Behind the Huge Variations in Dialysis Patient Mortality

"We want to find the secret of survival in dialysis centers with lower mortality.  What is it? We just don't know," he says.

One new approach that seeks to address this disparity came this week in a study  published by the American Society of Nephrology. Researchers in Los Angeles, San Francisco, Palo Alto, Albuquerque and Denver surveyed 423 personnel at 90 dialysis centers—both for profit and not-for-profit—to find out whether specific center practices might be influencing lower or higher death rates.

The researchers found 19 very specific conditions or factors present in centers with low ESRD mortality at higher levels than at centers with high patient mortality.

For example, low-mortality centers had better "patient engagement" manifested by patients' ability to stay for the entirety of their prescribed dialysis session; they didn't leave prematurely as some patients do. They also found greater willingness among patients' willingness to learn from staff.

Also, the number of patients considered to have good compliance with dietary advice was greater in centers with low mortality than it was in centers with high mortality, the staff surveys said.  In short, it sounds like these lower mortality centers offer a friendlier environment for the long hours patients must be there each week.