Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Apr;5(4):645-51.
doi: 10.2215/CJN.04550709. Epub 2010 Feb 25.

Model for equitable care and outcomes for remote full care hemodialysis units

Keevin Bernstein  1 , James Zacharias, James F Blanchard, B Nancy Yu, Souradet Y Shaw
Affiliations
Comparative Study

Model for equitable care and outcomes for remote full care hemodialysis units

Keevin Bernstein et al. Clin J Am Soc Nephrol. 2010 Apr.

Abstract

Background and objectives: Remotely located patients not living close to a nephrologist present major challenges for providing care. Various models of remotely delivered care have been developed, with a gap in knowledge regarding the outcomes of these heterogeneous models. This report describes a satellite care model for remote full-care hemodialysis units managed homogenously in the province of Manitoba, Canada, without onsite nephrologists. Survival in remotely located full-care units is compared with a large, urban full-care center with onsite nephrologists.

Design, setting, participants, & measurements: Data from a Canadian provincial dialysis registry were extracted on 2663 patients between 1990 and 2005. All-cause mortality after initiation of chronic hemodialysis was assessed with Cox proportional hazards regression. Both short-term (1 year) and long-term (2 to 5 years) survival were analyzed.

Results: Survival for patients receiving remotely delivered care was shown to be better than for those receiving care in the urban care center with this particular Canadian model of care. Furthermore, there was no difference when assessing short- and long-term survival. This was independent of distance from the urban center.

Conclusions: Chronic hemodialysis patients receiving remotely delivered care in a specialized facility attain comparable, if not better survival outcomes than their urban counterparts with direct onsite nephrology care. This model can potentially be adapted to other underserviced areas, including increasingly larger urban centers.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Long-term survival: local centers versus urban center.
See this image and copyright information in PMC

References

    1. Canadian Institute for Health Information: 2007 Annual Report: Treatment of End-Stage Organ Failure in Canada, 1996 to 2005, Ottawa, Canadian Institute for Health Information, 2007
    1. Lindsay RM, Hux J, Holland D, Nadler S, Richardson R, Lok C, Moist L, Churchill D: An investigation of satellite hemodialysis fallbacks in the province of Ontario. Clin J Am Soc Nephrol 4: 603–608, 2009 - PMC - PubMed
    1. Roderick P, Armitage A, Nicholson T, Mehta R, Gerard K, Mullee M, Drey N, Lamping D, Feest T, Greenwood R, Townsend J: A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales. Am J Kidney Dis 44: 121–131, 2004 - PubMed
    1. Roderick P, Nicholson T, Armitage A, Mehta R, Mullee M, Gerard K, Drey N, Feest T, Greenwood R, Lamping D, Townsend J: An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales. Health Technol Assess 9: 1–178, 2005 - PubMed
    1. Tonelli M, Hemmelgarn B, Culleton B, Klarenbach S, Gill JS, Wiebe N, Manns B, Alberta Kidney Disease Network : Mortality of Canadians treated by peritoneal dialysis in remote locations. Kidney Int 72: 1023–1028, 2007 - PubMed

MeSH terms