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Abstract: TH-PO279

Dialysis Facility Acquisitions and Patient Health Outcomes

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Erickson, Kevin F., Baylor College of Medicine, Bellaire, Texas, United States
  • Zhao, Bo, Baylor College of Medicine, Bellaire, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Bellaire, Texas, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine , Palo Alto, California, United States
  • Ho, Vivian, Baker Institute for Public Policy, Houston, Texas, United States

Mergers and acquisitions among healthcare providers are increasingly common. Although dialysis markets have undergone several decades of mergers and acquisitions, their effects on patient health outcomes are unknown.


We identified patients initiating in-center hemodialysis between 2001 and 2013 from a national ESRD registry and used difference-in-differences (DID) models to estimate the associations among dialysis facility acquisitions, mortality and hospitalization. We used multivariable Cox models and negative binomial models (with predicted marginal effects) to examine mortality and hospital days, respectively. All analyses adjusted for observed differences in patient and geographic characteristics. In addition to examining all facility ownership types, we conducted stratified analyses of facilities that were independently-owned and chain-owned prior to acquisition.


When examining all facility ownership types, dialysis facility acquisitions were independently associated with 0.63 additional hospital days per patient-year (95% CI 0.00 to 1.27; p=0.07). When examining independently-owned facilities, acquisitions led to 2.01 additional adjusted hospitalization days per patient-year (95% CI 0.53 to 3.48) and a nominally significant 13% relative increase in adjusted mortality (95% CI 4% to 22%).


Acquisition of independently-owned dialysis facilities by large dialysis organizations led to higher adjusted mortality and an increase in adjusted hospital days per patient-year.


  • NIDDK Support