More Deaths In For-Profit Dialysis Centers
2,500 More Die Each Year Than In Non-Profit Facilities
The studies analyzed by Devereaux's team looked at dialysis-center data from 1973 through 1997. That's a fatal flaw, according to David G. Warnock, MD, director of nephrology at the University of Alabama, Birmingham, and president-elect of the National Kidney Foundation.
Warnock doesn't doubt that the findings are true for that time period. But he says things are much different today.
"There has been major consolidation in the dialysis industry such that the for-profit chains -- FMC, GAMBRO, DeVita, and RCG -- now 'control' the great majority of U.S. dialysis patients," Warnock tells WebMD. "There is also a large 'non-profit' chain -- DCI -- which is not appreciably different than the others. Many of the distinctions described in the article have been blurred."
Moreover, Warnock says, new treatment guidelines have greatly improved the quality of dialysis care over the last five years.
Devereaux hopes this is true. But he says there's not yet any evidence to support this claim.
Meanwhile, Warnock says patients should ask hard questions of their dialysis centers. They are required to give this information.
"What is the individual dialysis patient to do?" Warnock asks. "They can certainly ask to see the specific outcome indicators for their individual dialysis unit: How does their unit compare to local, regional and national norms?"
Dialysis centers can be rated on the following numbers. Patients can contact the National Kidney Foundation to find out how their center ranks with other centers.
- How frequently do the center's patients die? This is listed as the Standardized Mortality Rate for the dialysis unit.
- How well does the center manage patients' anemia? This is judged by the percentage of patients with hemoglobin measurements above 11 gm/dL.
- How well does the center provide nutritional support and help fight infections? This is judged by the percentage of patients with albumin measurements above 3.5 gm/dL.
- How often does the center use permanent catheters? No more than 15% of the clinic's patients should be using temporary catheters.
- How well does the center control patients' phosphate levels? This is judged by the percentage of patients with phosphate measurements below 6.5 mg/dL.