c l i n i c a l p r a c t i c e
Dialysis in rural Newfoundland and Labrador
The Newfoundland &
Labrador Centre for Applied Health Research established the
Contextualized Health Research Synthesis Program to provide research evidence to help guide decision makers in the provincial health system on issues of pressing interest to Newfoundland & Labrador.
The Newfoundland & Labrador Centre for
Applied Health Research established the Contextualized Health
Research Synthesis Program (CHRSP) to provide research evidence to
help guide decision makers in the provincial health system on issues
of pressing interest to Newfoundland & Labrador.
In 2008, the CHRSP produced an Evidence in
Context Report on rural dialysis that posed the following research
“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 report found no persuasive evidence to
suggest that any of the available modalities of dialysis service,
including peritoneal dialysis and hemodialysis, is either more or less
appropriate for either clinical or economic reasons in rural or remote
populations in this province. Both types of dialysis are, in fact,
complementary forms of renal replacement therapy, and home-based
therapies were recommended as the primary option for rural and remote
In late 2012, the Newfoundland and
Labrador Centre for Applied Health Research conducted a review to
confirm that the findings of the 2008 study remain both current and
The updated review identified no research
indicating that findings presented in the original CHRSP report are
inaccurate or out of date.
There is still no persuasive or robust
evidence to suggest that either peritoneal dialysis or hemodialysis is
inappropriate in the unique rural and remote context of this province.
In the absence of evidence to the
contrary, home-based therapies should be considered the primary option
for rural and remote service provision, and specific contextual factors
should be considered when examining other options.
A preliminary examination into the
economic and clinical benefits of the NxStage system may be beneficial.
A copy of the full Evidence Update is
available on the
CHRSP does not conduct original research,
rather it analyzes the findings of high-level research (systematic
reviews, meta-analyses and health technology assessments) that have
already been done on the issue in question. The findings of these
studies are synthesized and are subjected to a systematic process of
‘contextualization’: they are analyzed in terms of their applicability
to the conditions and capacities of the unique context of Newfoundland &