8 Questions to Ask Any Dialysis Center Before You Start Treatment

Starting dialysis is one of the most significant medical transitions a person can experience. You will spend 12 or more hours per week at your dialysis facility, every week, for years. Choosing the right clinic matters enormously. Here are eight questions to ask before committing.

1. What is your CMS star rating?

Every Medicare-certified dialysis facility receives a 1-to-5 star rating from CMS based on patient outcomes. Ask the facility directly, or look it up on DialysisCenterUSA. A facility that does not know its own star rating — or avoids discussing it — is telling you something.

2. What is your infection rate?

Bloodstream infections are one of the most serious risks of dialysis, especially for patients using catheters. Ask about the facility's standardized infection ratio (SIR). A ratio below 1.0 means fewer infections than the national average. Above 1.0 means more.

3. What percentage of your patients are referred for kidney transplant?

This is the question that reveals the most about a facility's priorities. A clinic that actively refers patients for transplant evaluation is prioritizing the best long-term outcome. A clinic with a low referral rate may be prioritizing revenue retention. You can check any facility's transplant referral rate on DialysisCenterUSA.

4. Do you offer home dialysis or peritoneal dialysis?

Not every patient is a candidate for home dialysis, but it is worth asking. Home hemodialysis and peritoneal dialysis offer more scheduling flexibility, fewer dietary restrictions, and — for some patients — better outcomes than in-center hemodialysis. If a facility does not offer these options, ask if they can refer you to one that does.

5. Who owns this facility?

DaVita and Fresenius control approximately two-thirds of US dialysis facilities. Independent clinics still exist, and research suggests they may refer patients for transplant at higher rates. Knowing who owns your clinic helps you understand the financial incentives at play.

6. What is your patient-to-nurse ratio during my shift?

Staffing levels directly affect care quality. Ask how many patients each nurse is responsible for during your planned treatment time. More patients per nurse means less individual attention, slower response to alarms, and higher risk of complications during treatment.

7. What happens if I have a problem during treatment?

Ask specifically about emergency protocols. Is a physician on-site or on-call? How quickly can they intervene? What is the facility's policy for transferring patients to the emergency room? Knowing this before your first session is important.

8. Can I see your most recent inspection report?

Every dialysis facility is inspected by state surveyors under CMS oversight. The facility is required to make its most recent inspection report available. If they hesitate, you can find inspection deficiency data on DialysisCenterUSA or through the CMS Dialysis Facility Compare tool.

The bottom line

Your dialysis clinic is not just a treatment location — it is where you will spend a significant portion of your life. You have the right to ask these questions, and any facility that discourages you from asking is not acting in your best interest. Use CMS data, ask direct questions, and make the choice that works best for your health and your life.