Dialysis facility closures may harm patients’ health and increase their risk for hospitalization, a new study finds.

During 2001 to April 2014, 521 hemodialysis (HD) centers closed in the US, displacing 8386 patients. Compared with open facilities, closures were associated with a significant 9% higher risk for patient hospitalization within 180 days and an absolute annual rate increase of 1.69 hospital days per patient-year, Kevin F. Erickson, MD, MS, and colleagues from Baylor College of Medicine in Houston, Texas, and colleagues reported in the Journal of the American Society of Nephrology.

A model comparing propensity-matched patients in open and closed facilities likewise found a significant 7% increased relative risk of hospitalization within 180 days and an absolute annual rate increase of 1.08 hospital days per year.

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Closures were also associated with a nonsignificant 8% increase in mortality.

According to the investigators, displaced patients may miss treatments during the closure month, experience difficulty traveling to a new dialysis facility, and receive suboptimal dialysis while the new staff learns about their individual challenges, such as fluctuations in blood pressure, intradialytic symptoms, and difficulties with vascular access.

Ongoing changes to reimbursement in US dialysis care may increase the risk of dialysis facility closures, according to the investigators. The authors said their findings “highlight the need for effective policies that continue to mitigate risk of facility closures.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Niu J, Saeed MK, Winkelmayer WC, Erickson KF. Patient health outcomes following dialysis facility closures in the United States. J Am Soc Nephrol. doi:10.1681/ASN.2021020244