For a study, researchers sought to ascertain if the financial health of dialysis facilities influences whether juvenile patients on maintenance dialysis are placed on the kidney transplant waiting list or receive a kidney transplant.
The retrospective cohort analysis examined the medical records of 13,333 patients under the age of 18 who began receiving dialysis between 2000 and 2018 in US dialysis institutions (followed up through June 30, 2019). In addition, the duration of wait-listing and reception of a kidney transplant were examined by the profitability of dialysis centers using Cox models that were controlled for clinical and demographic characteristics.
The research covered a total of 13,333 pediatric patients who began maintenance dialysis (median age, 12 years [IQR, 3-15 years]; 6,054 females [45%]; 3,321 non-Hispanic Black patients [25%]; 3,695 Hispanic patients [28%]). The incidence of wait-listing was lower at profit-making facilities than at nonprofit ones during a median follow-up of 0.87 years (IQR, 0.39-1.85 years), at 36.2 vs. 49.8 per 100 person-years, respectively (absolute risk difference, -13.6 (95% CI, -15.4 to -11.8 per 100 years); adjusted hazard ratio [HR] for wait-listing at a profit vs. nonprofit facilities, 0.79; 95% CI, 0.75-0.83. The incidence of kidney transplant (from a living or deceased donor) was also lower at profit facilities than at nonprofit facilities during a median follow-up of 1.52 years (IQR, 0.75-2.87 years); the absolute risk difference was -9.8 (95% CI, -10.9 to -8.6 per 100 person-years) and the adjusted HR for a kidney transplant at a profit vs. nonprofit facilities was 0.71. (95% CI, 0.67-0.74).
Profit facility status was linked to higher wait times for wait lists and longer wait times for kidney transplants among a sample of pediatric patients undergoing dialysis in the US between 2000 and 2018.