Dialysis Center Ownership Affects Time to Transplant in Children

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Among pediatric patients with end stage kidney disease (ESKD), as with adults, those receiving care at for-profit dialysis facilities have longer times to waitlisting and kidney transplantation, reports a study in the Journal of the American Medical Association.

The researchers analyzed data from the US Renal Data System on 13,333 pediatric patients (younger than 18 years) who initiated dialysis at US facilities between 2000 and 2018, with follow-up through 2019. The patients were 55% male and 45% female, and median age was 12 years. Twenty-eight percent were Hispanic, and 25% were non-Hispanic Black. At follow-up, time to kidney transplant waitlisting and transplant receipt were compared for patients receiving care at for-profit versus nonprofit dialysis facilities.

The analysis included 3618 patients receiving dialysis at for-profit centers, 7907 at nonprofit centers, and 1748 who switched from one type of center to the other. Patients receiving care at for-profit facilities were older: median age, 13 versus 10 years. Rural patients were more likely to be treated at for-profit centers, whereas patients in the Northeast region were more likely to receive care at nonprofit facilities.

Overall, 76% of patients were placed on the transplant waitlist during follow-up. At a median follow-up of 0.87 years, incidence of waitlisting was 36.2 per 100 person-years at for-profit facilities versus 49.8 per 100 person-years at nonprofit facilities. The adjusted hazard ratio for waitlisting at for-profit dialysis centers was 0.79.

At a median follow-up of 1.52 years, 69% of patients received a kidney transplant. Rates of kidney transplantation were lower for young patients treated at for-profit dialysis centers: 21.5 versus 31.3 per 100 person-years, and the adjusted hazard ratio was 0.71.

Previous studies have reported lower transplantation and survival rates for adult ESKD patients receiving care at for-profit dialysis centers. The new study finds lower rates of waitlisting and transplant receipt for children and adolescents treated at for-profit versus nonprofit facilities.

The study “raises concerns that pediatric patients with ESKD may be disadvantaged for transplant access when they receive care at profit facilities,” the researchers wrote. They discussed their findings in light of ongoing efforts to ensure access to transplantation for children with ESKD [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; 328:451–459. doi: 10.1001/jama.2022.11231].

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