Before 1980, non-profit and hospital-based facilities provided the majority of care for pts with end stage renal disease(ESRD). Over the last 2 decades, for profit and independent units have become more frequent providers of ESRD care. The impact of this change on the choice of therapy in children with ESRD had not been previously examined. To determine whether facility profit status or affiliation is associated with dialysis modality choice in the pediatric ESRD population, we conducted a national cross-sectional study of 1568 prevalent pts (aged <19 yrs), using 1994 Health Care Financing Administration data.

The mean age(sd) of the 1568 pts was 14 yrs(sd 5.2). The mean duration of ESRD was 3.5 yrs(sd 3.5). The majority of pts (60%) were dialyzed in hospital based an in non-profit(72%) facilities. 45% pts were on peritoneal dialysis(PD), 55% on hemodialysis (HD).

In bivariate analysis, pediatric pts at hospital based units were twice as likely as those at independent units to receive PD over HD (OR 1.9 (95%CI 1.6, 2.4)). Children with ESRD at non-profit facilities were almost 3 times as likely as those at for-profit units to be on PD (OR 2.8 (95%CI 2.2,3.6)). In multivariate analysis, after controlling for pt age, race, duration of ESRD and free-standing or hospital based facility, pts at non-profit units were still almost 3 times more likely than those dialyzed at for-profit units to be on PD rather than HD(OR 2.9(95%CI 2.0, 4.2)). After controlling for the clustering of pts within each facility using the generalized estimation equation, the association between non-profit status and the use of PD persisted (OR 2.4(95% CI 1.6, 3.7)).

We conclude that children with ESRD treated at non-profit facilities are much more likely to receive PD than children treated at for profit facilities in this cross-sectional study. The difference in dialysis choice has clinical implications as PD is widely considered the preferred dialysis modality for children with ESRD, and has been associated with improved pt outcome and less cost. The association of profit status and dialysis choice suggests that clinical decisions in pediatrics may be influenced by the ownership of the health care facility where the patient is treated. Further analysis of dialysis choice for new pts with ESRD is needed to determine whether the profit status of the treating facility influences initial ESRD treatment choice.