The Provision of Dialysis Services in Rural and Remote Populations in Newfoundland and Labrador

Abstract

The province of Newfoundland and Labrador has the highest rate in the country of newly diagnosed patients over the age of 65 years with end-stage renal (kidney) disease (ESRD).1 Here, as elsewhere in Canada, the profile of patients undergoing dialysis has changed, with a growing number of older, and more medically frail, patients being offered dialysis. In January, 2008, there were 380 patients on dialysis in this province, 65% of whom were being treated by hemodialysis in main hospital-based dialysis units in St. John’s and Corner Brook, and in Grand Falls-Windsor, a satellite of St. John’s that operates much like a main unit. Hospital-based hemodialysis is the predominant modality of dialysis in this province despite the fact that it sometimes requires patients to travel long distances or to relocate, and that other modalities of dialysis are available, including home-based and satellite-based dialysis services (see Table 1 on page 2). Making decisions about the provision of dialysis services, particularly for rural and remote populations, poses challenges and should be guided by research evidence. Furthermore, the evidence available from health technology assessments and systematic reviews on dialysis must be interpreted in light of the Newfoundland and Labrador context, taking into account our aging population, our limited human and financial resources, and the geographic dispersion of small clusters of patients with ESRD living in remote parts of the province. Providing health decision makers with the best available evidence that is attuned to the capacities and characteristics of the province is the goal of the Contextualized Health Research Synthesis Program (CHRSP).