The following is a summary of “Association Between Dialysis Facility Ownership and Mortality Risk in Children With Kidney Failure,” published in the September 2023 issue of Nephrology by Ku et al.
Adults treated at for-profit dialysis facilities have a higher risk of death. Researchers conducted a retrospective study to determine whether for-profit dialysis facilities are associated with higher mortality risk in children with kidney failure and whether differences in access to transplants mediate this association.
They reviewed US Renal Data System records of 15,359 children who had initiated dialysis for kidney failure (January 1, 2000, and December 31, 2019). Adjusted Fine-Gray models were utilized to assess the association of the time-updated profit status of dialysis facilities with the risk of death, treating kidney transplants as a competing risk. Cox proportional hazards regression models were utilized to determine the time-updated profit status with the risk of death, regardless of transplant status.
The results showed 8,465 boys (55.3%) and 6,832 girls (44.7%) with a median age of 12 years (IQR: 3-15). Over a median follow-up of 1.4 years (IQR: 0.6-2.7) with censoring at transplant, the death rate was higher at profit facilities compared to nonprofit facilities (7.03 vs. 4.06 per 100 person-years). Children treated at profit facilities had a 2.07-fold higher risk of death (95% CI: 1.83-2.35) compared to those at nonprofit facilities in adjusted analyses accounting for the competing risk of transplant. When considering follow-up regardless of transplant status, the risk of death remained higher for children treated in profit facilities (hazard ratio: 1.47; 95% CI: 1.35-1.61). Lower access to transplant in profit facilities accounted for 67% of the association between facility profit status and the risk of death (95% CI: 45%-100%).
They concluded that children treated at for-profit dialysis facilities have a higher risk of death, partially due to lower access to transplants.