title: Hemodialysis in satellite dialysis units: incidence of patient fallback to the in-center dialysis unit.
abstract: BACKGROUND
  Patient fallbacks occur when a patient treated in a satellite dialysis unit (SDU) must be transferred to an in-center dialysis unit. Fallbacks have an impact on the in-center dialysis unit organization. This study was carried out to estimate the incidence and risk factors of patient fallback.
  
  
  METHODS
  Between 01/01/2006 and 31/12/2010 there were 193 patients starting dialysis in SDUs in one French region. The primary outcome was the incidence of temporary and permanent fallbacks with or without hospitalization. A survival analysis and binomial negative regression were used for the statistical analysis.
  
  
  RESULTS
  Among the 193 patients, 117 (60.6%; 95% confidence interval [CI]: 53.3-67.6) had at least one fallback, which occurred within a median of 249 days (interquartile range [IQR]: 71-469) after the first session in the SDU. The median number of fallbacks by subject was 1 (IQR: 0-4). The median duration of the fallback period was 4 days (IQR: 1-8) and median number of dialysis sessions during the fallback time was 1 (IQR: 1-3). Of the 494 temporary fallbacks, 210 were due to patient hospitalization, the main cause of which was cardiovascular disease. At univariate analysis, patients permanently transferred to in-center hemodialysis units were older, had more peripheral arteriopathy, cancer and arrhythmia. At multivariate analysis, peripheral arteriopathy (relative risk [RR] 2.06, 95% CI 1.05-4.09) and the center (center 2: RR 0.42, 95% CI 0.21-0.84; center 3: RR 2.88, 95% CI 1.20-6.91) were significantly associated with the number of fallbacks.
  
  
  CONCLUSIONS
  Fallback is a common event in hemodialysis patients treated in SDUs. Yet, the SDU system operates well since a third of patients treated in these units are still in SDUs at 2 years of follow-up. Factors associated with patient fallback are the center and cardiovascular disease.
authors.affiliation: Renal Epidemiology and Information Network, CHU de Caen, 14000, Caen, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Barthelemy
authors.forename: Thierry
authors.initials: T
authors.lastname: Lobbedez
authors.forename: Clemence
authors.initials: C
authors.lastname: Bechade
authors.forename: Patrick
authors.initials: P
authors.lastname: Henri
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Batho
authors.forename: Eric
authors.initials: E
authors.lastname: Cardineau
authors.forename: Alain
authors.initials: A
authors.lastname: Jeanson
authors.forename: Isabelle
authors.initials: I
authors.lastname: Landru
authors.forename: Françoise
authors.initials: F
authors.lastname: Lefort
authors.forename: Jacky
authors.initials: J
authors.lastname: Potier
authors.forename: Elie
authors.initials: E
authors.lastname: Zagdoun
authors.forename: Pascal
authors.initials: P
authors.lastname: Thibon
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003151:Community Health Centers / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult