiting Lists
D006454:Hemoglobins; D004921:Erythropoietin; D014508:Urea; D007501:Iron