Table 1.
Patient- and Facility-Level Characteristics at Start of Dialysis Within the US Renal Data System Overall and Stratified by Dialysis Facility Ownership, 2000–2016 a
| Characteristicsb | Total | Nonprofit Dialysis Facilitiesc | For-Profit Dialysis Facilitiesc | All Facilities | |||||
|---|---|---|---|---|---|---|---|---|---|
| Small Chains | Independent | Large Chain 1 | Large Chain 2 | Small Chains | Independent | Nonprofit | For-Profit | ||
| Facilities | 6511 (100) | 435 (6.7) | 324(5.0) | 2239 (34.4) | 2082 (32.0) | 997 (15.3) | 434(6.7) | 759 (11.7) | 5752 (88.3) |
| Patients | 1478 564(100) | 109 030 (7.4) | 78 287 (5.3) | 483 988(32.7) | 482 689 (32.6) | 225 890 (15.3) | 98 680 (6.7) | 187 317 (12.7) | 1 291 247(87.3) |
| Patient-Level Characteristics at Start of Dialysisb | |||||||||
| Age, median (IQR), y | 66 (55–76) | 65 (54–75) | 62 (51–73) | 66 (55–76) | 66 (55–76) | 66 (55–76) | 67 (56–76) | 64 (53–74) | 66 (55–76) |
| Age group, y | |||||||||
| 18–29 | 31 745 (2.1) | 2721 (2.5) | 3024 (3.9) | 10 371 (2.1) | 9456 (2.0) | 4379(1.9) | 1794(1.8) | 5745 (3.1) | 26 000 (2.0) |
| 30–39 | 67 186 (4.5) | 5372 (4.9) | 5069 (6.5) | 21 785 (4.5) | 21 195(4.4) | 9936(4.4) | 3829(3.9) | 10 441 (5.6) | 56 745 (4.4) |
| 40–49 | 143 339(9.7) | 111 38(10.2) | 9988 (12.8) | 46 268 (9.6) | 45 509(9.4) | 21 812(9.7) | 8624(8.7) | 21 126(11.3) | 122 213 (9.5) |
| 50–59 | 268 858(18.2) | 20 320 (18.6) | 16 313 (20.8) | 87 683 (18.1) | 86 466(17.9) | 40 996 (18.1) | 17 080 (17.3) | 36 633 (19.6) | 232 225 (18.0) |
| 60–69 | 364 820(24.7) | 26 401 (24.2) | 18 569 (23.7) | 119 203 (24.6) | 120 011 (24.9) | 56 176 (24.9) | 24 460 (24.8) | 44 970 (24.0) | 319 850 (24.8) |
| ≥70 | 602 616(40.8) | 43 078 (39.5) | 25 324 (32.3) | 198 678(41.1) | 200 052 (41.4) | 92 591 (41.0) | 42 893 (43.5) | 68 402 (36.5) | 534 214(41.4) |
| Sex | |||||||||
| Male | 818 096(55.3) | 61 160 (56.1) | 45 077 (57.6) | 268 830 (55.5) | 264 618 (54.8) | 124 064 (54.9) | 54 347 (55.1) | 106 237 (56.7) | 711 859 (55.1) |
| Female | 660 468(44.7) | 47 870 (43.9) | 33 210 (42.4) | 215 158(44.5) | 218 071 (45.2) | 101 826 (45.1) | 44 333 (44.9) | 81 080 (43.3) | 579 388 (44.9) |
| Race/ethnicity | |||||||||
| Non-Hispanic white | 805 905 (54.5) | 63 076 (57.9) | 41 721 (53.3) | 258 373 (53.4) | 280 730 (58.2) | 113 594 (50.3) | 48 411 (49.1) | 109 775 (55.7) | 696 130 (54.3) |
| Non-Hispanic black | 415 353 (28.1) | 28 831 (26.4) | 21 050 (26.9) | 134 024(27.7) | 138 400 (28.7) | 65 881 (29.2) | 27 167 (27.5) | 52 798 (26.8) | 362 555 (28.3) |
| Hispanic white | 178 763 (12.1) | 9222 (8.5) | 9997 (12.8) | 65 480 (13.5) | 48 979(10.1) | 28 906 (12.8) | 16 179(16.4) | 20 304(10.3) | 158 459 (12.4) |
| Otherd | 78 543 (5.3) | 7901 (7.2) | 5519(7.0) | 26 111(5.4) | 14 580(3.0) | 17 509 (7.8) | 6923 (7.0) | 14 197 (7.2) | 6346(5.0) |
| Insurance coveragee | |||||||||
| Medicare | 542 921 (39.8) | 40 590(40.4) | 24 339 (33.2) | 172 010(38.9) | 186 054 (41.5) | 84 647 (40.8) | 35 281 (38.4) | 64 929 (37.3) | 477 992 (40.2) |
| Medicaid | 377 827 (27.7) | 25 996 (25.8) | 20 724(28.3) | 126 842 (28.7) | 115 911 (25.9) | 57 570 (27.8) | 30 784 (33.5) | 46 720 (26.9) | 331 107 (27.8) |
| Employer | 239 678(17.6) | 18 328 (18.2) | 14 592 (19.9) | 77 010 (17.4) | 83 322 (18.6) | 34 250 (16.5) | 12 176(13.3) | 32 920 (18.9) | 20 6758 (17.4) |
| None | 103 263 (7.6) | 7957(7.9) | 6573 (9.0) | 32 806 (7.4) | 33 776(7.5) | 16 059 (7.7) | 6092 (6.6) | 14 530 (8.4) | 88 733 (7.5) |
| Otherf | 99 553 (7.3) | 7762 (7.7) | 7063 (9.6) | 33 113 (7.6) | 29 064(6.5) | 14 998 (7.2) | 7553 (8.2) | 14 825 (8.5) | 84 728 (7.1) |
| Attributed cause of ESKD | |||||||||
| Diabetes | 694 455 (47.0) | 51 095 (46.9) | 34 276 (43.8) | 229 209(47.4) | 226 561 (46.9) | 106 898 (47.3) | 46 416(47.1) | 85 371 (45.6) | 609 084 (47.2) |
| Hypertension | 439 480 (29.7) | 27 941 (25.6) | 19 561 (25.0) | 143 466(29.6) | 147 224 (30.5) | 70 466 (31.2) | 30 822 (31.2) | 47 502 (25.4) | 391 978 (30.3) |
| Other disease | 236 794(16.0) | 20 085 (18.4) | 15 942 (20.3) | 76 880 (15.9) | 75 047(15.5) | 33 450 (14.8) | 15 390 (15.6) | 36 027 (19.2) | 200 767 (15.5) |
| Glomerulonephritis | 107 835 (7.3) | 9909(9.1) | 8508 (10.9) | 34 433 (7.1) | 33 857(7.0) | 15 076 (6.7) | 6052 (6.1) | 18 417(9.8) | 89 418 (6.9) |
| Dialysis typeg | |||||||||
| In-center hemodialysis | 1 340 123 (91.1) | 98 475 (90.8) | 70 631 (91.4) | 437 359(90.9) | 444 756 (92.5) | 206 216 (91.6) | 82 686 (84.5) | 169 106 (91.0) | 1171 017(91.1) |
| Peritoneal dialysis | 108 819 (7.4) | 9085 (8.4) | 5958 (7.7) | 38 963 (8.1) | 30 590(6.4) | 17 070 (7.6) | 7153(7.3) | 15 043 (8.1) | 93 776 (7.3) |
| Home hemodialysis | 21 817(1.5) | 922 (0.8) | 700(0.9) | 4632 (1.0) | 5653 (1.2) | 1856(0.8) | 8054(8.2) | 1622 (0.9) | 20 195 (1.6) |
| Patient-Level Comorbidities at Start of Dialysis and Measuresof Access to Transplantationb | |||||||||
| Hypertension | 1 247 373 (84.4) | 92 469 (84.8) | 65 469 (83.6) | 405 013 (83.7) | 407 749 (84.5) | 192 857 (85.4) | 83 816 (84.9) | 157 938 (84.3) | 1 089 435 (84.4) |
| Diabetes | 710 345 (48.0) | 52 311 (48.0) | 34 245 (43.7) | 232 745 (48.1) | 230 242 (47.7) | 111 471 (49.3) | 49 331 (50.0) | 86 556 (46.2) | 623 789 (48.3) |
| Congestive heart failure | 490 683 (33.2) | 37 448 (34.3) | 23 981 (30.6) | 157 215 (32.5) | 162 272 (33.6) | 74 983 (33.2) | 34 784 (35.2) | 61 429 (32.8) | 429 254(33.2) |
| BMI>35h | 275 833 (18.7) | 19 509 (17.9) | 13 701 (17.5) | 88 874(18.4) | 94 357(19.5) | 41 854(18.5) | 17 538 (17.8) | 33 210 (17.7) | 242 623 (18.8) |
| Other cardiac disease | 20 6715 (14.0) | 15 800 (14.5) | 9731 (12.4) | 64 309 (13.3) | 68 370(14.2) | 32 509 (14.4) | 15 996 (16.2) | 25 531 (13.6) | 181 184(14.0) |
| Atherosclerotic heart disease | 205 331 (13.9) | 17 214(15.8) | 11 956 (15.3) | 60 848 (12.6) | 68 021 (14.1) | 30 827 (13.6) | 16 465 (16.7) | 29 170 (15.6) | 176 161 (13.6) |
| Peripheral vascular disease | 198 760(13.4) | 161 17(14.8) | 101 66(13.0) | 61 933 (12.8) | 67 045 (13.9) | 29 942 (13.3) | 13 557 (13.7) | 26 283 (14.0) | 172 477 (13.4) |
| Cerebrovascular disease | 143 362 (9.7) | 11 873 (10.9) | 6762 (8.6) | 44 201 (9.1) | 47 882 (9.9) | 22 045 (9.8) | 10 599 (10.7) | 18 635 (9.9) | 124 727 (9.7) |
| COPD | 142 639(9.6) | 11 763 (10.8) | 6653 (8.5) | 45 302 (9.4) | 47 751 (9.9) | 21 097 (9.3) | 10 073 (10.2) | 18 416(9.8) | 124 223 (9.6) |
| Cancer | 109 679(7.4) | 9566(8.8) | 5686 (7.3) | 34 539 (7.1) | 36 130(7.5) | 16 387 (7.3) | 7371 (7.5) | 15 252 (8.1) | 94427 (7.3) |
| Tobacco use | 92 390 (6.2) | 8788(8.1) | 4514 (5.8) | 29 497 (6.1) | 30 981 (6.4) | 13 295 (5.9) | 5315(5.4) | 13 302 (7.1) | 79 088 (6.1) |
| Nephrology care before ESKDi | 622 983 (42.1) | 50 017 (45.9) | 33 033 (42.2) | 199 389(41.2) | 202 491 (42.0) | 97 429 (43.1) | 40 624 (41.2) | 83 050 (69.3) | 539 933 (66.5) |
| Period of dialysis, median (IQR), y | |||||||||
| Before placement on waiting listJ | 2.0 (0.7–4.2) | 1.9 (0.7–4.2) | 1.5 (0.6–3.7) | 2.0 (0.7–4.3) | 2.0 (0.7–4.2) | 2.0 (0.7–4.2) | 1.9 (0.7–41) | 1.8 (0.6–4.0) | 2.0 (0.7–4.2) |
| Before first transplantk | 2.2 (0.8–4.5) | 2.3 (0.8–4.6) | 2.6 (1.0–5.0) | 2.2 (0.8–4.5) | 2.1 (0.8–4.4) | 2.1 (0.8–4.4) | 2.0 (0.7–4.4) | 2.4 (0.9–4.8) | 2.1 (0.8–4.4) |
| Not informed of transplant options due to medical reasonsl | 80 085 (5.4) | 8040(7.4) | 5761 (7.4) | 21 567 (4.5) | 25 617 (5.3) | 11 804 (5.2) | 7296(7.4) | 14 384 (7.3) | 65 701 (5.1) |
| Dialysis Facility-Level Characteristics | |||||||||
| Patients per facility, median (IQR) | 60 (39–87) | 61 (24–103) | 57 (24–103) | 61 (40–87) | 59 (40–84) | 59 (38–88) | 63 (38–92) | 59 (31–102) | 60 (40–86) |
| Patients:staff, median (IQR)m | 3.4 (2.7–41) | 3.1 (2.4–3.8) | 2.5 (1.9–3.2) | 3.6 (2.9–4.3) | 3.4 (2.8–4.0) | 3.5 (2.8–4.2) | 3.0 (2.3–3.7) | 2.8 (2.2–3.6) | 3.5 (2.8–4.2) |
| Social workers per facility, median (IQR)m | 1(0–1) | 1(0–1) | 1(1–1) | 1(0–1) | 1(0–1) | 1(1–1) | 1(1–1) | 1(0–1) | 1(0–1) |
| Patients:social workers per facility, median (IQR)m | 64 (47–83) | 66 (50–82.5) | 64 (48–82) | 63 (47–84) | 63 (43–86) | 53 (26–72) | 64.3 (49–85) | 59 (31–102) | 64.5 (48–83) |
| Hospitalization rate/100 person-years, median (IQR)n | 173.8 (142.3–209.4) | 159.7 (128.1–195.7) | 155.4 (122.2–185.5) | 179.4 (147.7–216.8) | 173.8 (142.3–208.6) | 174.2 (143.1–209.2) | 176.6 (139.7–219.7) | 157.1 (125.6–190.1) | 176.1 (144.4–211.7) |
| Standardized mortality ratio, mean (SD)m | 1.0 (0.4) | 1.0 (0.4) | 1.0 (0.5) | 1.0 (0.4) | 1.0 (0.3) | 1.0 (0.4) | 11 (0.5) | 1.0 (0.4) | 1.0 (0.4) |
| ESRD Network geographic areasm | |||||||||
| Northeasto | 238 682 (16.1) | 12 588 (11.5) | 32 812 (41.9) | 65 160 (13.5) | 76 260 (15.8) | 24876 (11.0) | 26 986 (27.3) | 46 818 (23.8) | 191 864(15.0) |
| Southp | 608 050 (41.1) | 38 995 (35.8) | 14 837 (19.0) | 186 182 (38.5) | 215 243 (44.6) | 120 286 (53.2) | 32 507 (32.9) | 58 022 (29.4) | 550 028 (42.9) |
| Midwestq | 333 802 (22.6) | 26 053 (23.9) | 20 166 (25.8) | 114 370(23.6) | 134 604 (27.9) | 19 280 (8.5) | 19 329 (19.6) | 48 649 (24.7) | 285 153 (22.3) |
| Westr | 298 030(20.2) | 31 394 (28.8) | 10 472 (13.4) | 118 276(24.4) | 56 582 (11.7) | 61 448 (27.2) | 19 858 (20.1) | 43 585 (22.1) | 25 4445 (19.9) |
| Metropolitan rural-urban classifications | 1 233 267 (84.2) | 88 324(81.5) | 62 967 (81.6) | 413 497(86.1) | 395 681 (82.6) | 187 732 (84.0) | 85 066 (88.0) | 34 191 (14.7) | 197 784 (85.3) |
| Distance from assigned facility to nearest transplant center, median (IQR), mt | 16.7 (6.1–53.2) | 14.5 (3.5–55.9) | 5.9 (0.8–46.7) | 15.2 (6.7–45.7) | 21.6 (6.6–60.8) | 16.5 (6.1–57.3) | 14.8 (6.4–53.0) | 10.1 (1.9–50.4) | 17.6 (6.6–54.1) |
Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; ESKD, end-stage kidney disease; ESRD, end-stage renal disease; IQR, interquartile range.
Data are expressed as No. (%) unless otherwise indicated. Patients were assigned to the last dialysis facility from which they were receiving treatment when the outcome event of interest occurred.
Baseline patient characteristics were obtained at the time the CMS-2728 form was completed.
P<.001 for all comparisons across nonprofit and for-profit facility ownership categories. The P values were calculated using the χ2 test for categorical variables, the Kruskal-Wallis for nonpara metric continuous variables, and the t test for parametric continuous variables.
Defined as Asian, Middle Eastern, Native American, Pacific Islander, or multiracial.
There were missing data for 115 322 patients (7.8%).
This category was collected and defined on the CMS-2728 form and was not further defined.
There are missing data for 7805 patients (0.5%).
Calculated as weight in kilograms divided by height in meters squared.
There were missing data for 546 900 patients (37.0%).
Calculated as the time receiving dialysis from the first date of dialysis treatment to either the date of first placement on the deceased donor kidney transplantation waiting list, at the end of the study, or time of death.
Calculated as the time receiving dialysis from the first date of dialysis treatment to either the date of first transplant (living or deceased donor kidney transplant), at the end of the study, or at time of death.
Obtained from item 27 on the CMS-2728 form. The attending physician recorded no if the patient had not been informed of their transplant options and entered all the reasons why a kidney transplant was not an option for the patient at that time.
Obtained from the Dialysis Facility Report, 2013–2016.
Obtained from the Dialysis Facility Compare, 2016.
Network 1: Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont; Network 2: New York; Network 3: New Jersey; and Network4: Delaware and Pennsylvania.
Network 5: District of Columbia, Maryland, Virginia, and West Virginia; Network 6: Georgia, North Carolina, and South Carolina; Network 7: Florida; Network 8: Alabama, Mississippi, and Tennessee; Network13: Arkansas, Louisiana, and Oklahoma; and Network 14: Texas.
Network 9/10: Illinois, Indiana, Kentucky, and Ohio; Network 11: Michigan, Minnesota, North Dakota, South Dakota, and Wisconsin; and Network 12: Iowa, Kansas, Missouri, and Nebraska.
Network 15: Arizona, Colorado, Nevada, New Mexico, Utah, and Wyoming; Network<16: Alaska, Idaho, Montana, Oregon, and Washington; Network 17: Hawaii and northern California; and Network 18: southern California.
Obtained from the US Department of Agriculture Rural and Urban Continuum Code. There were missing data for 13 322 patients (0.9%).
Calculated using the dialysis facility address from Dialysis Facility Compare (2013–2016) and the nearest transplant center address from the Scientific Registry of Transplant Recipients. There were missing data for 319177 patients (21.6%).