P KOTAGIRI1, L COLQUHOUN1, P MCLEAN1, M ROBERTS1,2
1Eastern Health, Nephrology Department, Victoria; 2Eastern Health Clinical School, Monash University, Victoria
Aim: We aimed to determine whether distance between patient address and hub renal service impacted initial dialysis modality.
Background: Remoteness is associated with several negative clinical outcomes and may be a barrier to home dialysis.
Methods: Patients referred to Eastern Health with Stage IV-V chronic kidney disease between 2011 and 2016 were included. The main outcomes were dialysis modality, initial access and dialysis location. In a catchment area with an Accessibility/Remoteness Index for Australia classified as “highly accessible” to “accessible”, the distance from hub renal service was calculated based on postcode and classified as: <10km, 10-20km, and >20km.
Results: Of 555 patients referred, 109 were lost to follow-up and 171 had not required renal replacement therapy by study end. Of the remaining patients, 114 resided <10km from the hub renal service (69 commenced dialysis), 111 resided 10-20km away (83 commenced dialysis) and 50 resided >20km away (40 commenced dialysis). Of those who commenced dialysis, 31 (45%), 39 (47%) and 19 (48%) patients commenced a home therapy, respectively (p=0.9) and 14 (20%), 12 (14%) and 6 (15%) patients started dialysis with a catheter, respectively (p=0.9). Overall, 78 received conservative care, 103 hemodialysis, 89 peritoneal dialysis and 5 a pre-emptive transplant. By the above distance grouping, 43 (38%), 26 (23%) and 9 (18%) patients received conservative care, respectively, and 40 (35%), 38 (34%) and 25 (50%) patients received haemodialysis, respectively.
Conclusion: Within a specific catchment area, distance from patient address to the hub renal service did not influence uptake of home dialysis therapies or timing of dialysis access. However, patients residing further away were more likely to receive haemodialysis and less likely to receive conservative care.