A clinical and cost evaluation of hemodialysis in renal satellite units in England and wales

Roderick, P; Armitage, A; Nicholson, T; Mehta, R; Gerard, K; Mullee, M; Drey, N; Lamping, D; Feest, T; Greenwood, R; Townsend, J; (2004) A clinical and cost evaluation of hemodialysis in renal satellite units in England and wales. American journal of kidney diseases, 44 (1). p. 121. ISSN 0272-6386 DOI: https://doi.org/10.1053/j.ajkd.2004.03.031

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Background: The prevalence rate of renal replacement therapy in the United Kingdom has increased significantly, particularly by long-term hemodialysis (HD) therapy in renal satellite units (RSUs). These are largely nurse-run units linked to main renal units (MRUs). We compared outcomes, processes of care, and costs in RSUs with those in MRUs. Methods: A cross-sectional comparison was performed of HD patients from a representative sample of 12 RSUs in England and Wales and HD patients in the linked MRUs deemed suitable by the senior nurse for RSU care. Data for patient characteristics, clinical process and outcome measures, health-related quality of life (HRQoL), and patient satisfaction were collected. A partial analysis of National Health Service and social care costs was undertaken. Geographic access was assessed by road time and distance traveled to dialysis sessions. Results: Seven hundred thirty-six of 895 eligible patients (82%) participated. RSU patients were older (mean age, 63 versus 57 years), but had comorbidity similar to that of MRU patients. There were no significant differences in most processes of care or clinical outcomes; achievement of standards for adequacy of dialysis (urea reduction ratio) was significantly greater in RSU patients and hospitalization in the last year was less frequent. Patient HRQoL was similar, but patient satisfaction was greater in RSU patients. RSU patients potentially saved 19 minutes traveling for each dialysis session. Costs for routine dialysis and health/social care were similar. Conclusion: RSUs appear to be as effective as main HD units for a wide spectrum of patients, improve geographic access, and are more acceptable to patients. There is evidence that they are as cost-effective as main units.

Item Type: Article
Keywords: hemodialysis (HD), satellite units, effectiveness, costs, accessibility, acceptability, Replacement therapy, morbidity, survival, disease, trials
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
PubMed ID: 15211445
Web of Science ID: 222802400014
URI: http://researchonline.lshtm.ac.uk/id/eprint/14443


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