Impact of Hemodialysis Center Accreditation on Patient Mortality: Korean Nationwide Cohort Study

Background: Since hemodialysis (HD) patients are prone to various complications and high mortality, they need to be treated in HD units with professional personnel, proper equipment, and facilities. The Korean Society of Nephrology has been conducting HD unit accreditation program since 2016. This study was performed to evaluate whether qualified dialysis center (QDC) reduced mortality of HD patients. Methods: This longitudinal, observational cohort study included 31,227 HD from 832 facilities. HD units were classified into two groups: the hospitals that have been certified as QDC between 2016 and 2018 (n = 219) and hospitals that have never been certified as QDC (non-QDC, n = 613). Baseline characteristics and patient mortality were compared between QDC vs. non-QDC groups using Korean HD quality assessment data from 2018. Multivariate logistic regression and Cox proportional hazards model was used to compare patient mortality between two groups. Results: Among study subjects, 30.6% of patients were treated at QDC and 69.4% were treated at non-QDC. The patients in the QDC were younger, had a longer dialysis duration, lower serum phosphorus and calcium levels, and higher hemoglobin and single-pool Kt/V levels compared to the patients from non-QDC group. After adjusting for demographic and clinical parameters, QCD independently reduced mortality risk (hazard ratio, 0.897; 95% confidence interval, 0.847–0.950; P < 0.001). Conclusion: HD unit accreditation program may reduce the risk of death among patients undergoing HD.A total of 5848 deaths occurred during 35.6 ± 8.5 months. After censoring 3515 (10.1%) cases who received kidney transplantation during follow-up, QDC group showed better survival compared to non-QDC group (P < 0.001). Abbreviations: QDC, qualified dialysis center.