MORTALITY IN END-STAGE RENAL-DISEASE IS ASSOCIATED WITH FACILITY-TO-FACILITY DIFFERENCES IN ADEQUACY OF HEMODIALYSIS

Death rates of end-stage renal disease (ESRD) patients treated with he modialysis vary substantially among treatment centers. The association between facility-to-facility differences in delivered hemodialysis do se and facility-specific mortality rates was examined among 5817 rando mly selected patients treated with hemodialysis on October 1, 1994, fr om all 213 hemodialysis treatment centers reporting to ESRD Network 6. The mean urea reduction ratio (URR) for each treatment center, a meas ure of hemodialysis adequacy, was calculated for each facility, using measurements made by center staff members during one treatment for eac h of the randomly selected patients. During 7 mo of follow-up tending April 30, 1995), 441 (7.6%) patients died. The average URR among the t reatment centers was 64.9%. There was a strong, inverse association be tween increasing treatment center URR and adjusted mortality count (P = 0.009). Other treatment center characteristics associated with incre ased mortality included free-standing status (P = 0.009) and decreasin g frequency of reported physician supervision of care (P = 0.01). It w as concluded that lower average levels of dialysis adequacy in treatme nt centers are associated with higher rates of death, and this associa tion persists after controlling for facility-to-facility differences i n patient and nonpatient characteristics.