(HealthDay News) — Safety net-reliant patients initiating maintenance dialysis are disproportionately cared for at nonprofit/independently owned and hospital-based facilities, according to a study published online in the Journal of the American Society of Nephrology.

Kevin F. Erickson, MD, from the Baylor College of Medicine in Houston, and colleagues examined patients initiating maintenance dialysis in 2008 to 2015 from the US Renal Data System and defined those who were uninsured or had only Medicaid coverage at dialysis onset and had not qualified for Medicare by the fourth dialysis month as “safety net-reliant.”

The researchers found that over time, there was a significant increase in the proportion of patients <65 years old initiating dialysis who were safety net-reliant, from 11 to 14%; 73% of those patients started dialysis at for-profit/chain-owned facilities compared with 76% of all patients starting dialysis. The relative risk for initiating dialysis at nonprofit/independently owned versus for-profit/independently owned facilities was 30% higher for patients who were safety net-reliant; they also had slightly lower relative risks for initiating dialysis at for-profit and nonprofit chain-owned facilities and an increased likelihood of receiving dialysis at hospital-based facilities.

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“Independently-owned nonprofit facilities (which are primarily affiliated with hospitals) provide a disproportionate share of safety-net dialysis care due to both their proximity to safety net-reliant populations and the process of dialysis facility selection and/or assignment,” the authors write.

Several authors disclosed financial ties to pharmaceutical, biotechnology, and dialysis companies.


Erickson KF, Shen JI, Zhao B, et al. Safety-Net Care for Maintenance Dialysis in the United States. J Am Soc Nephrol. doi:10.1681/ASN.2019040417

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