For-profit dialysis facilities correlate with increased time to wait-listing, transplant
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Pediatric patients who received care at for-profit dialysis facilities experienced significantly longer time for placement on the waitlist and receipt of a kidney transplant compared with those who received care at a nonprofit facility.
“Studies have shown that receipt of maintenance dialysis at profit facilities was associated with lower rates of transplant and worse survival among adults with end-stage kidney disease,” Sandra Amaral, MD, MHS, from the Children’s Hospital of Philadelphia and University of Pennsylvania, and colleagues wrote. They added, “This study examined the association between the profit status of U.S. dialysis facilities and the amount of time it took for pediatric patients with ESKD to be placed on the waiting list and receive a transplant.”
In a retrospective cohort study, researchers examined 13,333 patients younger than 18 years old (median age was 12 years; 45% were girls; 25% were “non-Hispanic Black” patients; 28% were Hispanic patients) who initiated dialysis between 2000 and 2018 in United States facilities. Data were derived from the U.S. Renal Data System.
Researchers identified the profit status of facilities using a combination of the type of ownership and for-profit or nonprofit variables from the facility file. Additionally, the status of a patient’s facility was updated whenever a patient switched from a facility with one status to a facility with another status.
Among the cohort, 60% were treated at a nonprofit facility, 27% at a profit facility and 13% switched facilities with status. Moreover, 75% of the cohort were registered on the wait list during the study and follow-up period and 69% received a kidney transplant.
Analyses revealed that during a median follow-up of 0.87 years, the occurrence of wait-listing at profit facilities was 36.2 per 100 person years and was 49.8 per 100 person years at nonprofit facilities. Similarly, a median follow-up of 1.52 years revealed the incidence of kidney transplant, whether living or deceased donor, was also lower at profit facilities than at nonprofit facilities, 21.5 vs. 31.3 per 100 person-years, respectively.
Using Cox proportional models, researchers measured time to waitlist and receipt of kidney transplantation by profit status of dialysis facilities. Models were adjusted for clinical and demographic factors.
In an accompanying editorial, Mary B. Leonard, MD, MSCE, and Paul C. Grimm MD, from Stanford University School of Medicine, wrote, “The substantial association between nonprofit dialysis facility ownership and greater access to transplants among pediatric patients likely reflects greater clinician experience with the special needs of pediatric patients with ESKD and their families, as well as more robust facility-level processes and structures needed to care for these vulnerable patients.”
They added, “Improving access to kidney transplants, availability, and outcomes for underrepresented groups with ESKD will require collecting national surveillance data on early steps to identify and overcome patient-level, clinician-level and system-level barriers to kidney transplants. These efforts also should include measures of interdisciplinary pediatric nephrology expertise. Pediatric patients may be a small part of the national transplant equation, but they have the most to gain.”
Reference:
Improving quality of care and outcomes for pediatric patients with end-stage kidney disease: The importance of pediatric nephrology expertise. https://jamanetwork.com/journals/jama/article-abstract/2794784 Published: Aug. 2, 2022. Accessed: Aug. 8, 2022.
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