In the Journals

Dialysis at for-profit facilities may mean reduced access to kidney transplant

Compared with nonprofit facilities, patients who received dialysis at for-profit facilities had a lower likelihood of accessing kidney transplantation, according to a recently published study.

“Only 14% of patients with incident end-stage kidney disease are placed on the deceased donor kidney transplantation waiting list or receive transplants within 1 year of ESKD diagnosis,” Jennifer C. Gander, PhD, of the Center for Research and Evaluation at Kaiser Permanente Georgia, and colleagues wrote. “Evidence suggests for-profit dialysis facilities have a lower standardized transplantation ratio, and their patients are less likely to be waitlisted compared with nonprofit facilities. It has [also] been suggested that for-profit dialysis facilities strive to reduce operating costs by limiting the provision of low-margin services (such as extended transplant discussions with patients and their families) in the interest of increasing returns to investors, and may impede their patients’ access to transplantation.”

Researchers sought to determine the association between facility ownership and patient-access to transplant. Using data from the U.S. Renal Data System, they conducted a retrospective cohort study of 1,478,564 patients with end-stage kidney disease treated at 6,511 dialysis facilities. Of the total cohort, 87% received care at a for-profit facility.

Researchers found for-profit facilities had lower 5-year cumulative incidence differences for placement on the deceased donor waiting list (-13.2%), receipt of a living donor kidney transplant (-2.3%) and receipt of a deceased donor kidney transplant (-4.3%) than non-profit facilities. In addition, among patients treated at for-profit facilities, lower relative rates were observed for placement on the waiting list (HR = 0.36) and receipt of either a living (HR = 0.52) or deceased donor transplant (HR = 0.44) than for those treated at non-profit facilities.

Medical building 
Patients who received dialysis at for-profit facilities had a lower likelihood of accessing kidney transplantation.
Source: Adobe Stock

Researchers noted that, unlike previous studies, this study also included patients undergoing home dialysis (8.9% of the cohort) and that these patients are more likely to undergo transplantation than those treated at facilities.

“Clinician-level barriers, including clinician perception of the appropriateness of the possible transplantation, poor medical follow-up, time spent with patients and format of transplant education, may lead to delays in access to transplantation, and could explain some of these findings, but are unmeasured in the national data,” the researchers concluded. “Additional barriers, such as resource allocation of staffing to enable transplant education, could also play a role because prior research found that increased staff may improve access to kidney transplantation. Although this study reported more staff and social workers per patient at for-profit facilities vs. nonprofit facilities, these findings did not explain the observed associations.” – by Melissa J. Webb

Disclosures: Gander reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Compared with nonprofit facilities, patients who received dialysis at for-profit facilities had a lower likelihood of accessing kidney transplantation, according to a recently published study.

“Only 14% of patients with incident end-stage kidney disease are placed on the deceased donor kidney transplantation waiting list or receive transplants within 1 year of ESKD diagnosis,” Jennifer C. Gander, PhD, of the Center for Research and Evaluation at Kaiser Permanente Georgia, and colleagues wrote. “Evidence suggests for-profit dialysis facilities have a lower standardized transplantation ratio, and their patients are less likely to be waitlisted compared with nonprofit facilities. It has [also] been suggested that for-profit dialysis facilities strive to reduce operating costs by limiting the provision of low-margin services (such as extended transplant discussions with patients and their families) in the interest of increasing returns to investors, and may impede their patients’ access to transplantation.”

Researchers sought to determine the association between facility ownership and patient-access to transplant. Using data from the U.S. Renal Data System, they conducted a retrospective cohort study of 1,478,564 patients with end-stage kidney disease treated at 6,511 dialysis facilities. Of the total cohort, 87% received care at a for-profit facility.

Researchers found for-profit facilities had lower 5-year cumulative incidence differences for placement on the deceased donor waiting list (-13.2%), receipt of a living donor kidney transplant (-2.3%) and receipt of a deceased donor kidney transplant (-4.3%) than non-profit facilities. In addition, among patients treated at for-profit facilities, lower relative rates were observed for placement on the waiting list (HR = 0.36) and receipt of either a living (HR = 0.52) or deceased donor transplant (HR = 0.44) than for those treated at non-profit facilities.

Medical building 
Patients who received dialysis at for-profit facilities had a lower likelihood of accessing kidney transplantation.
Source: Adobe Stock

Researchers noted that, unlike previous studies, this study also included patients undergoing home dialysis (8.9% of the cohort) and that these patients are more likely to undergo transplantation than those treated at facilities.

“Clinician-level barriers, including clinician perception of the appropriateness of the possible transplantation, poor medical follow-up, time spent with patients and format of transplant education, may lead to delays in access to transplantation, and could explain some of these findings, but are unmeasured in the national data,” the researchers concluded. “Additional barriers, such as resource allocation of staffing to enable transplant education, could also play a role because prior research found that increased staff may improve access to kidney transplantation. Although this study reported more staff and social workers per patient at for-profit facilities vs. nonprofit facilities, these findings did not explain the observed associations.” – by Melissa J. Webb

Disclosures: Gander reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.