Large Dialysis Companies Use Peritoneal Dialysis Less

NEW YORK—Large dialysis organizations use peritoneal dialysis significantly less than their smaller counterparts, which can lead to worse patient outcomes, according to a study published online April 9 in the American Journal of Kidney Diseases.

Peritoneal dialysis (PD) is the most used form of home dialysis, and the authors said its costs are significantly lower than in-center hemodialysis. The cost of PD supplies is more than in-center dialysis, but the staffing and capital costs are lower, according to the study.

The study authors wrote that, “it would be reasonable to suggest that the use of dialysis therapy modalities that decrease overall costs without compromising patient outcomes should be encouraged.”

PD’s use, however, lags. In 2005, only 6.6 percent of new dialysis patients were on PD, according to the U.S. Renal Data System. The study noted that the majority of these patients were not offered the PD option. In addition, many physicians have few opportunities to learn about the therapy in training, many units lack a home dialysis infrastructure, and there are concerns about can perform home dialysis.

Since 1996, the number of PD patients has decreased dramatically, according to the study. And during that time, the dialysis industry has changed significantly in ownership, due in large part to consolidation and the rise of large dialysis organizations, or LDOs.

To understand the relationship between facility ownership and the use of peritoneal dialysis, the researchers looked at data between 1996 and 2004 from LDOs, which were defined as corporations owning 20 or more freestanding dialysis clinics located in more than one state.

During the nine-year study period, the number of dialysis clinics in the country increased 53 percent, according to the study. In 1996, LDOs treated 39 percent of all dialysis patients. In 2004, they treated 63 percent.

The companies identified in the study included DaVita, Dialysis Clinics Inc., Everest, Fresenius, Gambro, National, Renal Care Group, RenalTreatmentCenters and Vivra. Four of those LDOs only existed during part of the study period, and other were merged with larger companies.

As a result, the researchers chose to not identify the specific LDO findings in the study partly because the results “may not be applicable to the consolidated entities as they exist today.” Therefore, the five LDOs in the study were labeled LDO 1, LDO 2, LDO 3, LDO 4 and LDO 5.