1. ¹Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
2. ²Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
3. ³Institute of Health Economics, Edmonton, Alberta, Canada
4. ⁴Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
5. ⁵Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
6. ⁶Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
7. ⁷Division of Nephrology, St Paul's Hospital, Vancouver, British Columbia, Canada
8. ⁸Division of Nephrology, Tufts-New England Medical Centre, Boston, Massachusetts, USA

Correspondence: M Tonelli, Division of Nephrology and Immunology, University of Alberta, 7-129 Clinical Science Building, 8440 112 Street, Edmonton, Alberta, Canada T6B 2B7. E-mail: mtonelli-admin@ualberta.ca

Received 16 March 2007; Revised 15 May 2007; Accepted 22 May 2007; Published online 18 July 2007.

Abstract

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.