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Death Rate Higher at For-Profit Dialysis Centers

By Merritt McKinney

NEW YORK, Nov 29 (Reuters Health) -- People who need dialysis because their kidneys have failed are more likely to die, and less likely to be put on a waiting list for a kidney transplant, if they receive care at a for-profit dialysis center rather than at a not-for-profit facility, according to results of a national study.

In the study of more than 3,500 people with kidney failure, those who underwent dialysis at for-profit dialysis centers were about 20% more likely to die during the study period than those treated at not-for-profit centers. Patients at for-profit centers were also about 26% less likely to be put on a waiting list for a kidney transplant, an operation that can significantly improve quality of life, according to a team of researchers led by Dr. Pushkal Garg of Harvard Medical School in Boston, Massachusetts. The difference in death rates may stem in part from attempts by for-profit facilities to cut costs, Garg and colleagues believe.

The amount paid per dialysis treatment by Medicare, which covers most dialysis patients, has not increased since 1973, the investigators note in The New England Journal of Medicine for November 25th. Therefore, they speculate, for-profit centers may be more likely than not-for-profit facilities to reduce costs by employing fewer staff members and using less equipment.

Likewise, attention to the financial bottom line may account for the lower referral rate for kidney transplants, according to the report. Since dialysis patients are a steady source of revenue, for-profit centers may be more reluctant than not-for-profit centers to put them on a kidney-transplant waiting list, Garg's team suggests.

Despite the findings, the study "...says absolutely nothing about the quality of care provided at any particular for-profit or not-for-profit (center)," Garg told Reuters Health.

The study results represent an average of many different dialysis centers, he pointed out. The researchers were not able to look at the results of individual facilities.

Furthermore, Garg said, the results apply only to free-standing dialysis centers, since the analysis did not include hospital-based dialysis programs.

People undergoing dialysis should not change their medical provider based on this study, Garg said. "That would be the absolute wrong thing for someone to do."

However, it is always a good idea to find out as much as possible before choosing a dialysis center, he noted. Garg recommends talking to the center's staff and patients, if possible, as well as checking to see if the facility is clean.

The current study, as well as previous research, suggest that, even though for-profit and not-for-profit dialysis centers face the same financial constraints, "for-profit facilities respond differently from not-for-profit facilities -- to the detriment of patient care," according to Dr. Norman Levinsky of Boston University Medical Center.

In an editorial that accompanies the study, Levinsky calls for a review of dialysis treatment in for-profit centers.

SOURCE: The New England Journal of Medicine 1999;341:1653-1660, 1691-1693.