Many Canadian patients who receive hemodialysis live far from their attending nephrologist, but whether distance affects their clinical outcome is unknown. Dr. Marcello Tonelli and colleagues investigated whether patients who live farther from their attending nephrologist are more likely to die than those who live closer.

In this retrospective cohort study of data from the Canadian Organ Replacement Register for 18 722 patients who received hemodialysis from 1990–2000, the authors found that death from all causes and from infectious causes increased proportionally with increasing distance between the patient’s residence location and their attending nephrologist.