This treatment approach is used less frequently at for-profit dialysis facilities, data suggest.


TORONTO—Dialysis centers that serve more than 62 patients and those with a late shift have higher proportions of patients receiving home dialysis, as do centers with greater percentages of younger patients and individuals who work full- or part-time, a study shows.

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For-profit facilities that are part of a chain, those with a higher ratio of patients to hemodialysis stations, and those in rural locations had a lower proportion of home dialysis patients.


The findings are based on an analysis of 3,480 dialysis providers by David R. Walker, PhD, of Baxter International Inc. in McGaw Park, Ill., and two colleagues, who examined data from the Dialysis Facility Compare database, the ESRD Network’s 2007 annual report, and the University of Washington Rural Health Research Center in Seattle.


The 3,480 providers had a total of 251,616 dialysis patients. The average number of patients per provider was 72 and the median was 63.


Dr. Walker noted that the non-association of a rural location with greater home dialysis use was a surprising finding. He stated it was expected that patients in rural areas would be more likely to be interested in home dialysis as they usually live farther from dialysis centers and would be less inconvenienced with home treatment than by traveling a greater distance to reach a center three times a week.


One possible reason, he said, is that “a minimum number of home dialysis patients may be needed for a home dialysis program to be profitable, and a rural center may not have enough patients for this.” Further work is necessary to better characterize the findings.


Findings were presented here at the annual meeting of the International Society for Pharmacoeconomics and Outcomes Research.


Commenting on the new findings, nephrologist Alan Kliger, MD, clinical professor of medicine at Yale University in New Haven, Conn., observed: “My hypotheses for the findings are that large facilities with younger patients have more opportunities to accommodate patients’ requests for home dialysis and that also, when facility management focuses on their core competency—that is, in-center dialysis—there will be less home dialysis. The unaddressed issue is that we may not be offering patient-centered care in the U.S.”