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June 18, 2003

Quality of Care in Profit vs Not-For-Profit Dialysis Centers—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(23):3087-3088. doi:10.1001/jama.289.23.3087

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.

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