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Open Access Highly Accessed Research article

The association between geographic proximity to a dialysis facility and use of dialysis catheters

Lisa M Miller16*, Lavern M Vercaigne26, Louise Moist3, Charmaine E Lok4, Navdeep Tangri56, Paul Komenda56, Claudio Rigatto56, Julie Mojica16 and Manish M Sood7

Author Affiliations

1 Health Science Centre, Winnipeg, MB, Canada

2 Faculty of Pharmacy, Apotex Building, Winnipeg, MB, Canada

3 Department of Medicine, Division of Nephrology, University of Western Ontario London, ON, Canada

4 Department of Medicine, Section of Nephrology, University Health network and the University of Toronto, Toronto, ON, Canada

5 Seven Oaks Hospital, Winnipeg, MB, Canada

6 University of Manitoba, Winnipeg, MB, Canada

7 Ottawa Hospital Research Institute, Section of Nephrology, The Ottawa Hospital, Ottawa, ON, Canada

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BMC Nephrology 2014, 15:40  doi:10.1186/1471-2369-15-40

Published: 27 February 2014

Abstract

Background

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.

Methods

We 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.

Results

Eighty 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.

Conclusion

Residing 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.

Keywords:
Vascular access; Central venous catheters; Arteriovenous fistula; Remote community; Rural community