Regional differences in renal replacement therapy in northern Norway 2000–2012

• Published in: International Journal of Circumpolar Health
• Main Authors: Jan Norum, Torbjørn Leivestad, Bjørn Odvar Eriksen, Siw Skår, Anne Fagerheim, Anna Varberg Reisæter
• Format: Article in Journal/Newspaper
• Language: English
• Published: Taylor & Francis Group 2015
• Subjects: Norway; renal replacement therapy; subarctic; survival; Arctic medicine. Tropical medicine; RC955-962; Arctic; Circumpolar Health; Finnmark; International Journal of Circumpolar Health; Nordland; Northern Norway; Subarctic; Troms
• Online Access: https://doi.org/10.3402/ijch.v74.24298; https://doaj.org/article/755e48e394c94742984a5b58f3c8b4a1

Objective: 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.