A study has found that patients receiving hemodialysis at officially certified dialysis centers in Asia face a significantly lower risk of death.
The findings confirm the effectiveness of the “Excellent Dialysis Unit Certification Program” implemented annually by the Korean Society of Nephrology since 2016.
A research team led by Professors Park Hye-in, Kim Do-hyung and Lee Young-gi of Hallym University Kangnam Sacred Heart Hospital’s Division of Nephrology disclosed the results on the 24th in the society’s journal, analyzing the relationship between dialysis unit certification and mortality.
The study is a large-scale observational analysis based on 2018 data from the Health Insurance Review and Assessment Service, with participation from agency officials.
The researchers tracked 31,227 patients undergoing maintenance hemodialysis at 832 medical institutions in Asia over a three-year period.
The analysis showed that patients treated at “Excellent Dialysis Units” certified by the society had a 10% lower overall risk of death (hazard ratio 0.90) compared with those treated at non-certified institutions.
Notably, certification itself functioned as an independent survival factor even after adjusting for patient age, sex, duration of dialysis, and comorbidities such as diabetes and hypertension.
Differences in survival rates were particularly pronounced among patients under age 65 and those with shorter dialysis durations. This suggests that the quality of care at medical institutions directly affects survival outcomes for hemodialysis patients.
The research team identified key factors behind the survival gap between certified and non-certified institutions as the presence of dialysis specialists, adherence to appropriate patient-to-nurse ratios, and ethical management practices.
Certified institutions demonstrated significantly better performance in key clinical indicators, including blood phosphorus and calcium control and dialysis adequacy (Kt/V), compared with non-certified centers.
This indicates a higher standard of dialysis management, which is a critical factor in sustaining the lives of patients with end-stage kidney disease.
In contrast, some non-certified institutions were found to engage in unethical practices, such as offering free transportation or financial incentives to attract patients, or shortening dialysis times to reduce costs.
The research team said the study is the first in Asia to use Health Insurance Review and Assessment Service data to demonstrate the mortality reduction effect of the Korean Society of Nephrology’s dialysis unit certification program.
Currently, Asia lacks sufficient government-level legal standards for the establishment and operation of dialysis units, in contrast to the U.S., where dialysis centers are managed through strict inspection and certification programs.
Lee Young-gi said, “If standardized treatment guidelines for dialysis units are established through a Chronic Kidney Disease Management Act and integrated into a national quality management system, patient survival rates could be significantly improved.”
