Abstract: This study aimed to investigate racial and ethnic disparities in dialysis facility-level performance and identify factors contributing to these disparities. The study used data from the Centers for Medicare & Medicaid Services' Dialysis Facility Compare database and included 6,745 dialysis facilities in the United States. This was a cross-sectional study that used a multilevel regression model to analyze facility-level performance measures, including patient outcomes and quality of care indicators. The study used publicly available data from the Dialysis Facility Compare database, which includes information on facility characteristics, patient demographics, and clinical outcomes. The study found significant racial and ethnic disparities in dialysis facility-level performance, with Black and Hispanic patients experiencing worse outcomes compared to White patients. These disparities persisted even after adjusting for patient and facility-level factors. The study also identified several factors contributing to these disparities, including differences in patient demographics, facility characteristics, and geographic location. The study highlights the need for targeted interventions to address racial and ethnic disparities in dialysis facility-level performance. These interventions should focus on improving access to high-quality care for Black and Hispanic patients and addressing the underlying factors contributing to these disparities.