Editorial Dialysis and Mortality: Does It Matter Where

A 70-year-old man with diabetic nephropathy and a history of multiple admissions for congestive heart failure is approaching the need for renal replacement therapy. He is struggling with his decision regarding the optimal dialysis modality. He lives alone in rural Washington, 60 miles from the nearest dialysis unit. He is a man of modest means and cannot afford the transportation costs associated with thrice weekly in-center hemodialysis. Given his less than optimal prior compliance with his complex medical regimen, he is a risky candidate for peritoneal or home hemodialysis. Due to transportation issues, he decides that peritoneal dialysis is his only viable option. Does geography impact on patient survival? Clinicians usually do not consider a patient’s residence when making clinica