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Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant in Pediatric Patients With End-stage Kidney Disease in the US.
JAMA. 2022 08 02; 328(5):451-459.JAMA

Abstract

Importance

Care of adults at profit vs nonprofit dialysis facilities has been associated with lower access to transplant. Whether profit status is associated with transplant access for pediatric patients with end-stage kidney disease is unknown.

Objective

To determine whether profit status of dialysis facilities is associated with placement on the kidney transplant waiting list or receipt of kidney transplant among pediatric patients receiving maintenance dialysis.

Design, Setting, and Participants

This retrospective cohort study reviewed the US Renal Data System records of 13 333 patients younger than 18 years who started dialysis from 2000 through 2018 in US dialysis facilities (followed up through June 30, 2019).

Exposures

Time-updated profit status of dialysis facilities.

Main Outcomes and Measures

Cox models, adjusted for clinical and demographic factors, were used to examine time to wait-listing and receipt of kidney transplant by profit status of dialysis facilities.

Results

A total of 13 333 pediatric patients who started receiving maintenance dialysis were included in the analysis (median age, 12 years [IQR, 3-15 years]; 6054 females [45%]; 3321 non-Hispanic Black patients [25%]; 3695 Hispanic patients [28%]). During a median follow-up of 0.87 years (IQR, 0.39-1.85 years), the incidence of wait-listing was lower at profit facilities than at nonprofit facilities, 36.2 vs 49.8 per 100 person-years, respectively (absolute risk difference, -13.6 (95% CI, -15.4 to -11.8 per 100 person-years; adjusted hazard ratio [HR] for wait-listing at profit vs nonprofit facilities, 0.79; 95% CI, 0.75-0.83). During a median follow-up of 1.52 years (IQR, 0.75-2.87 years), the incidence of kidney transplant (living or deceased donor) was also lower at profit facilities than at nonprofit facilities, 21.5 vs 31.3 per 100 person-years, respectively; absolute risk difference, -9.8 (95% CI, -10.9 to -8.6 per 100 person-years) adjusted HR for kidney transplant at profit vs nonprofit facilities, 0.71 (95% CI, 0.67-0.74).

Conclusions and Relevance

Among a cohort of pediatric patients receiving dialysis in the US from 2000 through 2018, profit facility status was associated with longer time to wait-listing and longer time to kidney transplant.

Links

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Authors+Show Affiliations

Amaral S
Children's Hospital of Philadelphia, Division of Pediatric Nephrology, Department of Pediatrics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
McCulloch CE
Department of Epidemiology and Biostatistics, University of California, San Francisco.
Lin F
Department of Epidemiology and Biostatistics, University of California, San Francisco.
Grimes BA
Department of Epidemiology and Biostatistics, University of California, San Francisco.
Furth S
Children's Hospital of Philadelphia, Division of Pediatric Nephrology, Department of Pediatrics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Warady B
Division of Pediatric Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
Brunson C
Division of Pediatric Nephrology, Children's National Health System, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Siyahian S
Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco.
Ku E
Department of Epidemiology and Biostatistics, University of California, San Francisco. Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco.

MeSH

AdolescentAmbulatory Care FacilitiesChildChild, PreschoolFemaleHealth Facility AdministrationHealth Services AccessibilityHumansKidney Failure, ChronicKidney TransplantationMaleOrganizations, NonprofitOwnershipRenal DialysisRetrospective StudiesTime FactorsWaiting Lists

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35916847

Citation

Amaral, Sandra, et al. "Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant in Pediatric Patients With End-stage Kidney Disease in the US." JAMA, vol. 328, no. 5, 2022, pp. 451-459.
Amaral S, McCulloch CE, Lin F, et al. Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant in Pediatric Patients With End-stage Kidney Disease in the US. JAMA. 2022;328(5):451-459.
Amaral, S., McCulloch, C. E., Lin, F., Grimes, B. A., Furth, S., Warady, B., Brunson, C., Siyahian, S., & Ku, E. (2022). Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant in Pediatric Patients With End-stage Kidney Disease in the US. JAMA, 328(5), 451-459. https://doi.org/10.1001/jama.2022.11231
Amaral S, et al. Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant in Pediatric Patients With End-stage Kidney Disease in the US. JAMA. 2022 08 2;328(5):451-459. PubMed PMID: 35916847.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant in Pediatric Patients With End-stage Kidney Disease in the US. AU - Amaral,Sandra, AU - McCulloch,Charles E, AU - Lin,Feng, AU - Grimes,Barbara A, AU - Furth,Susan, AU - Warady,Bradley, AU - Brunson,Celina, AU - Siyahian,Salpi, AU - Ku,Elaine, PY - 2022/8/2/entrez PY - 2022/8/3/pubmed PY - 2022/8/5/medline SP - 451 EP - 459 JF - JAMA JO - JAMA VL - 328 IS - 5 N2 - Importance: Care of adults at profit vs nonprofit dialysis facilities has been associated with lower access to transplant. Whether profit status is associated with transplant access for pediatric patients with end-stage kidney disease is unknown. Objective: To determine whether profit status of dialysis facilities is associated with placement on the kidney transplant waiting list or receipt of kidney transplant among pediatric patients receiving maintenance dialysis. Design, Setting, and Participants: This retrospective cohort study reviewed the US Renal Data System records of 13 333 patients younger than 18 years who started dialysis from 2000 through 2018 in US dialysis facilities (followed up through June 30, 2019). Exposures: Time-updated profit status of dialysis facilities. Main Outcomes and Measures: Cox models, adjusted for clinical and demographic factors, were used to examine time to wait-listing and receipt of kidney transplant by profit status of dialysis facilities. Results: A total of 13 333 pediatric patients who started receiving maintenance dialysis were included in the analysis (median age, 12 years [IQR, 3-15 years]; 6054 females [45%]; 3321 non-Hispanic Black patients [25%]; 3695 Hispanic patients [28%]). During a median follow-up of 0.87 years (IQR, 0.39-1.85 years), the incidence of wait-listing was lower at profit facilities than at nonprofit facilities, 36.2 vs 49.8 per 100 person-years, respectively (absolute risk difference, -13.6 (95% CI, -15.4 to -11.8 per 100 person-years; adjusted hazard ratio [HR] for wait-listing at profit vs nonprofit facilities, 0.79; 95% CI, 0.75-0.83). During a median follow-up of 1.52 years (IQR, 0.75-2.87 years), the incidence of kidney transplant (living or deceased donor) was also lower at profit facilities than at nonprofit facilities, 21.5 vs 31.3 per 100 person-years, respectively; absolute risk difference, -9.8 (95% CI, -10.9 to -8.6 per 100 person-years) adjusted HR for kidney transplant at profit vs nonprofit facilities, 0.71 (95% CI, 0.67-0.74). Conclusions and Relevance: Among a cohort of pediatric patients receiving dialysis in the US from 2000 through 2018, profit facility status was associated with longer time to wait-listing and longer time to kidney transplant. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/35916847/Association_Between_Dialysis_Facility_Ownership_and_Access_to_the_Waiting_List_and_Transplant_in_Pediatric_Patients_With_End_stage_Kidney_Disease_in_the_US_ DB - PRIME DP - Unbound Medicine ER -