In-Center Hemodialysis and Patient Travel Time in Aotearoa New Zealand: A Nationwide Geospatial and Data Linkage Study

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Abstract

Introduction

Prolonged travel time to receive dialysis is associated with decreased quality of life and increased mortality. However, patient travel time is rarely systematically analyzed during health service planning. This study’s aims were as follows: (i) examine spatio-temporal trends in travel time for people commencing dialysis in Aotearoa New Zealand (NZ), (ii) assess the relationship between travel time and dialysis modality, and (iii) create interactive nationwide maps to support renal service planning.

Methods

AcceSS and Equity in Treatment for kidney disease (ASSET), a health-linked data platform, was used to include all people commencing dialysis in NZ from 2006 to 2019 ( N = 6690). Patients’ one-way driving times from their residential location to the nearest hemodialysis unit were estimated using geospatial software. Multiple logistic regression modelling explored the association between travel time and dialysis modality, adjusting for demographic, clinical, and service factors.

Results

Median one-way driving time was 14 minutes (interquartile interval [IQI]: 8–31) and was significantly higher for patients living in rural (45 minutes [IQI: 28–62]) than in urban areas (11 minutes [IQI:8–18]; P < 0.001). Patients living farther from a unit were independently less likely to receive in-center hemodialysis (0.62 [95% confidence interval, CI: 0.52–0.72] for driving time ≥ 30 minutes; odds ratio, OR: 0.82 [95% CI:0.68–0.99] for 20–29; reference < 10), as were those in regions with greater hemodialysis unit capacity pressure. Our interactive maps demonstrate marked interregional variation in dialysis modality, patient travel time, and unit capacity.

Conclusion

Innovative service design is needed to reduce the burden of travel time, particularly for rural dialysis patients. We present novel geospatial techniques to support dialysis service planning that is targeted to the areas of greatest need.

Graphical abstract

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Most cited references 31

Record: found
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A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

Mary E Charlson, Peter Pompei, Kathy L. Ales … (1987)

The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.

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Is Open Access

KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

Paul E Stevens, Sofia B. Ahmed, Juan Jesus Carrero … (2024)

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Abstract: found
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Is Open Access

The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies

R Morton, A Tong, Mary Howard … (2010)

Objective To synthesise the views of patients and carers in decision making regarding treatment for chronic kidney disease, and to determine which factors influence those decisions. Design Systematic review of qualitative studies of decision making and choice for dialysis, transplantation, or palliative care, and thematic synthesis of qualitative studies. Data sources Medline, PsycINFO, CINAHL, Embase, social work abstracts, and digital theses (database inception to week 3 October 2008) to identify literature using qualitative methods (focus groups, interviews, or case studies). Review methods Thematic synthesis involved line by line coding of the findings of the primary studies and development of descriptive and analytical themes. Results 18 studies that reported the experiences of 375 patients and 87 carers were included. 14 studies focused on preferences for dialysis modality, three on transplantation, and one on palliative management. Four major themes were identified as being central to treatment choices: confronting mortality (choosing life or death, being a burden, living in limbo), lack of choice (medical decision, lack of information, constraints on resources), gaining knowledge of options (peer influence, timing of information), and weighing alternatives (maintaining lifestyle, family influences, maintaining the status quo). Conclusions The experiences of other patients greatly influenced the decision making of patients and carers. The problematic timing of information about treatment options and synchronous creation of vascular access seemed to predetermine haemodialysis and inhibit choice of other treatments, including palliative care. A preference to maintain the status quo may explain why patients often remain on their initial therapy.

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Author and article information

Contributors

Johanna M. Birrell

Journal

Journal ID (nlm-ta): Kidney Int Rep

Journal ID (iso-abbrev): Kidney Int Rep

Title: Kidney International Reports

Publisher: Elsevier

ISSN (Electronic): 2468-0249

Publication date PMC-release: 31 December 2024

Publication date Collection: March 2025

Publication date (Electronic): 31 December 2024

Volume: 10

Issue: 3

Pages: 921-934

Affiliations

[1 ]School of Public Health, University of Sydney, Sydney, New South Wales, Australia

[2 ]Department of Nephrology, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand

[3 ]Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia

[4 ]GeoHealth Laboratory, Te Taiwhenua O Te Hauora, University of Canterbury, Te Whare Wānanga O Waitaha, Christchurch, Ōtautahi, New Zealand

[5 ]Faculty of Health, Te Kaupeka Oranga, University of Canterbury, Te Whare Wānanga O Waitaha, Christchurch, Ōtautahi, New Zealand

[6 ]College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield, UK

Author notes

[∗ ] Correspondence: Johanna M. Birrell, Collaborative Centre for Organ Donation Evidence, 129A, Edward Ford Building (A27), School of Public Health, The University of Sydney, New South Wales 2006, Australia. jbir8326@ 123456uni.sydney.edu.au

Article

Publisher Item ID: S2468-0249(24)03474-0

DOI: 10.1016/j.ekir.2024.12.028

PMC ID: 11993220

PubMed ID: 40225379

SO-VID: 6f16a0f4-3a84-448a-96f4-fea2a784de97

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 5 November 2024

Date revision received : 15 December 2024

Date accepted : 23 December 2024