National Kidney Foundation Responds to Dialysis Patient Mortality Study

New York, NY
November 25, 1999

A study to be published in today’s New England Journal of Medicine comparing dialysis patients’ survival rates at for-profit centers vs. not-for-profit centers raises serious issues, but analyzes data describing dialysis conditions as they were nearly a decade ago, according to the National Kidney Foundation (NKF).

“We want patients to realize that a lot has happened in the management and care of dialysis patients in the last 10 years,” says Garabed Eknoyan, MD, co-chair of NKF’s Dialysis Outcomes Quality Initiative (DOQI).

The study, which included data from the late 1980's through 1993 on 3,569 dialysis patients, found that the mortality rate for patients treated in for-profit centers was 21.2 as compared with 17.1 for those treated in not-for-profit centers. Researchers concluded that for-profit ownership of dialysis facilities is associated with increased mortality and decreased rates of placement on the waiting list for kidney transplant.

According to the National Kidney Foundation, patient mortality cannot be completely tied to economics. The Journal study examined data that predated a number of key developments in dialysis care. In 1994, NKF convened a consensus conference addressing the fact that the U.S. has the highest dialysis mortality rate of any industrialized nation in both for-profit and not-for-profit centers. Since then, NKF launched Dialysis Outcomes Quality Initiative, focusing on four key areas of dialysis care — hemodialysis, peritoneal dialysis, vascular access and anemia management. These were published in 1997 and have been adopted to a great extent by dialysis centers and the government.

Both NKF-DOQI and the advent of erythropoietin (Epogen) have effected improvements in patient outcomes that are not reflected in this study.

Says Garabed Eknoyan, MD, co-chair of NKF-DOQI, “Practice guidelines that standardize care have made a significant difference in outcomes. Additionally, through education and materials such as a dialysis report card, DOQI has begun to empower patients to become partners with the dialysis centers in managing their own care and in taking responsibility for their own outcomes.”

The following are NKF’s key concerns about this study:

  • A vast difference of the magnitude noted by this study’s researchers (20%) in the mortality rate of patients at for profit centers vs. not-for-profit centers has not been substantiated by prior studies on this issue or in ongoing prospective studies.
  • The data covers a period from the late 1980's through 1993.
  • Japan, where two-thirds of the dialysis centers are for-profit, has the lowest patient mortality in the world.
  • In the past few years, there has been a consolidation of dialysis providers. Currently, the majority of dialysis facilities are for-profit. Most of these providers have quality improvement programs which are excellent.

Despite these concerns, Eknoyan says the publication of this study raises awareness of the serious issues of dialysis mortality. NKF plans to increase its efforts to improve all outcomes of dialysis treatment, regardless of facility type. At the same time, the federal government’s Health Care Financing Administration is working on the release of center-specific outcomes data, enabling patients to evaluate the outcomes of their centers and advocate for the best possible care.

The National Kidney Foundation is dedicated to preventing kidney and urinary tract diseases, improving the health and well-being of individuals and families affected by these diseases and increasing the availability of all organs for transplantation.