Mortality of Canadians treated by peritoneal dialysis in remote locations

• Published in: Kidney international Vol. 72; no. 8; pp. 1023 - 1028
• Main Authors: Tonelli, M., Hemmelgarn, B., Culleton, B., Klarenbach, S., Gill, J.S., Wiebe, N., Manns, B.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2007; Nature Publishing; Elsevier Limited
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Canada; cohort-study; Emergency and intensive care: renal failure. Dialysis management; end-stage renal disease; geography; Health Services Accessibility; Humans; Intensive care medicine; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Medical sciences; mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; peritoneal dialysis; Peritoneal Dialysis - mortality; Proportional Hazards Models; Prospective Studies; Renal failure; Risk Factors; rural; Rural Population; Survival Analysis; Treatment Outcome; Canada; North America; America; mortality; peritoneal dialysis; end-stage renal disease; cohort-study; geography; rural; Kidney disease; Geography; Nephrology; Urinary system disease; Rural environment; Mortality; Terminal stage; Epidemiology; Peritoneal dialysis; Urology; Extrarenal dialysis; Treatment; Cohort study; Renal failure; Rural area; Localization
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/sj.ki.5002443

Patients residing in remote locations may be more likely to initiate peritoneal dialysis when starting renal replacement therapy to avoid relocation. These patients may have reduced access to medical care, however. To examine the hypothesis that patients residing some distance from their nephrologists would be more likely to select peritoneal dialysis but have an increased risk of mortality, we used prospectively collected data in a random sample of 26 775 patients initiating dialysis in Canada between 1990 and 2000. The distance between the patient's residence at dialysis inception and the practice location of their nephrologists was calculated. We used Cox proportional hazard models to determine the adjusted relation between this distance and clinical outcomes over a mean follow-up period of 2.5 years up to 14 years. Remote-dwelling patients were more likely than urban dwellers to commence peritoneal dialysis in distances ranging from 50 to greater than 300 km than those residing within 50 km. The adjusted rates of death and the adjusted hazard ratio among patients initiating peritoneal dialysis was significantly higher in those living further from the nephrologists than those living within 50 km. Further study into the quality of care delivered to remote-dwelling patients on peritoneal dialysis is needed.