For patients suffering from kidney failure, dialysis treatments are their literal lifeline. Without such treatments several times a week, the toxins that would normally be removed by their kidneys begin to build up in the bloodstream, eventually reaching deadly levels.

Nearly 400,000 Americans rely on dialysis, which can be difficult and time-consuming, often leaving patients vulnerable to infection and other medical problems.

An ongoing investigation into dialysis clinics by Propublica, a non-profit investigative reporting organization, shows a wide range in the quality of care that clinics provide, and consequently, how often their patients die.

The goal is to help patients make wise choices about where to seek care and to encourage poor-performing centers to improve.

"It doesn't matter if someone's blood is cleaned really well if they acquire an infection and die," said Roberta Mikles, a retired nurse and San Diego-based patient safety advocate. "This gives you a pretty clear picture of what's going on in the facility."

That database shows that in the San Gabriel Valley area, some clinics had as few as one in 20 patients die between 2007 and 2010. At others, as many as one in three patients died during the same time period.

Using the datebase, patients can search for a clinic and see how it compares on 15 key measures, ranging from mortality and hospitalization to transplant rates and infection control.

Among the best-performing clinics in the San Gabriel Valley were:

The Kaiser Foundation Hospital Medical Center in Baldwin Park, which had an overall mortality rate of 5 percent. That is 62 percent better than would be expected for clinics with similar patient demographics. Kaiser officials declined to be interviewed for this story.

The Huntington Dialysis Center in Pasadena, which had an overall mortality rate of 12 percent. That is 39 percent better than would be expected. Huntington officials did not return calls requesting comment.

Among the worst performing clinics were:

The Montebello Dialysis Center, which had a first-year mortality rate of 48 percent. That is 150 percent worse than would be expected. Its overall mortality rate was not significantly higher than would be expected.

The Temple City Dialysis Facility, which had a 33 percent overall mortality rate. That rate is 62 percent worse than would be expected.

The Azusa Dialysis Center, which has an overall mortality rate of 25 percent. That is 87 percent worse than would be expected. It's first-year mortality rate was even worse. Of those patients, 45 percent - nearly half - died. That rate is 190 percent worse than would be expected.

Because each clinic will have its own mix of patient demographics, the comparison to other similar clinics provides a clearer view of how a clinic is performing. Clinics are therefore compared based on patient demographics such as age, race, ethnicity, gender, body mass index, and several other categories to provide the actual versus expected rating.

Inspections reveal issues

Records of state inspections at the Temple City and Azusa clinics reveal a multitude of problems, including improper sanitation of equipment, dirty conditions, and a lack of labels on dialysis solutions and chemicals.

When Temple City Dialysis was inspected in June 2009, the inspector found that employees were not sanitizing pieces of equipment. The inspector also found dust on floors, counters and air vents, leaks in the ceiling, and debris on the floor of some rooms. Bottles of sterilizing fluid were stored in milk crates, trash bins were placed on dialysis machines and stained towels were found under a sink.

When Azusa Dialysis was inspected in September 2009, many of the same conditions were found. Ceiling and wall vents had "an accumulation of dust," there was dust and debris on the floor, and a handwashing sink was being used to store supplies. Soiled gloves and a syringe were found on the floor of one room, and sterilizing liquid was stored in a dusty milk crate.

Sterilization and cleanliness are important during any medical treatment, but especially so in dialysis. Because the patient's blood is being removed from their body to be cleaned, bacteria and viruses in or on the equipment could potentially be passed directly into the bloodstream.

Messages left for the administrator at Azusa Dialysis were not returned. State records identify the administrator as Yaseen Bari, who is also on record as the administrator of Temple City Dialysis.

Connie Salvador, director of nursing at Temple City Dialysis, said the problems at the clinic were "not really related to patient care."

"It's nothing serious that we need to take care of - it's an overnight fix like the ceiling. They found a leak and you have to repair that," Salvador said.

Many factors cited

Administrators defended their clinics, despite high mortality rates, saying many factors that contribute to patient deaths are out of their control.

Lauren Moughon, spokeswoman for DaVita, one of the largest chains of dialysis centers in the country, said mortality rates are often "just the luck of the draw."

"People that crash into dialysis tend to be much more fragile and much sicker because their blood has gotten toxic and it's just a bad situation," she said.

Salvador said Temple City Dialysis has a high mortality rate because some of the clinic's patients stopped dialysis and died after entering hospice care.

And she said sometimes life-threatening infections result from regulations put in place by HMOs. In particular, she said the clinic cannot remove patient catheters without prior approval, leading to an increased possibility of infection while they wait.

That sentiment was echoed by Mary Shih, administrator of the Rosemead Dialysis Center. That clinic has an overall mortality rate of 20 percent and a first-year mortality rate of 36 percent.

Some patients do not do their part to stay healthy, Shih said. One patient, who was a construction worker, got an infection after getting his catheter dirty while working, she said.

"No matter what you tell patients they just don't listen," Shih said. "It's hard, it's really difficult."

Shih also described how larger clinics with more resources engage in "cherry picking" the healthiest patients. That leaves the smaller clinics with only the sicker patients who are more likely to die.

Brian Hess, a 30-year-old dialysis patient from Oklahoma, said he's seen cherry picking first hand. Some clinics will turn away patients who have health problems in addition to kidney disease, he said. A friend of his was refused treatment at some clinics because of his mental illness.

"I don't think someone should be turned away for something like that when this is a life-or-death situation," he said.

Hess, who has been suffering from kidney disease from age 6, agreed that patients are often responsible for their own health issues, but said nurses don't always seem trained well for their jobs.

"It's on both sides of the fence with the patients and with the nurses and the techs and it all has to do with education on both sides," Hess said.

And he said clinics do seem to vary a lot in quality, with some being too crowded or not clean enough.

Because of the poor conditions at some clinics and the possibility he could catch an infection during treatment, Hess has now switched over to home dialysis. He said it is not only cheaper, he feels better about the process because he is in charge of his own treatment.

"The (treatments) in centers are designed to clean your blood just enough to keep you alive, whereas at home you're doing it much more often and so you're doing a much more thorough cleaning so you're healthier and feeling better," Hess said.

Staff Writer James Figueroa contributed to this report, as did Sandy Kleffman of the San Jose Mercury News.

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