Children Twice as Likely to Die if Treated at For-Profit Dialysis Centers, Study Warns

For-profit dialysis centers are less likely to offer potentially life-saving treatment if those services are less profitable, researchers found.

A new study raises concerns over the treatment of children at for-profit dialysis centers, suggesting that they may face higher death rates at facilities that are more focused on making money than saving lives.

In findings published this month in the medical journal JAMA Pediatrics, researchers indicate that children who receive dialysis at for-profit facilities have double the risk of dying, when compared to children who receive treatment at nonprofit facilities, and also face a higher risk of being hospitalized for more days overall.

Even when the patient’s kidney transplant status is disregarded, researchers from the University of California, San Francisco still found a 1.5 times higher death rate among children treated at for-profit dialysis centers, leading to calls for additional studies to identify the root causes and targeted interventions that can ensure equal quality of care, even at facilities focused on generating a profit.

The study involved a review of data on 15,359 child patients from the U.S. Renal Data System, involving children who began receiving dialysis for kidney failure at U.S. facilities from 2000 to 2019. Patients were followed up for an average of 1.4 years.

Prior research has found that adults treated at profit dialysis facilities face a higher risk of death, and this new study sought to determine what impact profit status had on the outcomes for children with kidney failure, and whether any such association was mediated by differences in access to receiving a kidney transplant.

The findings suggest that the risk of death for child patients at for-profit clinics was 7 per 100 person-years, and it was only 4 per 100 person-years at nonprofit dialysis centers.

When researchers disregarded kidney transplant status, the risk of death for children was still 1.5 times higher at for-profit clinics, compared to nonprofit centers.

Focus on Profits Endangers Child Patients

Researchers suggested that lower access to kidney transplants at for-profit facilities accounted for 67% of the increased risk of child deaths.

Other studies indicate private facilities often refuse to offer other medical treatments that would decrease the risk of death or prevent lengthy hospital stays. The interventions are often withheld due to financial costs.

For-profit facilities are less likely to offer treatments that are less profitable, while nonprofit facilities will offer treatment regardless of the cost, researchers found.

Roughly 84% of dialysis patients in the United States are treated at one of two major dialysis clinics, DaVita or Fresenius Medical Care.

Nonprofit facilities also often maintain close relationships with doctors at local hospitals, academic centers, and nephrologists. This can help provide better care for children if they need quick access to specialists or hospitalization.

Researchers said the findings point to a need to identify the root cause for health risks during dialysis treatment, and the need for for-profit facilities to offer targeted interventions to improve child death rates.