Prakash Suma, Coffin Rick, Schold Jesse, Lewis Steven A, Gunzler Douglas, Stark Susan, Howard Matthew, Rodgers Darlene, Einstadter Douglas, Sehgal Ashwini R
Case Western Reserve University,1 Cleveland, Ohio, USA;
Perit Dial Int. 2014 Jan-Feb;34(1):24-32. doi: 10.3747/pdi.2012.00234.
Rural residence is associated with increased peritoneal dialysis (PD) utilization. The influence of travel distance on rates of home dialysis utilization has not been examined in the United States. The purpose of this study was to determine whether travel distances to the closest home and in-center hemodialysis (IHD) facilities are a barrier to home dialysis. ♢
This was a retrospective cohort study of patients aged ≥ 18 years initiating dialysis between 2005 and 2011. Unadjusted PD and home hemodialysis (HHD) rates were compared by travel distances to both the closest home dialysis and closest IHD facilities. Adjusted PD and HHD utilization rates were examined using multivariable logistic regression models. ♢
There were 98,608 patients in the adjusted analyses. 55.5% of the dialysis facilities offered home dialysis. IHD, PD and HHD patients traveled median distances of 5.4, 3.5 and 6.6 miles respectively to their initial dialysis facilities. Unadjusted analyses showed an increase in PD rates and decrease in HHD rates with increased travel distances. Adjusted odds of PD and HHD were 1.6 and 1.2 respectively for a ten mile increase in distance to the closest home dialysis facility, while for distances to the closest IHD facility the odds ratios for both PD and HHD were 0.7 (all p < 0.01). ♢
In metropolitan areas, PD and HHD generally increased with increased travel distance to the closest home dialysis facility and decreased with greater distance to an IHD facility. Examination of travel distances to PD and HHD facilities separately may provide further insight on specific barriers to these modalities which can serve as targets for future studies examining expansion of home dialysis utilization.
农村居民腹膜透析（PD）的使用率较高。在美国，旅行距离对家庭透析使用率的影响尚未得到研究。本研究的目的是确定到最近的家庭和中心血液透析（IHD）设施的旅行距离是否是家庭透析的障碍。♢
这是一项对2005年至2011年间开始透析的18岁及以上患者的回顾性队列研究。通过到最近的家庭透析和最近的IHD设施的旅行距离比较未调整的PD和家庭血液透析（HHD）率。使用多变量逻辑回归模型检查调整后的PD和HHD使用率。♢
调整分析中有98,608名患者。55.5%的透析设施提供家庭透析。IHD、PD和HHD患者到其初始透析设施的中位距离分别为5.4英里、3.5英里和6.6英里。未调整分析显示，随着旅行距离增加，PD率上升，HHD率下降。到最近的家庭透析设施距离每增加10英里，PD和HHD的调整后比值比分别为1.6和1.2，而到最近的IHD设施距离增加时，PD和HHD的比值比均为0.7（所有p<0.01）。♢
在大都市地区，到最近的家庭透析设施的旅行距离增加时，PD和HHD通常增加，而到IHD设施的距离增加时则下降。分别检查到PD和HHD设施的旅行距离可能会进一步深入了解这些模式的特定障碍，这些障碍可作为未来研究扩大家庭透析使用率的目标。
