Research Activities, February 2014
Large for-profit dialysis chains use significantly more injectable medications compared to non-profits
Patient Safety and Quality of Care
Patients receiving dialysis may receive a variety of injectable drugs, including epoetin (to manage anemia), iron, and vitamin D. Dialysis facilities frequently use these drugs to subsidize their declining Medicare payments for routine dialysis and laboratory services. However, patients receiving dialysis from large for-profit facilities have a higher risk of dying. In fact, a new study found that large for-profit chain facilities gave higher dosages of epoetin, iron, and vitamin D, but their administration did not result in improved survival.
The U.S. Renal Data System was used to obtain data on 3,884 freestanding dialysis facilities. Researchers identified 37,942 Medicare patients with end-stage renal disease in 2006. During the next 2 years, the researchers evaluated the use of the three injectable drugs commonly used in dialysis patients. The specific endpoint of the study was all-cause mortality during the 2-year followup. After the study period, 44 percent of patients survived and 31 percent died. Another 25 percent were eliminated from the study for various reasons. More than 70 percent of patients in 2006 received their dialysis from the four largest chain facilities. Large for-profit chains had higher epoetin dosages as well as higher vitamin D dosages compared with non-profit chains and independent facilities. However, this did not result in improved survival.
The researchers call for more studies to understand how dialysis facility status affects outcomes. The study was supported by AHRQ (HS18697).
See "Organizational status of dialysis facilities and patient outcome: does higher injectable medication use mediate increased mortality?" by Yi Zhang Ph.D., Mae Thamer, Ph.D., Onkar Kshirsagar, M.S., and Dennis J. Cotter, M.S.E., in the June 2013 HSR: Health Services Research 48(3), pp. 949-971.