Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In their meta-analysis, Dr Devereaux
and colleagues1 concluded that hemodialysis
care in private not-for-profit centers was associated with a lower risk of
mortality compared with care in private for-profit centers.
From more than 7045 citations, the authors selected only 8 to use in
their analyses. Of these, 1 involved patients in a single state from 1973
to 19812; 3 were from dissertations that
have never been peer reviewed or published3- 5;
and 1 was a letter to the editor.6 The article
by Garg et al7 was previously critiqued.8,9 The study of McClellan et al10 showed no differences in mortality between for-profit
and not-for-profit dialysis facilities, and the study by Irvin11 was
an analysis of US Renal Data System (USRDS) data that found only a small (1%-2%)
higher probability of dying in a for-profit dialysis unit.
Bosch J, Hakim RM, Lazarus JM, McAllister CJ. Quality of Care in Profit vs Not-For-Profit Dialysis Centers—Reply. JAMA. 2003;289(23):3087-3088. doi:10.1001/jama.289.23.3087