Abstract
BackgroundResiding remotely from health care resources appears to impact quality of care delivery. It remains unclear if there are differences in vascular access based on distance of one’s residence to dialysis centre at time of dialysis initiation, and whether region or duration of pre-dialysis care are important effect modifiers.MethodsWe studied the association of distance from a patients’ residence to the nearest dialysis centre and central venous catheter (CVC) use in an observational study of 26,449 incident adult dialysis patients registered in the Canadian Organ Replacement Registry between 2000–2009. Multivariate logistic regression was used to assess the association between distance in tertiles and CVC use, adjusted for patient demographics and comorbidities. Geographic region and duration of pre-dialysis care were examined as potential effect modifiers.ResultsEighty percent of patients commenced dialysis with a CVC. Incident CVC use was highest among those living > 20 km from the dialysis centre (OR 1.29 (1.24-1.34)) compared to those living < 5 km from centre. The length of pre-dialysis care and geographic region were significant effect modifiers; among patients residing in the furthest tertile (>20 km) from the nearest dialysis centre, incident CVC use was more common with shorter length of pre-dialysis care (< 1 year) and residence in central regions of the country.ConclusionResiding further from a dialysis centre is associated with increased CVC use, an effect modified by shorter pre-dialysis care and the geographic region of the country. Efforts to reduce geographical disparities in pre dialysis care may decrease CVC use.
Highlights
Residing remotely from health care resources appears to impact quality of care delivery
Central venous catheters (CVCs) are increasingly used as the first-line vascular access in incident hemodialysis patients [6,7]. Mortality risk in those commencing hemodialysis with a central venous catheter (CVC) has been reported as six times greater than the risk of death in arteriovenous fistula (AVF) or arteriovenous graft (AVG) use combined [8]
Co-morbid illnesses were associated with incident CVC use whereas increasing age, hemoglobin, albumin, BMI and hypertension were associated with incident AVF/AVG
Summary
Residing remotely from health care resources appears to impact quality of care delivery It remains unclear if there are differences in vascular access based on distance of one’s residence to dialysis centre at time of dialysis initiation, and whether region or duration of pre-dialysis care are important effect modifiers. Central venous catheters (CVCs) are increasingly used as the first-line vascular access in incident hemodialysis patients [6,7] Mortality risk in those commencing hemodialysis with a CVC has been reported as six times greater than the risk of death in arteriovenous fistula (AVF) or arteriovenous graft (AVG) use combined [8]. Less is known about the CKD and ESRD population residing in rural and remote locations; an association with increased mortality and poor achievement of evidence-based quality indicators has been shown [18,19,20]. Areas for intervention and improvement in rural populations are often difficult to identify, costly and resource intensive [21,22]
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