ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2022 and some content may be unavailable. To unlock all content for 2022, please visit the archives.

Abstract: SA-PO392

Nephrologist Ownership of Dialysis Facilities and Dialysis Outcomes

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Lin, Eugene, University of Southern California Keck School of Medicine, Los Angeles, California, United States
  • Kanter, Genevieve, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Mccoy, Matthew S., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Lung, Khristina I., University of Southern California, Los Angeles, California, United States
  • Rapista, Derick, Duke University School of Medicine, Durham, North Carolina, United States
  • Berns, Jeffrey S., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Nephrologist ownership of dialysis facilities presents a financial conflict of interest because owners can change dialysis prescriptions to increase profitability. Alternatively, facility owners could be more motivated to provide patient-centered care. In this study, we investigated the association between the ownership of dialysis facilities and dialysis outcomes.


Through a Freedom of Information Act request, we obtained a list of freestanding dialysis facilities’ owners in 2018 from the Centers for Medicare and Medicaid Services (CMS), which we linked to a 100% sample of adults with fee-for-service Medicare receiving dialysis for end-stage kidney disease from January 2017 to November 2017 at freestanding facilities. In a multivariable analysis at the patient-month level, we studied the association between outcomes and facility ownership. We conducted a difference-in-differences analysis to mitigate selection bias. For each outcome, we compared patients managed by nephrologist owners at their own facilities versus at other facilities. To eliminate systematic differences between facilities owned by nephrologists and owned by non-nephrologists, we conducted the same comparison for patients managed by nephrologist non-owners. The difference between these comparisons (difference-in-differences) is the change in outcome associated with nephrologist ownership. We adjusted for patient, facility, and geographic confounders.


Nephrologist ownership was associated with a 2.6 percentage point increase (95% CI: 1.4%, 3.8%, p=0.0005) of home dialysis use over a baseline rate of 9.7% (a 27% relative increase). We observed no statistically significant differences in other outcomes, including mortality, transplantation or waitlisting, hospitalizations or 30-day readmissions, missed dialysis treatments, receipt of an erythropoietin-stimulating agent, blood transfusions, use of a fistula or a catheter, or dialysis adequacy (p > 0.05 for all other outcomes).


Nephrologist ownership was associated with a large increase in home dialysis use. We did not observe adverse events associated with a profit motive. However, because it was difficult to obtain ownership data, our analysis was limited to a cross-sectional analysis of nephrologist owners. CMS should make nephrologist ownership of dialysis facilities more transparent.


  • NIDDK Support