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To the Editor: Dr Devereaux and colleagues¹ hypothesized that understaffing and shorter dialysis treatment time in for-profit dialysis centers were among possible causes for their higher mortality rates. We think other interpretations are likely. First, 5 of 7 studies in their meta-analysis were published more than 10 years ago and the data analyzed in these studies were even older. It is possible that current practice patterns are significantly different. Second, although multivariate adjustment was carried out for such potential confounding factors as age, race, and underlying kidney disease, the authors did not assess the quality of care delivered by nephrologists.

Similarly, they did not account for affiliation of dialysis units with academic medical centers. We have previously reported that our non–hospital-based dialysis unit, which is owned by one the largest for-profit dialysis companies, has a significantly lower annual mortality rate² than is the overall average reported by the United States . . . [Full Text of this Article]

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