Regional Differences in Renal Replacement Therapy in Northern Norway 2000-2012

Overview

Journal Int J Circumpolar Health

Date 2015 Feb 13

PMID 25672881

Authors

Jan Norum

Torbjorn Leivestad

Bjorn Odvar Eriksen

Siw Skar

Anne Fagerheim

Anna Varberg Reisaeter

Affiliations

Soon will be listed here.

Abstract

Objectives: Distance from residence location to a centre for renal replacement therapy (RRT) may influence patients' quality of life and prognosis. Northern Norway constitutes 45% of Norway's landmass, but has less than 10% of the population.

Methods: In this study, we analysed all patients in northern Norway consecutively registered in the Norwegian Renal Registry during 2000-2012. A total of 634 patients (Nordland County 321 patients, Troms County 215 patients and Finnmark County 98 patients) were investigated.

Results: There were more smokers (31% vs. 22%) and patients with diabetes (32% vs. 22%) in Finnmark, but the difference did not reach statistical significance. Patients undergoing RRT and living in Finnmark County had a significantly worse outcome (P=0.03). The median survivals after initiation of RRT were 3.8 years (Finnmark), 6.4 years (Troms) and 5.4 years (Nordland), respectively. The most common causes of death were cardiovascular disease (53%), infections (16%), withdrawal from therapy (15%) and malignancy (13%). In a Cox analysis, age (P<0.0001), diabetes (P=0.008) and smoking at any time (P<0.004) were individual factors correlated with inferior prognosis.

Conclusion: Age, smoking and diabetes were prognostic factors. Residents of the northernmost county (Finnmark) experienced an inferior prognosis. Long distance from residence location to hospital may be another factor, but this could not be documented. Preventive strategies should be improved.

References

Cooper J, Claudi T, Thordarson H, Lovaas K, Carlsen S, Sandberg S . Treatment of type 1 diabetes in the specialist health service--data from the Norwegian Diabetes Register for Adults. Tidsskr Nor Laegeforen. 2013; 133(21):2257-62. DOI: 10.4045/tidsskr.13.0153. View

Neugarten J, Acharya A, Silbiger S . Effect of gender on the progression of nondiabetic renal disease: a meta-analysis. J Am Soc Nephrol. 2000; 11(2):319-329. DOI: 10.1681/ASN.V112319. View

Buturovic-Ponikvar J, Gubensek J, Arnol M, Kandus A, Bren A, Ponikvar R . High mortality in the first year after kidney graft failure. Transplant Proc. 2013; 45(4):1431-4. DOI: 10.1016/j.transproceed.2013.01.102. View

Samuel S, Hemmelgarn B, Nettel-Aguirre A, Foster B, Soo A, Alexander R . Association between residence location and likelihood of transplantation among pediatric dialysis patients. Pediatr Transplant. 2012; 16(7):735-41. DOI: 10.1111/j.1399-3046.2012.01694.x. View

Norum J, Elsbak T . Air ambulance flights in northern Norway 2002-2008. Increased number of secondary fixed wing (FW) operations and more use of rotor wing (RW) transports. Int J Emerg Med. 2011; 4:55. PMC: 3173293. DOI: 10.1186/1865-1380-4-55. View

Nayha S . Environmental temperature and mortality. Int J Circumpolar Health. 2006; 64(5):451-8. DOI: 10.3402/ijch.v64i5.18026. View

Tangri N, Kitsios G, Inker L, Griffith J, Naimark D, Walker S . Risk prediction models for patients with chronic kidney disease: a systematic review. Ann Intern Med. 2013; 158(8):596-603. DOI: 10.7326/0003-4819-158-8-201304160-00004. View

Pruthi R, Casula A, MacPhee I . UK Renal Registry 15th annual report: Chapter 3 demographic and biochemistry profile of kidney transplant recipients in the UK in 2011: national and centre-specific analyses. Nephron Clin Pract. 2013; 123 Suppl 1:55-80. DOI: 10.1159/000353322. View

Norum J . Cardiovascular disease (CVD) in the Norwegian Arctic. Air ambulance operations 1999-2009 and future challenges in the region. Int Marit Health. 2010; 62(3):117-22. View

10.

Axelrod D, Dzebisashvili N, Schnitzler M, Salvalaggio P, Segev D, Gentry S . The interplay of socioeconomic status, distance to center, and interdonor service area travel on kidney transplant access and outcomes. Clin J Am Soc Nephrol. 2010; 5(12):2276-88. PMC: 2994090. DOI: 10.2215/CJN.04940610. View

11.

Sanchez-Perales C, Vazquez-Ruiz de Castroviejo E, Segura-Torres P, Borrego-Utiel F, Garcia-Cortes M, Garcia-Garcia F . Incidence of acute myocardial infarction in the evolution of dialysis patients. Nefrologia. 2012; 32(5):597-604. DOI: 10.3265/Nefrologia.pre2012.Jun.11464. View

12.

van Dijk P, Zwinderman A, Dekker F, Schon S, Stel V, Finne P . Effect of general population mortality on the north-south mortality gradient in patients on replacement therapy in Europe. Kidney Int. 2006; 71(1):53-9. DOI: 10.1038/sj.ki.5002008. View

13.

Cho Y, Badve S, Hawley C, McDonald S, Brown F, M N . The effects of living distantly from peritoneal dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study. BMC Nephrol. 2012; 13:41. PMC: 3444345. DOI: 10.1186/1471-2369-13-41. View

14.

Rumpsfeld M, Arild E, Norum J, Breivik E . Telemedicine in haemodialysis: a university department and two remote satellites linked together as one common workplace. J Telemed Telecare. 2005; 11(5):251-5. DOI: 10.1258/1357633054471885. View

15.

Eriksen B, Ingebretsen O . The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int. 2006; 69(2):375-82. DOI: 10.1038/sj.ki.5000058. View

16.

Seliger S, Davis C, Stehman-Breen C . Gender and the progression of renal disease. Curr Opin Nephrol Hypertens. 2001; 10(2):219-25. DOI: 10.1097/00041552-200103000-00010. View