title: Home hemodialysis in the remote Canadian north: treatment in Manitoba fly-in communities.
abstract: Manitoba has the highest prevalence of ESRD in Canada. Northern Manitoba is a very sparsely settled area with a high proportion of aboriginal ESRD patients. Relocating to urban areas for dialysis is psychosocially and culturally stressful to patients. Delivering dialysis care in a home setting has demonstrated advantages in both clinical, economic, and health related quality of life domains. Establishing home hemodialysis in very remote communities has significant challenges, including poor and inadequate housing, unreliable water supply, limited community medical backup, and poor road access to communities especially for delivery of supplies. These challenges necessitate the development of strong community partnerships, and well documented processes for contingencies. A dedicated interdisciplinary support and training team at the urban hub is essential.
authors.affiliation: Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. jzacharias@hsc.mb.ca
authors.forename: James
authors.initials: J
authors.lastname: Zacharias
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Judy
authors.initials: J
authors.lastname: Olson
authors.forename: Allison
authors.initials: A
authors.lastname: Bourne
authors.forename: Doug
authors.initials: D
authors.lastname: Franklin
authors.forename: Keevin
authors.initials: K
authors.lastname: Bernstein
mesh_terms: D006297:Health Services Accessibility; D006437:Hemodialysis, Home / Q000592:standards*; D006801:Humans; D008350:Manitoba