Children's Hospital of Philadelphia, Division of Pediatric Nephrology, Department of Pediatrics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Department of Epidemiology and Biostatistics, University of California, San Francisco.
JAMA. 2022 Aug 2;328(5):451-459. doi: 10.1001/jama.2022.11231.
Care of adults at profit vs nonprofit dialysis facilities has been associated with lower access to transplant. Whether profit status is associated with transplant access for pediatric patients with end-stage kidney disease is unknown.
To determine whether profit status of dialysis facilities is associated with placement on the kidney transplant waiting list or receipt of kidney transplant among pediatric patients receiving maintenance dialysis.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study reviewed the US Renal Data System records of 13 333 patients younger than 18 years who started dialysis from 2000 through 2018 in US dialysis facilities (followed up through June 30, 2019).
Time-updated profit status of dialysis facilities.
Cox models, adjusted for clinical and demographic factors, were used to examine time to wait-listing and receipt of kidney transplant by profit status of dialysis facilities.
A total of 13 333 pediatric patients who started receiving maintenance dialysis were included in the analysis (median age, 12 years [IQR, 3-15 years]; 6054 females [45%]; 3321 non-Hispanic Black patients [25%]; 3695 Hispanic patients [28%]). During a median follow-up of 0.87 years (IQR, 0.39-1.85 years), the incidence of wait-listing was lower at profit facilities than at nonprofit facilities, 36.2 vs 49.8 per 100 person-years, respectively (absolute risk difference, -13.6 (95% CI, -15.4 to -11.8 per 100 person-years; adjusted hazard ratio [HR] for wait-listing at profit vs nonprofit facilities, 0.79; 95% CI, 0.75-0.83). During a median follow-up of 1.52 years (IQR, 0.75-2.87 years), the incidence of kidney transplant (living or deceased donor) was also lower at profit facilities than at nonprofit facilities, 21.5 vs 31.3 per 100 person-years, respectively; absolute risk difference, -9.8 (95% CI, -10.9 to -8.6 per 100 person-years) adjusted HR for kidney transplant at profit vs nonprofit facilities, 0.71 (95% CI, 0.67-0.74).
Among a cohort of pediatric patients receiving dialysis in the US from 2000 through 2018, profit facility status was associated with longer time to wait-listing and longer time to kidney transplant.
营利性与非营利性透析机构对成年人的护理与移植机会较低有关。营利性机构对儿科终末期肾病患者的移植机会是否存在影响尚不清楚。
本研究旨在确定营利性透析机构的盈利状况是否与儿科患者接受维持性透析后进入肾脏移植等候名单或接受肾脏移植有关。
设计、地点和参与者：本回顾性队列研究在美国透析机构接受透析的 13333 名年龄在 18 岁以下的患者（2000 年至 2018 年期间开始透析）的美国肾脏数据系统记录中进行（随访至 2019 年 6 月 30 日）。
透析机构的盈利状况。
采用 Cox 模型，根据临床和人口统计学因素进行调整，分析透析机构盈利状况与肾脏移植等候名单和接受肾脏移植之间的时间关系。
本研究共纳入 13333 名接受维持性透析的儿科患者（中位年龄为 12 岁[四分位距，3-15 岁]；6054 名女性[45%]；3321 名非西班牙裔黑人患者[25%]；3695 名西班牙裔患者[28%]）。在中位 0.87 年（四分位距，0.39-1.85 年）的随访中，营利性机构的等候名单发生率低于非营利性机构，分别为 36.2/100 人年和 49.8/100 人年（绝对风险差，-13.6[95%CI，-15.4 至-11.8/100 人年；营利性与非营利性机构相比，等待名单的调整后危害比[HR]为 0.79[95%CI，0.75-0.83]）。在中位随访 1.52 年（四分位距，0.75-2.87 年）期间，营利性机构的肾脏移植（活体或已故供体）发生率也低于非营利性机构，分别为 21.5/100 人年和 31.3/100 人年；绝对风险差，-9.8[95%CI，-10.9 至-8.6/100 人年），营利性与非营利性机构相比，调整后的肾脏移植 HR 为 0.71[95%CI，0.67-0.74]）。
在 2000 年至 2018 年期间，美国接受透析治疗的儿科患者队列中，营利性机构的状况与等候名单时间延长和肾脏移植时间延长有关。
