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August 22/29, 2007

Epoetin Dosing and Dialysis Facility Ownership—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(8):861-863. doi:10.1001/jama.298.8.862-b

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.

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