Author: Linda Carroll
The likelihood that U.S. patients with renal failure will get a kidney transplant is lower for those who get dialysis at for-profit dialysis centers, a new study shows.
In examining the records of more than a million dialysis patients, researchers found that compared to patients getting dialysis at nonprofit facilities, patients treated at for-profit dialysis centers were less likely to make it onto a kidney transplant list and less likely to receive a new kidney from either a living or a deceased donor.
The implication is that for-profit facilities may be biased toward keeping patients on dialysis.
“In a 17-year-long study we found that U.S. patients with end-stage kidney disease who receive dialysis in for profit facilities have lower access to kidney transplantation compared to patients who receive care in non-profit dialysis facilities,” said study coauthor Rachel Patzer, an associate professor and director of health services research in the department of surgery & department of medicine at Emory University School of Medicine. “The current system has no financial incentive for dialysis providers to educate, to spend time with and to refer patients for transplant.”
As reported in JAMA, Patzer’s team analyzed data from the U.S. Renal Data System and from Dialysis Facility Compare, which provides information on each facility’s profit status and corporate ownership, and the Dialysis Facility Report, which captures information on facility-level patient demographics, mortality, treatment patterns and transplantation rates.
The researchers ultimately focused on nearly 1.5 million patients diagnosed between 2000 to 2016, 87% of whom received care at for-profit facilities. During the study period, 121,680 patients (8.2%) were placed on a waiting list for a deceased-donor transplant, 49,290 (3.3%) actually received a deceased-donor kidney transplant, and 23,762 (1.6%) received a living-donor kidney transplant.
Patients at for-profit facilities were 64% less likely to get on a transplant waiting list, 56% less likely to get a transplant from a deceased donor and 48% less likely to receive a kidney transplant from a living donor.
There may be ways to improve the situation, 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,” Patzer said in an email. “The new executive order announced this summer, called the Kidney Health Initiative, is a step in the right direction in that it proposes new payment models to promote access to kidney transplantation, among other components.”
The new study is “very important,” said Dr. Martin Wijkstrom, an assistant professor of transplant surgery at the University of Pittsburgh Medical School and director of islet cell transplantation at UPMC. “It may not be the first to point out this disparity but it’s pretty comprehensive.”
“It’s scary to see such low numbers,” Wijkstrom said. “When I was reading the study, I started thinking how this could be fixed.”
What Wijkstrom came up with was this: patients should get counseling about kidney transplantation before they are referred for dialysis, preferably when they are getting a procedure to create a “vascular access route” that will allow the patient to be connected with the dialysis machine.
“That way you remove the referral from the nephrologist (who is working for the dialysis facility),” Wijkstrom said. “There’s always going to be conflict of interest in the situation where the nephrologist there does the referring.”