Accredited Dialysis Centers Cut Patient Death Risk by 10%, Study Finds

A new study has found that the choice of medical facility for hemodialysis can significantly affect mortality risk for patients with kidney failure.

A research team led by Professors Park Hye-in, Kim Do-hyung and Lee Young-ki of the nephrology department at Hallym University Kangnam Sacred Heart Hospital tracked 31,227 hemodialysis patients across 832 medical institutions in South Korea over three years. Patients treated at facilities accredited by the Korean Society of Nephrology (KSN) had a 10% lower overall mortality risk compared to those at non-accredited facilities, the team announced on the 24th.

Hemodialysis is a renal replacement therapy that substitutes for kidney function. The kidneys filter and remove waste products and excess fluid from the body. When kidney function is severely impaired or lost, sustaining life becomes difficult. Patients with end-stage kidney disease, where kidney function falls below 15%, must undergo a process in which blood is drawn out of the body through a specialized catheter to remove waste products. The procedure typically requires about four hours per session, three times a week.

The KSN has voluntarily operated an "Accredited Dialysis Facility" certification program since 2016 to drive quality improvement in hemodialysis. The program comprehensively evaluates infection control, emergency response systems, dialysis equipment maintenance, staffing levels and other factors related to patient safety and quality of care based on international standards.

The research team noted that accreditation status served as an independent survival variable even after adjusting for patient age, sex and underlying conditions such as diabetes and hypertension. The survival gap was particularly pronounced among patients under 65 with relatively shorter dialysis histories. This suggests that receiving treatment at facilities with standardized quality management from the early stages of dialysis directly affects patient survival.

The team identified three key factors behind the survival gap between accredited and non-accredited facilities: the presence of on-site dialysis specialists, compliance with appropriate patient-to-nurse ratios and ethical operations. Accredited facilities demonstrated significantly superior performance in key clinical indicators such as blood phosphorus and calcium level management and dialysis adequacy (Kt/V) compared to non-accredited facilities. These indicators are critical for sustaining the lives of end-stage kidney disease patients and serve as evidence of more appropriate dialysis management. In contrast, some non-accredited facilities were found to cut dialysis time and use low-cost equipment to reduce expenses, raising risks of diminished care quality. Some facilities also engaged in unethical practices such as offering free shuttle bus services and providing cash or gifts to attract patients. Critics point out that the unethical practices of certain "high-volume, low-margin" operators can increase complications and threaten patient lives.

The medical community is calling urgently for the passage of the "Chronic Kidney Disease Management Act" currently proposed in the National Assembly and the establishment of standard treatment criteria for dialysis facilities. South Korea currently lacks adequate legal standards for the establishment and operation of dialysis facilities, leaving the sector in a regulatory blind spot. This stands in stark contrast to advanced countries such as the United States, which manage dialysis facilities through rigorous standard inspections and accreditation programs.

"This study is highly significant as the first in South Korea to demonstrate the mortality reduction effect of the society's accreditation system using Health Insurance Review and Assessment Service data," said Professor Lee Young-ki, the study's corresponding author. "If the government and the society collaborate to build a national quality management system, we could dramatically improve survival rates for hemodialysis patients."

The study was published in a recent issue of Kidney Research and Clinical Practice (KRCP), the official journal of the Korean Society of Nephrology, under the title "Impact of Dialysis Facility Accreditation on Patient Mortality."