NDT Advance Access originally published online on April 9, 2008
Nephrology Dialysis Transplantation 2008 23(7):2434-2435; doi:10.1093/ndt/gfn164
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Haemodialysis in satellite units outside the hospital
Correspondence and offprint requests to: E-mail: alfonso.otero.gonzalez{at}sergas.es
Sir,
Prakash et al. [1] recently demonstrated the efficiency of Satellite Dialysis Units in ‘non-urban’ areas of Ontario. Among the features of such units, the absence of the ‘physical presence’ of a nephrologist stands out. Renal replacement therapy is currently a first-order financial problem for all health services, and in the year 2010 it is estimated that the cost will reach a trillion dollars [2]. Regardless of the need to establish primary–secondary prevention strategies in stages 2–3 of chronic renal disease (CRD), resources need to be optimized and the therapeutic model (TM) diversified to make such treatment demand sustainable. For this reason, and taking into account the limited world experience, we would like to present data gathered since the year 1986.
Ourense, a province in the northwest of Spain (Figure 1), has a population of 338 448 inhabitants, and the ageing index (ratio between the population over 65 years of age and the population under 20 years of age) is over 180—the mean for Spain being 82 [3]. The relative variation of the population (1991–2001) is 4.6%, and its GDP is 71.6% of the EU-25 [4]. Moreover, the only Nephrology Department is in the provincial capital. Besides the Nephrology Department Dialysis Unit, three out-hospital units have been created (Figure 1): one urban (FRIAT HD) and the other two in district hospitals (HC)—Verín (HCVe) and Valdeorras (HCV)—with distances to the reference centre of 80–130 km, which is between 480 and 780 km/week/patient.
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Care is provided by expert nurses, connected with the reference centre by Telemedicine, and the clinical documentation is computer based and located on the web. The nephrologists visit the unit periodically (twice a month) and reviews all the control protocols and dialysis practices. These out-hospital units are subjected to ISO 9002 quality control [5].
The TM of patient incidents (159 pmp) and the prevalence (688 pmp) is very efficient (Table 1), with a PD rate higher than the mean for the whole region (i.e. Galicia) and country (Spain). In addition, the evolution of the TM in the period 1988–2006 led to more efficient options: PD and Tx, with no influence due to the coexistence of out-hospital units. The actuarial overall mean is 125.19 ± 5.8 months (95% CI, 113.70–134.67), and the most significant risk factors were age [RR: 1.053 (95% CI, 1.041–1.061)] and diabetes mellitus [RR: 3.46 (95% CI, 2.37–4.99)].
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In conclusion, these types of units are efficient, and in view of the care problem increasingly present in extrarenal management, the TM needs to be diversified and self-service options chosen, whenever so allowed by the clinical situation.
Conflict of interest statement. None declared.
Nephrology Service, Ourense Hospital Complex, c/Ramón Puiga 57, 32005, Ourense, Spain
Notes
Editorial Note: Dr Prakash et al did not wish to reply to this letter.
References
- Prakash S, Austin PC, Oliver MJ, et al. Regional effects of satellite haemodialysis units on renal replacement therapy in non-urban Ontario, Canada. Nephrol Dial Trasplant (2007) 22:2297–2303.[CrossRef]
- Lysaght MJ. Maintenance dialysis population dynamics: current trends and long-term implications. J Am Soc Nephrol (2002) 13:S37–S40.
[Abstract/Free Full Text] - http://www.ige.xunta.es.
- http://www.ine.es.
- http://www.iso.ch.
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