Treatment bias in the management of end-stage renal disease

A study was conducted of 419 patients with end-stage renal disease (ESRD) being treated by center or home hemodialysis or by renal transplantation at four facilities located within 2.5 km of each other. The objectives were to examine the distribution of patients among the three modes of treatment and to analyze patient transfers to alternate modes of ESRD therapy. While white patients at each facility were comparable (P greater than 0.05) on age, sex, travel time to treatment, marital status, work or employment status, and the presence of diabetes mellitus, the distribution of patients among the treatment modes differed significantly (P less than 0.001) across the facilities. Similarly, the sociodemographic and diagnostic characteristics of the nonwhite patients were comparable at each of the facilities (P greater than 0.05); however, despite observable variation among the facilities in the distribution of these patients, the differences did not achieve statistical significance (P greater than 0.05). Patient transfers to alternate modes of ESRD therapy were infrequent, and among center hemodialysis patients, the distribution of transfers differed significantly across the facilities (P less than 0.001). It is concluded that the distribution of patients was dependent on the patient's initial mode of therapy and the staff attitudes at the individual facilities.