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September 13, 2019

For-profit dialysis center patients less likely to receive a transplant, study finds

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    Editor's note: JAMA on April 21, 2020, published a correction that retracted and replaced the original study after the authors discovered "a major coding error … occurred in their data management and analysis." The authors reanalyzed the data to address the errors and have republished their findings. While the reanalysis did not change the main findings and overall conclusion it did "reveal important differences in effect size and strength of the associations." We have updated the below story to include a link to the corrected study and have updated the findings.

    Patients with renal failure who get dialysis at for-profit dialysis centers are less likely to receive a kidney transplant than patients who get dialysis at nonprofit centers, according to a study published Tuesday in JAMA.

    Here are 5 key tactics to attract and retain transplant patients

    For-profit dialysis patients are less likely to receive transplants

    Kidney transplants are usually the best form of treatment for someone with end-stage renal disease, F. Perry Wilson, an assistant professor at Yale School of Medicine writes in a Medscape commentary. "It's cheaper than dialysis, less burdensome than dialysis, and associated with longer survival than dialysis," Wilson writes.

    But some health experts have speculated that for-profit dialysis centers have an inventive to keep patients on dialysis, and therefore are less likely than nonprofit dialysis centers to get their patients on transplant lists.

    To find out, a team of researchers analyzed data for nearly 1.5 million patients diagnosed with renal failure from 2000 to 2016 from the U.S. Renal Data System and the Dialysis Facility Compare. The patients were treated at about 6,500 dialysis centers, and 87% received care at for-profit facilities.

    The researchers found that the 5-year cumulative incidence differences were lower at for-profit facilities than nonprofit facilities for the three main outcomes: −2.6% for waiting list placement, −0.9% for living donor kidney transplant, and −1.4% for deceased donor kidney transplant.


    The study authors noted that there are several factors that could cause the discrepancy between transplant and list rates at for-profit and nonprofit centers, such as patient education, patient willingness to get a transplant, tests to find a match, and case mix. Further, while the study findings do not show that for-profit dialysis centers intentionally delay patients from getting transplants, the authors noted that the trends held for patients who switched from for-profit centers to nonprofit, which suggests "there's more to the story," Wilson writes.

    Rachel Patzer, a co-author of the study and an associate professor and director of health services research in the departments of surgery and medicine at Emory University School of Medicine, speculated that the system does not give for-profit centers any incentive to get patients on the transplant list. "The current system has no financial incentive for dialysis providers to educate, to spend time with, and to refer patients for transplant," Patzer said.

    To bridge the transplant gap, Patzer said, "Incentives must be aligned so that regardless of whether it's a for-profit or a non-profit facility, the facility is incentivized to encourage those patients who are eligible for kidney transplant to pursue it" (Carroll, Reuters, 9/10; Wilson, Medscape, 9/11; Calandra, Managed Care Mag, 9/11).

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