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Dialysis chains and placement on the waiting list for a cadaveric kidney transplant.
Transplantation. 2014 Sep 15; 98(5):543-51.T

Abstract

BACKGROUND

The proliferation of multi-unit for-profit dialysis chains in the ESRD industry has raised concerns for patient quality of care including access to renal transplantation therapy (RTT). The effect of dialysis facility chain status on RTT is unknown.

METHODS

Data from the United States Renal Data System were used to identify 4,465 dialysis facilities and 56,714 dialysis patients who started hemodialysis in 2006. Patients were followed from initiation of hemodialysis in 2006 to placement on the renal transplant waiting list or to December 31, 2009. The role of dialysis facility chain status (affiliation, size, and ownership) on placement on the renal transplant waiting list was evaluated by multi-level mixed-effect regression models that account for clustering within facilities.

RESULTS

Patients from for-profit chain facilities, compared to nonprofit chain facilities, were 13% (95% CI 0.77-0.98) less likely to be waitlisted. In contrast, among nonchains, facility ownership did not influence likelihood of being waitlisted. There was also a marginally significant difference in waiting list placement by chain size: large chains compared with mid or small chains were 8% (95% CI 0.84-1.00) less likely to place patients on the waiting list. After adjustment for patient and facility characteristics, dialysis facility chain affiliation (chain-affiliated or not) was not found to be independently associated with the likelihood of placement on the transplant waitlist.

CONCLUSION

Dialysis chain affiliation expands previously observed ownership-related differences in placement on the waiting list. For-profit ownership of dialysis chain facilities appears to be a significant impediment to access to renal transplants.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Zhang Y
1 Medical Technology and Practice Patterns Institute, Bethesda, MD. 2 Yale School of Public Health, New Haven, CT. 3 Address correspondence to: Dennis Cotter, M.S.E., Medical Technology and Practice Patterns Institute, 5272 River Road, Suite 500, Bethesda, MD.
Thamer M
No affiliation info available
Kshirsagar O
No affiliation info available
Cotter DJ
No affiliation info available
Schlesinger MJ
No affiliation info available

MeSH

AdolescentAdultAgedFemaleFollow-Up StudiesHealth Care SectorHealth Services AccessibilityHumansKidney Failure, ChronicKidney TransplantationMaleMiddle AgedModels, StatisticalOrganizations, NonprofitOwnershipRegression AnalysisRenal DialysisRetrospective StudiesUnited StatesWaiting ListsYoung Adult

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

24798304

Citation

Zhang, Yi, et al. "Dialysis Chains and Placement On the Waiting List for a Cadaveric Kidney Transplant." Transplantation, vol. 98, no. 5, 2014, pp. 543-51.
Zhang Y, Thamer M, Kshirsagar O, et al. Dialysis chains and placement on the waiting list for a cadaveric kidney transplant. Transplantation. 2014;98(5):543-51.
Zhang, Y., Thamer, M., Kshirsagar, O., Cotter, D. J., & Schlesinger, M. J. (2014). Dialysis chains and placement on the waiting list for a cadaveric kidney transplant. Transplantation, 98(5), 543-51. https://doi.org/10.1097/TP.0000000000000106
Zhang Y, et al. Dialysis Chains and Placement On the Waiting List for a Cadaveric Kidney Transplant. Transplantation. 2014 Sep 15;98(5):543-51. PubMed PMID: 24798304.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dialysis chains and placement on the waiting list for a cadaveric kidney transplant. AU - Zhang,Yi, AU - Thamer,Mae, AU - Kshirsagar,Onkar, AU - Cotter,Dennis J, AU - Schlesinger,Mark J, PY - 2014/5/7/entrez PY - 2014/5/7/pubmed PY - 2014/12/19/medline SP - 543 EP - 51 JF - Transplantation JO - Transplantation VL - 98 IS - 5 N2 - BACKGROUND: The proliferation of multi-unit for-profit dialysis chains in the ESRD industry has raised concerns for patient quality of care including access to renal transplantation therapy (RTT). The effect of dialysis facility chain status on RTT is unknown. METHODS: Data from the United States Renal Data System were used to identify 4,465 dialysis facilities and 56,714 dialysis patients who started hemodialysis in 2006. Patients were followed from initiation of hemodialysis in 2006 to placement on the renal transplant waiting list or to December 31, 2009. The role of dialysis facility chain status (affiliation, size, and ownership) on placement on the renal transplant waiting list was evaluated by multi-level mixed-effect regression models that account for clustering within facilities. RESULTS: Patients from for-profit chain facilities, compared to nonprofit chain facilities, were 13% (95% CI 0.77-0.98) less likely to be waitlisted. In contrast, among nonchains, facility ownership did not influence likelihood of being waitlisted. There was also a marginally significant difference in waiting list placement by chain size: large chains compared with mid or small chains were 8% (95% CI 0.84-1.00) less likely to place patients on the waiting list. After adjustment for patient and facility characteristics, dialysis facility chain affiliation (chain-affiliated or not) was not found to be independently associated with the likelihood of placement on the transplant waitlist. CONCLUSION: Dialysis chain affiliation expands previously observed ownership-related differences in placement on the waiting list. For-profit ownership of dialysis chain facilities appears to be a significant impediment to access to renal transplants. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/24798304/Dialysis_chains_and_placement_on_the_waiting_list_for_a_cadaveric_kidney_transplant_ DB - PRIME DP - Unbound Medicine ER -