Regional differences in renal replacement therapy in northern Norway 2000–2012

Abstract

ObjectiveDistance from residence location to a centre for renal replacement therapy (RRT) may influence patients’ quality of life and prognosis. Northern Norway constitutes 45% of Norway's landmass, but has less than 10% of the population.MethodsIn this study, we analysed all patients in northern Norway consecutively registered in the Norwegian Renal Registry during 2000–2012. A total of 634 patients (Nordland County 321 patients, Troms County 215 patients and Finnmark County 98 patients) were investigated.ResultsThere were more smokers (31% vs. 22%) and patients with diabetes (32% vs. 22%) in Finnmark, but the difference did not reach statistical significance. Patients undergoing RRT and living in Finnmark County had a significantly worse outcome (P=0.03). The median survivals after initiation of RRT were 3.8 years (Finnmark), 6.4 years (Troms) and 5.4 years (Nordland), respectively. The most common causes of death were cardiovascular disease (53%), infections (16%), withdrawal from therapy (15%) and malignancy (13%). In a Cox analysis, age (P<0.0001), diabetes (P=0.008) and smoking at any time (P<0.004) were individual factors correlated with inferior prognosis.ConclusionAge, smoking and diabetes were prognostic factors. Residents of the northernmost county (Finnmark) experienced an inferior prognosis. Long distance from residence location to hospital may be another factor, but this could not be documented. Preventive strategies should be improved.

Clinical telemedicine utilization in paediatric nephrology at a tertiary care centre

“…Studies have shown that the complementary use of telemedicine and in-person consultations is a viable and economic method of medical practice that does not result in a decrease in the quality of care, 12,13 and may improve the quality of care for renal patients. 14 Of the three models described in this study, the block clinic model established in Windsor had the most substantial impact on increasing the number of telemedicine consultations. This clinic model, first described in this study, provides a good template for future nephrology and non-nephrology paediatric block clinics that could be set-up in similar regional sites such as Sudbury or Thunder Bay.…”