Regional effects of satellite haemodialysis units on renal replacement therapy in non-urban Ontario, Canada

BACKGROUND: To provide better dialysis care to rural communities, the Ministry of Health chose to build satellite haemodialysis (HD) units, which are affiliated with, but are distant to, a main renal centre. We considered whether constructing such units in rural regions of Ontario, Canada, alleviated under-service of rates of renal replacement therapy (RRT) locally, decreased patient travel distance and decreased local peritoneal dialysis (PD) utilization. METHODS: We compared two groups of rural regions at two time points (years 1995 and 2002) in a before and after cross-sectional study. These regions were either already serviced by a satellite unit in 1995 (control group, 10 communities), or had new satellite units built between the years 1995 and 2002 (exposure group, 24 communities). RESULTS: The exposure group had a slightly greater increase in prevalent rate of RRT over time, but this did not reach statistical significance (control group increased 401 per million, exposure group 436 per million, P = 0.8). The mean weekly travel distance was reduced by 210.6 km after the construction of new satellite units (P < 0.001). There was no significant difference between the groups in reduction of PD proportion (P = 0.4). There was a significant increase in the number of elderly receiving RRT once local access was provided. CONCLUSIONS: In conclusion, constructing satellite units increased access to renal care for elderly patients and reduced travel time for HD patients living in rural communities.