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n undeveloped regions there are not enough dialysis units, so end-stage renal disease (ESRD) patients need to travel long
distances for hemodialysis (HD) sessions. In the north of Cear? state, Brazil, there is only a single dialysis unit serving a
population of 1,800,000 inhabitants. This population is spread over several small municipalities within a radius of 150 miles.
We studied the impact of living far from the dialysis unit on ESRD patients? outcomes. Among prevalent ESRD patients on HD,
we found no differences regarding self-perceived outcomes, such as depression and quality of life, between patients living near
and far from the dialysis unit. However, prevalent patients living near the dialysis unit were twice as likely to receive kidney
transplantation as those living far from the dialysis unit. Regarding incident HD patients, the chance of awareness of chronic
kidney disease before starting HD is two times higher among patients living near the dialysis unit (OR=2.24; 95% CI=1.20-4.17;
p=0.010). We concluded that HD patients living near the dialysis unit have two important advantages: they most often receive
transplants and they have more chance of being advised about their condition before starting regular HD. Transplantation and
knowledge about chronic kidney disease before starting HD are important variables in the context of ESRD treatment, and efforts
are needed to decrease the disadvantages related to these outcomes among patients living far from dialysis units.
Paulo Roberto Santos M.D., Ph.D. is a nephrologist and Associate Professor at the Federal University of Cear?, Brazil. He coordinates the
Postgraduate Program in Health Sciences at Federal University of Cear? and is the director of the dialysis unit at Santa Casa de Sobral Hospital.
He is the current editor of the topic ?Psychological aspects of end-stage renal disease patients? of the journal Frontiers in Affective Disorders and
Psychosomatic Research. His line of research comprises self-perceived outcomes and prognostic factors among end-stage renal disease patients
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