title: Hemodialysis in a satellite unit: clinical performance target attainment and health-related quality of life.
abstract: OBJECTIVE
  In Canada, patients are increasingly receiving hemodialysis (HD) in satellite units, which are closer to their community but further from tertiary care hospitals and their nephrologists. The process of care is different in the satellites with fewer visits from nephrologists and reliance on remote communication. The objective of this study is to compare clinical performance target attainment and health-related quality of life (HRQOL) in patients receiving HD in satellite versus in-center units.
  
  
  METHODS
  The London Health Sciences Centre in London, Ontario, Canada, has both tertiary care center and satellite HD units. All eligible patients who received dialysis treatment at one of these units as of July 24, 2008, were enrolled into a cross-sectional study (n = 522). Patient attainment of hemoglobin, albumin, calcium-phosphate (Ca-P) product, Kt/V, and vascular access targets were compared. Participants were also administered the Kidney Disease Quality of Life Short-Form questionnaire.
  
  
  RESULTS
  Satellite patients were more likely to attain clinical performance targets for albumin (adjusted odds ratio [OR] = 4.87 [95% confidence interval [CI]: 2.13 to 11.14]), hemoglobin (OR = 1.59 [95% CI: 1.08 to 2.35]), and Ca-P product (OR = 2.02 [95% CI: 1.14 to 3.60]), as well as for multiple targets (P < 0.05). HRQOL scores were largely similar between groups.
  
  
  CONCLUSIONS
  Patients receiving HD in a satellite unit were just as likely, or more likely, to demonstrate attainment of clinical performance targets as those dialyzing in-center, while maintaining a similar HRQOL. This supports the increased use of satellite units to provide care closer to the patient's community.
authors.affiliation: Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Diamant
authors.forename: Ann
authors.initials: A
authors.lastname: Young
authors.forename: Kerri
authors.initials: K
authors.lastname: Gallo
authors.forename: Wang
authors.initials: W
authors.lastname: Xi
authors.forename: Rita S
authors.initials: RS
authors.lastname: Suri
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Louise M
authors.initials: LM
authors.lastname: Moist
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards*; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D016009:Chi-Square Distribution; D003151:Community Health Centers / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006436:Hemodialysis Units, Hospital / Q000592:standards*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000523:psychology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010710:Phosphates / Q000097:blood; D019984:Quality Indicators, Health Care / Q000592:standards*; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D010710:Phosphates; D012709:Serum Albumin; D002118:Calcium