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Geographic Dialysis Facility Density and Early Dialysis Initiation
Vagish Hemmige1, Priya Deshpande2, Keith C Norris3
1Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
JAMA Network Open
|January 3, 2024
Summary
Higher dialysis facility density in a health service area (HSA) is associated with earlier initiation of maintenance hemodialysis. This finding suggests that increased access to care may influence the timing of dialysis treatment for patients with kidney disease.
Area of Science:
- Nephrology and Public Health
- Health Services Research
Background:
- The timing of maintenance hemodialysis initiation is a critical clinical decision.
- Health system support, indicated by dialysis facility density, may influence this decision.
- Previous studies have not established a link between high dialysis facility density and early hemodialysis initiation.
Purpose of the Study:
- To investigate the association between the density of dialysis facilities within a health service area (HSA) and the initiation of hemodialysis at an earlier stage of chronic kidney disease.
- To determine if greater availability of dialysis centers correlates with earlier treatment commencement.
Main Methods:
- A cross-sectional analysis utilized data from the US Renal Data System (USRDS) for patients initiating hemodialysis between 2011-2019.
- Data were geolocated to HSAs and linked with demographic and socioeconomic information from the American Community Survey.
- Dialysis facility density was categorized, and the odds of initiating hemodialysis at an estimated glomerular filtration rate (eGFR) >10 mL/min/1.73 m² were analyzed.
Main Results:
- The study included 844,466 individuals across 3397 HSAs.
- Higher HSA dialysis facility density was associated with younger patients, higher poverty rates, and a greater proportion of Black individuals.
- Patients in the densest HSAs had significantly higher odds of initiating hemodialysis earlier (eGFR >10 mL/min/1.73 m²) compared to those in less dense areas.
Conclusions:
- Health service area dialysis facility density is associated with earlier hemodialysis initiation.
- Increased geographic accessibility to dialysis services may encourage earlier treatment commencement.
- These findings highlight the role of healthcare infrastructure in shaping clinical decisions for end-stage renal disease management.
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