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Abstract: SA-PO393

Risk of Death in Hospital-Based vs. Free-Standing Dialysis Facilities in the United States

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Zhang, Lucy, University of California San Francisco School of Medicine, San Francisco, California, United States
  • Amaral, Sandra, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Mcculloch, Charles E., University of California San Francisco School of Medicine, San Francisco, California, United States
  • Grimes, Barbara A., University of California San Francisco School of Medicine, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco School of Medicine, San Francisco, California, United States
Background

Prior studies have shown that dialysis facility type is associated with differential patient outcomes, including access to transplantation and mortality risk. It is unclear whether there are any differences in survival in patients receiving care at dialysis facilities that are affiliated with a hospital versus free-standing, and whether such mortality risk varies by race/ethnicity.

Methods

We included adults >18 years who started dialysis between 2014-2018 who were registered in the USRDS and examined the association between dialysis facility affiliation (hospital-based versus free-standing) and risk of death using Cox models and adjusting for age, race, sex, region, cause of kidney disease, dialysis facility network, insurance, county size, co-morbidities, distance to dialysis facility, year of dialysis initiation, and dialysis modality. We then tested for interaction between facility type and race/ethnicity and performed subgroup analysis due to the presence of an interaction (p<0.05).

Results

We included a total of 283,957 patients with a mean age of 55 years. Approximately 59% were men and 30% were Black patients (Table 1). Patients receiving dialysis from hospital-affiliated dialysis facilities had a 12.1% higher risk of death than those receiving dialysis at free-standing facilities (95% CI 7-17%). We detected an interaction between type of dialysis facility and race/ethnicity (p<0.05). Black patients showed a higher differential between hospital and free-standing than other races (Table 2).

Conclusion

Hospital-affiliation (vs. free-standing status) was associated with higher risk of death in dialysis facilities, but findings varied by race. This finding may be due to different patient mix, with hospital-affiliated facilities treating sicker patients. Further studies are needed to further explore drivers of these findings.

Funding

  • NIDDK Support