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

Abstract

"I n Canada, no one is denied renal replacement therapy because of their residence location; however, a substantial proportion of patients receiving dialysis live more than 300 km from the closest nephrologist.1 Since this geographic barrier may make it more difficult to provide highquality renal care, it is plausible that disparities in access to appropriate care may result in differences in health outcomes. Despite the potential implications for health policy, this issue has not been formally studied. We sought to examine this issue using data collected prospectively from patients who began hemodialysis in Canada between 1990 and 2000. We hypothesized that patients who lived farther away from their attending nephrologist would be more likely than patients who lived closer to die after starting dialysis."