Hemodialysis in a Satellite Unit: Clinical Performance Target Attainment and Health-Related Quality of Life

• Published in: Clinical journal of the American Society of Nephrology Vol. 6; no. 7; pp. 1692 - 1699
• Main Authors: Diamant, Michael J, Young, Ann, Gallo, Kerri, Xi, Wang, Suri, Rita S, Garg, Amit X, Moist, Louise M
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.07.2011
• Subjects: Aged; Ambulatory Care Facilities - standards; Biomarkers - blood; Calcium - blood; Chi-Square Distribution; Community Health Centers - standards; Cross-Sectional Studies; Female; Health Status; Health Status Indicators; Hemodialysis Units, Hospital - standards; Hemoglobins - analysis; Humans; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; Logistic Models; Male; Middle Aged; Odds Ratio; Ontario; Outcome and Process Assessment (Health Care) - standards; Phosphates - blood; Quality Indicators, Health Care - standards; Quality of Life; Renal Dialysis - adverse effects; Renal Dialysis - standards; Risk Assessment; Risk Factors; Serum Albumin - analysis; Surveys and Questionnaires; Treatment Outcome; Ontario
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.07650810

In Canada, patients are increasingly receiving hemodialysis (HD) in satellite units, which are closer to their community but further from tertiary care hospitals and their nephrologists. The process of care is different in the satellites with fewer visits from nephrologists and reliance on remote communication. The objective of this study is to compare clinical performance target attainment and health-related quality of life (HRQOL) in patients receiving HD in satellite versus in-center units. The London Health Sciences Centre in London, Ontario, Canada, has both tertiary care center and satellite HD units. All eligible patients who received dialysis treatment at one of these units as of July 24, 2008, were enrolled into a cross-sectional study (n = 522). Patient attainment of hemoglobin, albumin, calcium-phosphate (Ca-P) product, Kt/V, and vascular access targets were compared. Participants were also administered the Kidney Disease Quality of Life Short-Form questionnaire. Satellite patients were more likely to attain clinical performance targets for albumin (adjusted odds ratio [OR] = 4.87 [95% confidence interval [CI]: 2.13 to 11.14]), hemoglobin (OR = 1.59 [95% CI: 1.08 to 2.35]), and Ca-P product (OR = 2.02 [95% CI: 1.14 to 3.60]), as well as for multiple targets (P < 0.05). HRQOL scores were largely similar between groups. Patients receiving HD in a satellite unit were just as likely, or more likely, to demonstrate attainment of clinical performance targets as those dialyzing in-center, while maintaining a similar HRQOL. This supports the increased use of satellite units to provide care closer to the patient's community.