US dialysis facility closures raise concerns about access to care
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Key takeaways:
- Adults diagnosed with end-stage renal disease increased during the study, but facility openings decreased.
- Closed facilities had a higher impact among those with dual eligibility status.
SAN DIEGO — U.S. dialysis facility closures from 2018 to 2023 raise concerns about access to vital care, particularly in rural communities, according to data from ASN Kidney Week.
The study used CMS data to identify 8,220 unique dialysis facilities in 7,120 census tracts during the study period. Meri Varkila, MD, of the Stanford University school of medicine in California, and colleagues examined growth and closures trends to study if closures disproportionately affected socioeconomically disadvantaged populations.
The research consisted of a serial cross-sectional study of dialysis facilities placed under geospatial analysis and examined for differential access trends over time. The study also evaluated social vulnerability index, census region, rural or urban area designation, and racial and ethnic composition between census tracts.
Overall, 1,297 facilities opened and 704 closed during 5 years, the researchers found.
“However, when we examine data at a more granular level, we saw a rather different picture emerging,” Varkila said in the presentation. “Although in the first years, between 2018 and 2020, there were more openings than closures, you could see the steady trend in a declining rate of facility openings with respect to facility closures, which were increasing over time, eventually leading to a reversal of the trend in growth at the end of 2021 where the number of facility closures actually exceeded the number of facility openings.”
While patients diagnosed with end-stage renal disease increased from 782,844 in 2018 to 815,142 by 2023, annual facility closures also increased, while new openings decreased.
Varkila and colleagues reported 563 neighborhoods had a decrease in access to dialysis services. Census tracts in rural areas were more likely to experience closures with 10.5% of rural areas affected compared with 8.4% in urban areas. The Midwestern United States specifically had 10.3% of census tracts with closures vs. 6.2% of tracts in the West.
Neighborhoods with higher social vulnerability indices did not have more closures.
Researchers noted the trend of steady growth reversed by 2022 and that closed facilities had a higher impact among those with dual eligibility status and non-Hispanic Black adults.
“Further work should dive into reasons behind closures and find out what the individual-level health outcomes are for patients who are disproportionately affected,” Varkila said.
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