Options for Dialysis Services in Rural and Remote NL

The Research Question:

"In meeting the needs for dialysis services in rural and remote populations, what are the differences among the available treatment options with regards to efficacy/effectiveness, cost, acceptability, and feasibility in Newfoundland and Labrador?"


The province of Newfoundland and Labrador has the highest rate in Canada of newly diagnosed patients over the age of 65 years with end-stage renal (kidney) disease (ESRD). Here, as elsewhere in Canada, the profile of patients undergoing dialysis has changed, with a growing number of older and more medically frail patients being offered dialysis.

In January, 2008, there were 380 patients on dialysis in this province, 65% of whom were being treated by hemodialysis in main hospital-based dialysis units in St. John’s, Corner Brook, and Grand Falls-Windsor.

At the time of this study, hospital-based hemodialysis was the predominant modality of dialysis in the province despite the fact that it sometimes required patients to travel long distances or to relocate, and despite the fact that other modalities of dialysis were available, including home-based and satellite-based dialysis services.

Making decisions about the provision of dialysis services, particularly for rural and remote populations, posed many challenges and required guidance from the available research evidence.  CHRSP recognized that the evidence available from health technology assessments and systematic reviews on dialysis would have to be interpreted in light of Newfoundland and Labrador's unique context, taking into account our aging population, our limited human and financial resources, and the fact that patients with ESRD may often live in remote parts of the province.

The CHRSP Project Team:

  • Dr. Brendan Barrett, Nephrologist, Faculty of Medicine, Memorial University (Team Leader)
  • Dr. Stephen Bornstein, Director, NLCAHR (CHRSP Program Coordinator)
  • Dr. Renaldo Battista, Université de Montréal (External Reviewer)
  • Dr. Mike Doyle, Health Economist, DHCS and Memorial University (Health System Partner)
  • Susan Gillam, CEO, Western Regional Integrated Health Authority (Health System Co-investigator)
  • Janice Butler, Senior Research Officer, CHRSP
  • Cindy Mosher, CADTH Liaison Officer
  • Doreen MacNeil, Research Assistant, CHRSP

Evidence Update:

To confirm that the results of our 2008 synthesis remain current and relevant to decision makers, CHRSP revisited the research evidence on options for rural dialysis in late 2012. Our results, summarized in this report, confirmed that the findings from the 2008 report remain valid. It is important to note that our Evidence Update also addressed the introduction of a new home-dialysis technology that was developed after our original study was published.



Newfoundland & Labrador Centre for Applied Health Research

230 Elizabeth Ave, St. John's, NL, CANADA, A1B 3X9

Postal Address: P.O. Box 4200, St. John's, NL, CANADA, A1C 5S7

Tel: (709) 864-8000