CALGARY, Alberta—Patients living in remote or rural areas have worse quality of care and mortality compared to those people living in areas closer to specialized care, according to a study in the January 2011 issue of Kidney International.
“Among people with CKD, remote dwellers were less likely to receive specialist care, recommended laboratory testing, and appropriate medications, and were more likely to die or be hospitalized compared with those living closer to a nephrologist,” the authors wrote.
The researchers looked at 31,452 people 18 years and older in Alberta, Canada, with an estimated glomerular filtration rate (eGFR) less than 45 ml/min per 1.73 m2. In addition, these people had their serum creatinine measured at least once in 2005. They then looked at the outcomes of 6,545 patients who lived more than 50 km from the nearest nephrologist.
Over a median follow-up of 27 months, 7,684 participants died and 15,075 were hospitalized at least once, according to the study. Those people further from specialized care were significantly less likely to visit a nephrologist or a multidisciplinary CKD clinic within 18 months of the index measurement of the eGFR when compared with those living within 50 km of a nephrologist, according to the study.
Also, diabetics in remote areas were significantly less likely to have hemoglobin A1c evaluated within one year of their eGFR measurement, to have urinary albumin assessed biannually, or to receive an angiotensin converting enzyme inhibitor or receptor blocker in the setting of diabetes or proteinuria, the researchers found. In addition, remote-dwelling participants were also significantly more likely to die or be hospitalized during follow-up than those living closer.
