NKF Responds to 11/20 JAMA study on Dialysis Mortality

New York, NY
November 20, 2002

An article published today in JAMA, "Comparision of Mortality Between Private For-Private and Private Not-For-Profit Hemodialysis Centers (Vol. 288 No. 19)," concludes a lower-risk mortality rate for hemodialysis care associated in private not-for-profit centers than private for-profit centers. The National Kidney Foundation (NKF) say industry changes have blurred the distinction between private not-for-profit and for-profit hemodialysis centers found in eight observational studies conducted in the mid-1990s.

"There is no reason to doubt the validity of these findings relevant to that time period, but I am very uncomfortable applying these results to 2002," said David G. Warnock, MD, president-elect of the National Kidney Foundation.

Reasons for marked improvements lay in major consolidations of the private for-profit and not-for-profit hemodialysis dialysis industry and the overall quality indicators. FMC, GAMBRO, DeVita, and RCG now lead the majority of U.S. dialysis patients in for-profit centers. DCI, a major not-for-profit chain, is not appreciably different than the for-profit centers.

While the studies show a significant increase in mortality in for-profit facilities, the NKF's Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines and the Clinical Management Project of the ESRD Network have stimulated the overall quality indicator over the last five years.

Patients may untangle the confusion by reviewing specific outcome indicators about their dialysis unit. They may compare their unit against local, regional and national norms using these indicators:

• Adequacy of dialysis, as judged by the percentage of patients with measured values of "Kt/v" over 1.3.
• Adequacy of anemia management as judged by the percentage of patients with hemoglobin measurements above 11 gm/dL.
• Adequacy of nutritional support and anti-inflammatory measures as judged by percentage of patients with albumin measurements above 3.5 gm/dL.
• Use of non-permanent accesses, as judged by the percentage of patients with temporary catheters for dialysis, should not exceed 15% of the dialysis clinic population.
• Adequacy of phosphate control, as judges by percentage of patients with phosphate measurements below 6.5 mg/dL.

"Patients should also recognized the Standardized Mortality Rate for the their dialysis unit," said Warnock. "The SMR will help them decide if they are receiving optimal care at their unit. It is important to emphasize that these quality indicators have been codified and widely distributed across the country in the NKF K/DOQI guidelines."