Likelihood of Transplant Lower at Profit-Driven Dialysis Facilities
More research needed to understand the mechanisms behind difference in transplant access
TUESDAY, Oct. 15, 2019 (HealthDay News) -- Patients with end-stage kidney disease who undergo dialysis at for-profit institutions are less likely to receive a kidney transplant, according to a study published online Sept. 10 in the Journal of the American Medical Association.
Jennifer C. Gander, Ph.D., of the Center for Research and Evaluation at Kaiser Permanente Georgia in Atlanta, and colleagues gathered data from 1,478,564 patients with end-stage renal disease who were receiving dialysis at one of 6,511 dialysis facilities in the United States between 2000 and 2016. The facilities were classified as nonprofit small chains (435 facilities; 7.4 percent of patients), nonprofit independent facilities (324 facilities; 5.3 percent of patients), for-profit large chains with more than 1,000 facilities (2,239 and 2,082 facilities; 32.7 and 32.6 percent of patients), for-profit small chains with fewer than 1,000 facilities (997 facilities; 15.3 percent of patients), and for-profit independent facilities (434 facilities; 6.7 percent of patients).
The researchers found that compared with patients at nonprofit facilities, patients at for-profit facilities were less likely to receive either a living donor or deceased donor kidney transplant (2.3 and 4.3 percent less likely, respectively); patients at for-profit facilities were also 13.2 percent less likely to be placed on the deceased donor waiting list. Adjusted Cox regression analysis also showed lower relative rates for the three outcomes: receipt of living donor transplant (hazard ratio, 0.52), receipt of a deceased donor transplant (hazard ratio, 0.44), and being placed on the deceased donor waiting list (hazard ratio, 0.36). Overall, 87 percent of patients were treated at for-profit facilities.
"Among U.S. patients with end-stage kidney disease, receiving dialysis at for-profit facilities compared with nonprofit facilities was associated with a lower likelihood of accessing kidney transplantation," the authors write. "Further research is needed to understand the mechanisms behind this association."