Fluctuations in tap water fluoride levels: a potential problem for practitioners

Prior to the early 1980s, two Winnipeg hospitals provided hemodialysis for all patients in Manitoba with chronic renal failure. Because no other hemodialysis centres existed, families were forced to relocate to the city. Because of these factors, the Manitoba Renal Failure Advisory Committee proposed the development of an outreach hemodialysis program. Under the auspices of the Health Sciences Centre in Winnipeg, this outreach program has evolved into the current Manitoba Local Centre Dialysis Program. Hemodialysis services are now available in an additional seven health care centres throughout Manitoba and northwestern Ontario. This program has benefited many and in some instances, families previously separated by distances of up to 500 miles have been reunited. Creativity has been one of the most essential ingredients in the evolution of this unique program.