Dataset Information

Association between proximity to the attending nephrologist and mortality among patients receiving hemodialysis.

ABSTRACT:

Background

Many Canadian patients who receive hemodialysis live far from their attending nephrologist, which may affect clinical outcomes. We investigated whether patients receiving hemodialysis who live farther from their attending nephrologist are more likely to die than those who live closer.

Methods

We studied a random sample of 18,722 patients who began hemodialysis between 1990 and 2000 in Canada. We calculated the distance between each patient's residence location at the start of dialysis and the practice location of their attending nephrologist. We used Cox proportional hazards models to examine the adjusted relation between distance and clinical outcomes (death from all causes, infectious causes and cardiovascular causes) over a follow-up period of up to 14 years.

Results

During the follow-up period (median 2.5 yr, interquartile range 1.0-4.7 yr), 11,582 (62%) patients died. Compared with patients who lived within 50 km of their nephrologist, the adjusted hazard ratio of death among those who lived 50.1-150 km away was 1.06 (95% confidence interval [CI] 1.01-1.12), 1.13 (95% CI 1.04-1.22) for those who lived 150.1-300 km away and 1.13 (95% CI 1.03-1.24) for those who lived more than 300 km from their nephrologist (p for trend < 0.001). The risk of death from infectious causes increased with greater distance from the attending nephrologist (p for trend < 0.001). The risk of death from cardiovascular causes did not increase with distance from the attending nephrologist (p for trend = 0.21). Compared with patients who lived within 50 km of their nephrologist, the adjusted hazard ratio of death among those who lived more than 300 km away was 1.75 (95% CI 1.32-2.32) for infectious causes and 0.93 (95% CI 0.79-1.09) for cardiovascular causes.

Conclusions

Mortality associated with hemodialysis was greater among patients who lived farther from their attending nephrologist, as compared with those who lived closer. This was especially evident for death from infectious causes.

SUBMITTER: Tonelli M

PROVIDER: S-EPMC2025630 | biostudies-literature | 2007 Oct

REPOSITORIES: biostudies-literature

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Publications

Association between proximity to the attending nephrologist and mortality among patients receiving hemodialysis.

Tonelli Marcello M Manns Braden B Culleton Bruce B Klarenbach Scott S Hemmelgarn Brenda B Wiebe Natasha N Gill John S JS

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20071001 9

<h4>Background</h4>Many Canadian patients who receive hemodialysis live far from their attending nephrologist, which may affect clinical outcomes. We investigated whether patients receiving hemodialysis who live farther from their attending nephrologist are more likely to die than those who live closer.<h4>Methods</h4>We studied a random sample of 18,722 patients who began hemodialysis between 1990 and 2000 in Canada. We calculated the distance between each patient's residence location at the st ...[more]

PMID: 17954893

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Project description:Background and objectivesFrailty is common among patients on dialysis and increases vulnerability to dependency and death.Design, setting, participants, & measurementsWe examined the predictive ability of frailty on the basis of physical performance and self-reported function in participants of a US Renal Data System special study that enrolled a convenience sample of 771 prevalent patients on hemodialysis from 14 facilities in the Atlanta and northern California areas from 2009 to 2011. Performance-based frailty was assessed using direct measures of grip strength (weakness) and gait speed along with weight loss, exhaustion, and low physical activity; poor self-reported function was substituted for weakness and slow gait speed in the self-reported function-based definition. For both definitions, patients meeting three or more criteria were considered frail.ResultsThe mean age of 762 patients included in analyses was 57.1±14.2 years old; 240 patients (31%) met the physical performance-based definition of frailty, and 396 (52%) met the self-reported function-based definition. There were 106 deaths during 1.7 (interquartile range, 1.4-2.4) years of follow-up. After adjusting for demographic and clinical characteristics, the hazard ratio (HR) for mortality for the performance-based definition (2.16; 95% confidence interval [95% CI], 1.41 to 3.29) was slightly higher than that of the self-reported function-based definition (HR, 1.93; 95% CI, 1.24 to 3.00). Patients who met the self-report-based definition but not the physical performance definition of frailty (n=192) were not at statistically significantly higher risk of mortality than those who were not frail by either definition (n=330; HR, 1.41; 95% CI, 0.81 to 2.45), but those who met both definitions of frailty (n=204) were at significantly higher risk (HR, 2.46; 95% CI, 1.51 to 4.01).ConclusionsFrailty, defined using either direct tests of physical performance or self-reported physical function, was associated with higher mortality among patients receiving hemodialysis. Future studies are needed to determine the utility of assessing frailty in clinical practice.

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Dataset Information

Association between proximity to the attending nephrologist and mortality among patients receiving hemodialysis.

Background

Methods

Results

Conclusions

Publications

Association between proximity to the attending nephrologist and mortality among patients receiving hemodialysis.

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