Flawed Study, Or Uncomfortable Truth?

Kidney failure patients treated at for-profit dialysis centers have higher death rates than those who undergo treatment at nonprofit ones, according to an analysis that blames financial pressures.

Pooling results from eight studies of U.S. dialysis centers from 1973 through 1997, the researchers found an 8 percent increased risk of death among patients who received dialysis at for-profit centers.

That works out to about 2,500 extra deaths nationwide each year among patients treated at for-profit centers, which are the most common type in the United States, the researchers said.

Some doctors strongly criticized the report and said it does not reflect current practices.

But Dr. Sidney Wolfe of the consumer advocacy group Public Citizen said the study echoes his own research linking for-profit health maintenance organizations with lower-quality medical care.

The study appears in Wednesday's Journal of the American Medical Association.

The analysis was conducted by researchers at McMaster University in Hamilton, Ontario, and comes amid a heated debate in Canada over whether to allow private for-profit health care to start operating there.

"Our results suggest the inadvisability of introducing private for-profit dialysis centers into the Canadian health care system," the researchers said.

McMaster researcher Dr. P.J. Devereaux said "economic realities" facing for-profit centers may explain the results.

"They have to generate money to satisfy shareholders," and to do so may end up cutting costs, he said. That may result in fewer skilled staffers and shorter dialysis times, Devereaux said.

Dr. Paul Scheel, a Johns Hopkins University kidney specialist who was not involved in the research, called it "absolute rubbish."

"It tells you how dialysis was practiced in the early 1980s and '90s and has absolutely zero relevance today," he said.

Dr. David Warnock, president-elect of the National Kidney Foundation, said he also was "very uncomfortable applying these results to 2002."

According to Warnock, the dialysis industry has recently been consolidated, with four major for-profit chains and one large nonprofit group running most of the U.S. centers.

"Many of the distinctions described in the article have been blurred," Warnock said. He also said the overall quality of dialysis has improved markedly over the past five years, prompted in part by National Kidney Foundation guidelines.

The four clinic chains Warnock cited issued a statement Tuesday accusing the journal of publishing a "misleading article."

The data is old and based on a selective re-analysis led by Devereaux, "a leading proponent of government-run health care in Canada," said Fresenius Medical Care North America, DaVita Inc., Gambro Health Care Inc. and Renal Care Group Inc.

By Lindsey Tanner