Comparative mortality of hemodialysis patients at for-profit and not-for-profit dialysis facilities in the United States, 1998 to 2003: A retrospective analysis
Foley, R.N Fan, Q Liu, J Gilbertson, D.T Weinhandl, E.D Chen, S.-C Collins, A.J
Foley, R.N
Liu, J
Gilbertson, D.T
Weinhandl, E.D
Chen, S.-C
Collins, A.J
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Alternative Title
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. © 2008 Foley et al; licensee BioMed Central Ltd.
Keywords
hemoglobin, iron, recombinant erythropoietin, urea, erythropoietin, hemoglobin, iron, urea, adult, aged, article, blood transfusion, comparative study, confidence interval, controlled study, drug use, female, follow up, hazard, hazard ratio, health care facility, health center, hemodialysis, hemodialysis patient, hemoglobin blood level, hospital admission, human, male, mortality, population, renal replacement therapy, retrospective study, statistical significance, United States, urea blood level, blood, dose response, intravenous drug administration, kidney transplantation, metabolism, middle aged, mortality, multivariate analysis, outpatient department, proportional hazards model, renal replacement therapy, statistics, United States, Adult, Aged, Ambulatory Care Facilities, Blood Transfusion, Dose-Response Relationship, Drug, Erythropoietin, Female, Health Facilities, Proprietary, Hemoglobins, Humans, Injections, Intravenous, Iron, Kidney Transplantation, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Renal Dialysis, Retrospective Studies, United States, Urea, Waiting Lists
Source Title
BMC Nephrology
Publisher
Series/Report No.
Collections
Rights
Attribution 4.0 International
Date
2008
DOI
10.1186/1471-2369-9-6
Type
Article