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Epoetin Dosing and Dialysis Facility Ownership—Reply
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In Reply: Drs Kliger and Nissenson do not believe that our main finding—higher epoetin doses in for-profit dialysis facilities—might be explained by financial incentives. Although we indicated that quality of care decisions, including performance measures requiring reporting hematocrits greater than 33%, might also be important, we believe that the potential of financial incentives to lead to higher hematocrit targets and higher epoetin doses must be acknowledged. They claim that "there may be additional plausible explanations" for our findings, but do not suggest any. Such alternative explanations should be specified so that they can be tested by us and by other investigators.
Financial Disclosures: Dr Kaufman reported serving as a consultant and receiving grant support from Amgen and F. Hoffmann-La Roche. No other authors reported disclosures.
Mae Thamer, PhD
mthamer@mtppi.org
Yi Zhang, MS;
Dennis J. Cotter, MSE
Medical Technology and Practice Patterns Institute
Bethesda, Maryland
James Kaufman, MD
Renal Section
Veterans Affairs Boston Healthcare Systems
Boston, Massachusetts
Miguel A. Hernán, MD
Harvard School of Public Health
Boston, Massachusetts
Letters Section Editor: Robert M. Golub, MD, Senior Editor.
JAMA. 2007;298(8):862.
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