Importance Care of adults at profit vs nonprofit dialysis facilities has been associated with lower access to transplant. Whether profit status is associated with transplant access for pediatric patients with end-stage kidney disease is unknown. Objective To determine whether profit status of dialysis facilities is associated with placement on the kidney transplant waiting list or receipt of kidney transplant among pediatric patients receiving maintenance dialysis. Design, Setting, and Participants This retrospective cohort study reviewed the US Renal Data System records of 13 333 patients younger than 18 years who started dialysis from 2000 through 2018 in US dialysis facilities (followed up through June 30, 2019). Exposures Time-updated profit status of dialysis facilities. Main Outcomes and Measures Cox models, adjusted for clinical and demographic factors, were used to examine time to wait-listing and receipt of kidney transplant by profit status of dialysis facilities. Results A total of 13 333 pediatric patients who started receiving maintenance dialysis were included in the analysis (median age, 12 years [IQR, 3-15 years]; 6054 females [45%]; 3321 non-Hispanic Black patients [25%]; 3695 Hispanic patients [28%]). During a median follow-up of 0.87 years (IQR, 0.39-1.85 years), the incidence of wait-listing was lower at profit facilities than at nonprofit facilities, 36.2 vs 49.8 per 100 person-years, respectively (absolute risk difference, -13.6 (95% CI, -15.4 to -11.8 per 100 person-years; adjusted hazard ratio [HR] for wait-listing at profit vs nonprofit facilities, 0.79; 95% CI, 0.75-0.83). During a median follow-up of 1.52 years (IQR, 0.75-2.87 years), the incidence of kidney transplant (living or deceased donor) was also lower at profit facilities than at nonprofit facilities, 21.5 vs 31.3 per 100 person-years, respectively; absolute risk difference, -9.8 (95% CI, -10.9 to -8.6 per 100 person-years) adjusted HR for kidney transplant at profit vs nonprofit facilities, 0.71 (95% CI, 0.67-0.74). Conclusions and Relevance Among a cohort of pediatric patients receiving dialysis in the US from 2000 through 2018, profit facility status was associated with longer time to wait-listing and longer time to kidney transplant.

中文翻译：

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美国终末期肾病儿科患者透析设施所有权与进入等候名单和移植之间的关联。

重要性 营利性透析机构与非营利性透析机构相比，成人护理与较低的移植机会有关。盈利状况是否与终末期肾病儿科患者的移植机会相关尚不清楚。目的 确定透析机构的利润状况是否与接受维持性透析的儿科患者排在肾移植候补名单或接受肾移植有关。设计、设置和参与者 这项回顾性队列研究审查了 13333 名 18 岁以下患者的美国肾脏数据系统记录，这些患者从 2000 年到 2018 年在美国透析机构开始透析（随访至 2019 年 6 月 30 日）。曝光 透析设施的及时更新的利润状况。主要结果和措施 Cox 模型，根据临床和人口因素进行调整，用于根据透析设施的盈利状况检查等待时间和接受肾移植的时间。结果 共有 13333 名开始接受维持性透析的儿科患者被纳入分析（中位年龄，12 岁 [IQR，3-15 岁]；6054 名女性 [45%]；3321 名非西班牙裔黑人患者 [25%] ; 3695 名西班牙裔患者 [28%])。在 0.87 年的中位随访期间（IQR，0.39-1.85 年），营利机构的候补发生率低于非营利机构，分别为每 100 人年 36.2 人和 49.8 人（绝对风险差异，- 13.6（95% CI，每 100 人年 -15.4 至 -11.8；在营利机构与非营利机构等待名单的调整后风险比 [HR]，0.79；95% CI，0.75-0.83）。中位随访期间1.52 年（IQR，0.75-2。87 岁），肾移植（活体或已故捐献者）的发生率在营利机构也低于非营利机构，分别为每 100 人年 21.5 例和 31.3 例；绝对风险差异，-9.8（95% CI，-10.9 至 -8.6 每 100 人年）盈利性肾移植与非盈利性机构的调整后 HR，0.71（95% CI，0.67-0.74）。结论和相关性 在 2000 年至 2018 年期间在美国接受透析的一组儿科患者中，获利设施状态与更长的等待时间和更长的肾移植时间相关。每 100 人年 6 例）盈利性肾移植与非盈利性机构的调整后 HR，0.71（95% CI，0.67-0.74）。结论和相关性 在 2000 年至 2018 年期间在美国接受透析的一组儿科患者中，获利设施状态与更长的等待时间和更长的肾移植时间相关。每 100 人年 6 例）盈利性肾移植与非盈利性机构的调整后 HR，0.71（95% CI，0.67-0.74）。结论和相关性 在 2000 年至 2018 年期间在美国接受透析的一组儿科患者中，获利设施状态与更长的等待时间和更长的肾移植时间相关。