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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
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Association Between Dialysis Facility Ownership and Mortality Risk in Children With Kidney Failure
Elaine Ku1,2, Charles E McCulloch2, Alexandra Bicki1
1Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco, San Francisco.
JAMA Pediatrics
|September 5, 2023
Summary
Children undergoing dialysis at for-profit facilities face a higher mortality risk compared to nonprofit facilities. This increased risk is partly due to reduced access to kidney transplants.
Area of Science:
- Pediatric Nephrology
- Health Services Research
- Epidemiology
Background:
- For-profit dialysis facilities in adults are linked to increased mortality.
- Understanding this association in pediatric populations is crucial for improving care.
Purpose of the Study:
- To investigate the association between for-profit dialysis facility status and mortality risk in children with kidney failure.
- To examine if transplant access mediates this association.
Main Methods:
- Retrospective cohort study using US Renal Data System records (2000-2019).
- Analysis of 15,359 children initiating dialysis.
- Time-updated profit status and competing risks (transplant) were analyzed using Fine-Gray and Cox regression models.
Main Results:
- Children at for-profit facilities had a 2.07-fold higher risk of death (95% CI, 1.83-2.35) compared to nonprofit facilities.
- This risk remained elevated (HR, 1.47; 95% CI, 1.35-1.61) when transplant was not censored.
- Reduced transplant access at for-profit facilities mediated 67% of the increased mortality risk.
Conclusions:
- For-profit dialysis facility status is associated with significantly higher mortality in children with kidney failure.
- Lower transplant access in these facilities is a key factor mediating this disparity.
- Targeted interventions are needed to address disparities and improve outcomes in pediatric dialysis care.
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