Research article

Comparative mortality of hemodialysis patients at for-profit and not-for-profit dialysis facilities in the United States, 1998 to 2003: A retrospective analysis

Robert N Foley^1,2 , Qiao Fan¹ , Jiannong Liu¹ , David T Gilbertson¹ , Eric D Weinhandl¹ , Shu-Cheng Chen¹ and Allan J Collins^1,2

¹  United States Renal Data System, 914 South 8th Street, Suite S-406, Minneapolis, Minnesota, USA

²  Department of Medicine, Phillips-Wangensteen Building, University of Minnesota, Minneapolis, Minnesota, USA

author email corresponding author email

BMC Nephrology 2008, 9:6doi:10.1186/1471-2369-9-6

Published:	26 June 2008

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.