title: Association of increased travel distance to dialysis units with the risk of anemia in rural chronic hemodialysis elderly.
abstract: Geographic remoteness has been found to influence health-related outcomes negatively. As reported in the literature, rural dialysis patients have a higher risk of mortality with increasing travel distance to dialysis units. However, few studies have focused on the impact of travel distances on the development of dialysis complications. We utilized a prospectively collected chronic hemodialysis patient cohort from a rural regional hospital for analysis. Data on demographics, comorbidities, and serum laboratory results were obtained. Correlation analyses between travel distance to dialysis units and dialysis complications were conducted, and significantly correlated parameters were entered into multivariate logistic regression models to determine their exact associations. A total of 46 rural chronic hemodialysis patients were enrolled, with an average age higher than others in the literature. Significant correlation was found between travel distance and serum hemoglobin levels (R(2) = -0.34, P value = 0.029). Multivariate logistic regression found that every 1 km increase in travel distance was associated with an increased risk of anemia (hemoglobin <9 g/dL) (odds ratio 1.46; P value = 0.01). Sensitivity analyses further showed that the associated risk was partially attenuated by serum albumin (odds ratio 1.83; P value = 0.07) and ferritin (odds ratio 1.39; P value = 0.08) levels. This is the first study to demonstrate the association between increased travel distance to dialysis units and the risk of anemia in chronic dialysis patients, especially elderly. Malnutrition, inflammation, and atherosclerosis syndrome could be partially responsible for the observed association. Further research is required to confirm our findings.
authors.affiliation: Department of Medicine, National Taiwan University Hospital Jin-Shan branch, New Taipei City, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chia-Ter
authors.initials: CT
authors.lastname: Chao
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lai
authors.forename: Jenq-Wen
authors.initials: JW
authors.lastname: Huang
authors.forename: Chih-Kang
authors.initials: CK
authors.lastname: Chiang
authors.forename: Sheng-Jen
authors.initials: SJ
authors.lastname: Huang
mesh_terms: D000368:Aged; D000740:Anemia / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D012424:Rural Population; D013997:Time Factors; D014195:Travel
keywords: Anemia; dialysis unit; end-stage renal disease; geographic distance; hypoalbuminemia; inflammation