The following is the summary of “Association Between Nephrologist Ownership of Dialysis Facilities and Clinical Outcomes” published in the November 2022 issue of Internal medicine by Lin, et al.
American nephrologists who also own dialysis clinics may be tempted to alter their standard of care in order to boost their businesses’ bottom lines. The purpose of this study is to examine whether or not clinical outcomes improve when nephrologists operate their own dialysis centers. This cross-sectional analysis relied on information from the United States Renal Data System and a separate database of individuals who own non-pediatric dialysis centers. Adults receiving dialysis for End – stage renal disease at participating sites between January 2017 and November 2017 were randomly selected as participants. From April 2020 through August 2022, data were evaluated.
Exposures After controlling for differences in patient outcomes between nephrologist owners and nonowners in other facilities, researchers used a difference-in-differences analysis to evaluate the outcomes associated with nephrologist ownership by comparing the difference in outcomes between patients treated by nephrologist owners and patients treated by nonowners within facilities owned by nephrologists. Treatment volumes (missed treatments, transplant list status), erythropoietin-stimulating agent (ESA) use and outcomes (anemia, defined as hemoglobin level less than 10 g/dL, and blood transfusions), quality metrics (mortality, hospitalizations, 30-day readmissions, hemodialysis adequacy, arteriovenous fistula use, and hemodialysis catheter use for ≥3 months), and home dialys. Results Patients undergoing dialysis for End – stage renal disease were numbered at 251,651 (median [IQR] age, 66 [46-85] years; 112,054 [44.5%] female; 97,65 [3.9%] Asian; 86,837 [34.5%] Black; 148,617 [59.1%] White; 38,938 [15.1%] Hispanic).
A 2.4 percentage point (95% CI, 1.1-3.8 percentage point) increase in home dialysis, a 2.2 percentage point (95% CI, 3.6-0.7 percentage point) decrease in the probability of receiving an ESA, and no significant difference in anemia or blood transfusions were observed when patients were treated by nephrologist owners at their owned facilities. Missed treatments, transplant waitlisting, mortality, hospitalizations, 30-day readmissions, hemodialysis adequacy, fistula, and long-term dialysis catheter use were not different amongst patients treated by nephrologist owners at their owned facilities. This cross-sectional cohort analysis showed that nephrologist ownership was linked to higher rates of home dialysis, lower rates of ESA usage, and no difference in rates of anemia or blood transfusions.