Tonelli M, Hemmelgarn B, Culleton B, Klarenbach S, Gill J S, Wiebe N, Manns B
Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Kidney Int. 2007 Oct;72(8):1023-8. doi: 10.1038/sj.ki.5002443. Epub 2007 Jul 18.
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.
居住在偏远地区的患者在开始肾脏替代治疗时可能更倾向于选择腹膜透析以避免搬迁。然而，这些患者获得医疗服务的机会可能较少。为了检验居住在离肾病专家较远地区的患者更有可能选择腹膜透析但死亡风险增加这一假设，我们使用了前瞻性收集的数据，这些数据来自1990年至2000年间在加拿大开始透析的26775名患者的随机样本。计算了患者开始透析时的居住地址与肾病专家执业地点之间的距离。我们使用Cox比例风险模型来确定在平均随访2.5年至14年期间，该距离与临床结局之间的校正关系。居住在偏远地区的患者比居住在城市的患者更有可能在距离50公里至大于300公里的范围内开始腹膜透析，而不是居住在50公里以内的患者。开始腹膜透析的患者中，居住距离肾病专家较远的患者的校正死亡率和校正风险比显著高于居住在50公里以内的患者。需要进一步研究为接受腹膜透析的偏远地区患者提供的医疗服务质量。
