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Transplantation rates for patients in non-profit versus for-profit dialysis centers

From JAMA,September 10, 2019  Volume 322, Number 10:
J::AMA
September 10, 2019 Volume 322, Number 10Association Between Dialysis Facility Ownership and Accessto Kidney Transplantation

Jennifer C. Gander, PhD; Xingyu Zhang, PhD; Katherine Ross, MPH; Adam S. Wilk, PhD; Laura McPherson, MPH; Teri Browne, PhD;Stephen O. Pastan, MD; Elizabeth Walker, MS; Zhensheng Wang, PhD; Rachel E. Patzer, PhD, MPH

"MAIN OUTCOMES AND MEASURES: Access to kidney transplantation was defined as time from initiation of dialysis to placement on the deceased donor kidney transplantation waiting list,receipt of a living donor kidney transplant, or receipt of a deceased donor kidney transplant.Cumulative incidence differences and multivariable Cox models assessed the associationbetween dialysis facility ownership and each outcome.
RESULTS: Among 1 478 564 patients, the median age was 66 years (interquartile range, 55-76years), with 55.3% male, and 28.1% non-Hispanic black patients. Eighty-seven percent ofpatients received care at a for-profit dialysis facility. A total of 109 030 patients (7.4%)received care at 435 nonprofit small chain facilities; 78 287 (5.3%) at 324 nonprofitindependent facilities; 483 988 (32.7%) at 2239 facilities of large for-profit chain 1; 482 689(32.6%) at 2082 facilities of large for-profit chain 2; 225 890 (15.3%) at 997 for-profit smallchain facilities; and 98 680 (6.7%) at 434 for-profit independent facilities. During the studyperiod, 121 680 patients (8.2%) were placed on the deceased donor waiting list, 23 762 (1.6%)received a living donor kidney transplant, and 49 290 (3.3%) received a deceased donorkidney transplant. For-profit facilities had lower 5-year cumulative incidence differences foreach outcome vs nonprofit facilities (deceased donor waiting list: −13.2% [95% CI, −13.4% to−13.0%]; receipt of a living donor kidney transplant: −2.3% [95% CI, −2.4% to −2.3%]; andreceipt of a deceased donor kidney transplant: −4.3% [95% CI, −4.4% to −4.2%]). AdjustedCox analyses showed lower relative rates for each outcome among patients treated at allfor-profit vs all nonprofit dialysis facilities: deceased donor waiting list (hazard ratio [HR], 0.36[95% CI, 0.35 to 0.36]); receipt of a living donor kidney transplant (HR, 0.52 [95% CI, 0.51 to0.54]); and receipt of a deceased donor kidney transplant (HR, 0.44 [95% CI, 0.44 to 0.45]).
CONCLUSIONS AND RELEVANCE: Among US patients with end-stage kidney disease, receiving dialysis at for-profit facilities compared with nonprofit facilities was associated with a lower likelihood of accessing kidney transplantation. Further research is needed to understand the mechanisms behind this association.

Here are the figures. "For-profit large chains" seem to give the slowest access to being put on the transplant waiting list, receiving a living donation, or receiving a deceased donation.

HT: Irene Wapnir

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