12 results on '"Couchoud, Cecile"'
Search Results
2. Low performance of prognostic tools for predicting dialysis in elderly people with advanced CKD.
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Prouvot J, Pambrun E, Couchoud C, Vigneau C, Roche S, Allot V, Potier J, Francois M, Babici D, Prelipcean C, and Moranne O
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- Aged, Aged, 80 and over, Disease Progression, Glomerular Filtration Rate, Humans, Prognosis, Prospective Studies, Renal Dialysis, Risk Factors, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic therapy, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic therapy
- Abstract
Introduction: Clinical decision-making about care plans can be difficult for very elderly people with advanced chronic kidney disease (CKD). Current guidelines propose the use of prognostic tools predicting end stage renal disease (ESRD) to assist in a patient-centered shared decision-making approach. Our objective was to evaluate the existing risk model scores predicting ESRD, from data collected for a French prospective multicenter cohort of mainly octogenarians with advanced CKD., Methods: We performed a rapid review to identify the risk model scores predicting ESRD developed from CKD patient cohorts and evaluated them with data from a prospective multicenter French cohort of elderly (> 75 years) patients with advanced CKD (estimated glomerular filtration rate [eGFR] < 20 mL/min/1.75m
2 ), followed up for 5 years. We evaluated these scores (in absolute risk) for discrimination, calibration and the Brier score. For scores using the same time frame, we made a joint calibration curve and compared areas under the curve (AUCs)., Results: The PSPA cohort included 573 patients; their mean age was 83 years and their median eGFR was 13 mL/min/1.73 m2 . At the end of follow-up, 414 had died and 287 had started renal replacement therapy (RRT). Our rapid review found 12 scores that predicted renal replacement therapy. Five were evaluated: the TANGRI 4-variable, DRAWZ, MARKS, GRAMS, and LANDRAY scores. No score performed well in the PSPA cohort: AUCs ranged from 0.57 to 0.65, and Briers scores from 0.18 to 0.25., Conclusions: The low predictiveness for ESRD of the scores tested in a cohort of octogenarian patients with advanced CKD underlines the need to develop new tools for this population., (© 2021. Italian Society of Nephrology.)- Published
- 2021
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3. Factors associating with differences in the incidence of renal replacement therapy among elderly: data from the ERA-EDTA Registry.
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Helve J, Kramer A, Abad-Diez JM, Couchoud C, de Arriba G, de Meester J, Evans M, Glaudet F, Grönhagen-Riska C, Heaf JG, Lezaic V, Nordio M, Palsson R, Pechter Ü, Resic H, Santamaria R, Santiuste de Pablos C, Massy ZA, Zurriaga Ó, Jager KJ, and Finne P
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- Adult, Age Factors, Aged, Data Collection, Europe epidemiology, Female, Humans, Incidence, Kidney Failure, Chronic epidemiology, Male, Middle Aged, Survival Rate trends, Kidney Failure, Chronic therapy, Renal Replacement Therapy statistics & numerical data
- Abstract
Background: The incidence of renal replacement therapy (RRT) in the general population ≥75 years of age varies considerably between countries and regions in Europe. Our aim was to study characteristics and survival of elderly RRT patients and to find explanations for differences in RRT incidence., Methods: Patients ≥75 years of age at the onset of RRT in 2010-2013 from 29 national or regional registries providing data to the European Renal Association-European Dialysis and Transplant Association Registry were included. Chi-square and Mann-Whitney U tests were used to assess variation in patient characteristics and linear regression was used to study the association between RRT incidence and various factors. Kaplan-Meier curves and Cox regression were employed for survival analyses., Results: The mean annual incidence of RRT in the age group ≥75 years of age ranged from 157 to 924 per million age-related population. The median age at the start of RRT was higher and comorbidities were less common in areas with higher RRT incidence, but overall the association between patient characteristics and RRT incidence was weak. The unadjusted survival was lower in high-incidence areas due to an older age at onset of RRT, but the adjusted survival was similar [relative risk 1.00 (95% confidence interval, 0.97-1.03)] in patients from low- and high-incidence areas., Conclusions: Variation in the incidence of RRT among the elderly across European countries and regions is remarkable and could not be explained by the available data. However, the survival of patients in low- and high-incidence areas was remarkably similar.
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- 2018
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4. Survival advantage of planned haemodialysis over peritoneal dialysis: a cohort study.
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Thiery A, Séverac F, Hannedouche T, Couchoud C, Do VH, Tiple A, Béchade C, Sauleau EA, and Krummel T
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- Aged, Female, Follow-Up Studies, France epidemiology, Humans, Kidney Failure, Chronic mortality, Male, Middle Aged, Propensity Score, Survival Rate trends, Kidney Failure, Chronic therapy, Peritoneal Dialysis methods, Registries, Renal Dialysis methods
- Abstract
Background: Previous studies comparing the outcomes in haemodialysis (HD) with those in peritoneal dialysis (PD) have yielded conflicting results., Methods: The aim of the study was to compare the survival of planned HD versus PD patients in a cohort of adult incident patients who started renal replacement therapy (RRT) between 2006 and 2008 in the nationwide REIN registry (Réseau Epidémiologie et Information en Néphrologie). Patients who started RRT in emergency or stopped RRT within 2 months were excluded. Adjusted Cox models, propensity score matching and marginal structural models (MSMs) were used to compensate for the lack of randomization and provide causal inference from longitudinal data with time-dependent treatments and confounders including transplant censorship, modality change over time and time-varying covariates., Results: Among a total of 13 767 dialysis patients, 13% were on PD at initiation of RRT and 87% were on HD. The median survival times were 53.5 months or 4.45 years and 38.6 months or 3.21 years for patients starting on HD and PD, respectively. Regardless of the model used, there was a consistent advantage in terms of survival for HD patients: hazard ratio (HR) 0.76 [95% confidence interval (95% CI) 0.69-0.84] with the Cox model using propensity score; HR 0.67 (95% CI 0.62-0.73) in the Cox model with censorship for each treatment change; and HR 0.82 (95% CI 0.69-0.97) with MSMs. However, MSMs tended to reduce the survival gap between PD and HD patients., Conclusion: This large cohort study using various statistical methods to minimize the bias appears to demonstrate a better survival in planned HD than in PD.
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- 2018
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5. Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis.
- Author
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Decourt A, Gondouin B, Delaroziere JC, Brunet P, Sallée M, Burtey S, Dussol B, Ivanov V, Costello R, Couchoud C, and Jourde-Chiche N
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- Aged, Aged, 80 and over, Amyloidosis blood, Amyloidosis mortality, Cause of Death, Female, France epidemiology, Humans, Incidence, Kaplan-Meier Estimate, Kidney Failure, Chronic epidemiology, Kidney Failure, Chronic mortality, Kidney Failure, Chronic physiopathology, Kidney Transplantation, Male, Middle Aged, Multiple Myeloma mortality, Proportional Hazards Models, Recovery of Function, Registries, Risk Factors, Time Factors, Treatment Outcome, Amyloidosis epidemiology, Immunoglobulin Light Chains blood, Kidney physiopathology, Kidney Failure, Chronic therapy, Multiple Myeloma epidemiology, Renal Dialysis adverse effects, Renal Dialysis mortality, Renal Dialysis trends
- Abstract
Background and Objectives: Monoclonal gammopathies (MGs) with renal involvement can lead to ESRD caused by myeloma cast nephropathy (MCN), immunoglobulin light chain amyloidosis (ALA), or light-chain deposition disease (LCDD). Few studies have focused on the prognosis of patients with MG on chronic dialysis. We evaluated the outcomes of patients with MG incident on chronic dialysis in France., Design, Setting, Participants, & Measurements: All incident patients registered in the Renal Epidemiology and Information Network Registry between 2002 and 2011 with ESRD caused by ALA, LCDD, or MCN were included. Patient's survival, censored for renal transplantation, renal recovery, and loss to follow-up, as well as renal outcomes were analyzed and compared with a control group. Risk factors and causes of death were analyzed., Results: We included 1459 patients, comprising 265 (18%) patients with ALA, 334 (23%) patients with LCDD, and 861 (59%) patients with MCN. Median age was 72 years, and 56% were men. Median follow-up was 13.1 months. Renal recovery was observed in 9.1% of patients and more frequent after 2006. Kidney transplantation was rare in this population (2.3%). Among 1272 patients who remained on dialysis, 67% died. Median survival on dialysis was 18.3 months. Main causes of death were malignancies (34.4%), cardiovascular diseases (18%), infections (13.3%), and cachexia (5.2%). Independent risk factors of death were age (hazard ratio [HR], 1.03 per year increase; 95% confidence interval [95% CI], 1.02 to 1.03), frailty (HR, 1.93; 95% CI, 1.58 to 2.36), congestive heart failure (HR, 1.54; 95% CI, 1.23 to 1.93), and dialysis initiation on a central catheter (HR, 1.40; 95% CI, 1.11 to 1.75). Factors associated with a lower risk of death were year of dialysis initiation (HR, 0.95 per year increase; 95% CI, 0.91 to 0.99) and high BP (HR, 0.80; 95% CI, 0.67 to 0.97)., Conclusions: Survival of patients with ALA, LCDD, or MCN on chronic dialysis is poor but has improved over time. Progressive malignancy is the main cause of death in this population. Renal recovery has increased since 2006., (Copyright © 2016 by the American Society of Nephrology.)
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- 2016
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6. Trends in dialysis modality choice and related patient survival in the ERA-EDTA Registry over a 20-year period.
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van de Luijtgaarden MW, Jager KJ, Segelmark M, Pascual J, Collart F, Hemke AC, Remón C, Metcalfe W, Miguel A, Kramar R, Aasarød K, Abu Hanna A, Krediet RT, Schön S, Ravani P, Caskey FJ, Couchoud C, Palsson R, Wanner C, Finne P, and Noordzij M
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- Adult, Aged, Aged, 80 and over, Clinical Decision-Making, Europe, Female, Humans, Kaplan-Meier Estimate, Kidney Failure, Chronic mortality, Kidney Transplantation statistics & numerical data, Male, Middle Aged, Peritoneal Dialysis statistics & numerical data, Prevalence, Propensity Score, Proportional Hazards Models, Registries, Renal Dialysis statistics & numerical data, Kidney Failure, Chronic therapy, Peritoneal Dialysis trends, Renal Dialysis trends
- Abstract
Background: Although previous studies suggest similar patient survival for peritoneal dialysis (PD) and haemodialysis (HD), PD use has decreased worldwide. We aimed to study trends in the choice of first dialysis modality and relate these to variation in patient and technique survival and kidney transplant rates in Europe over the last 20 years., Methods: We used data from 196 076 patients within the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry who started renal replacement therapy (RRT) between 1993 and 2012. Trends in the incidence rate and prevalence on Day 91 after commencing RRT were quantified with Joinpoint regression. Crude and adjusted hazard ratios (HRs) for 5-year dialysis patient and technique survival were calculated using Cox regression. Analyses were repeated using propensity score matching to control for confounding by indication., Results: PD prevalence dropped since 2007 and HD prevalence stabilized since 2009. Incidence rates of PD and HD decreased from 2000 and 2009, respectively, while the incidence of kidney transplantation increased from 1993 onwards. Similar 5-year patient survival for PD versus HD patients was found in 1993-97 [adjusted HR: 1.02, 95% confidence interval (95% CI): 0.98-1.06], while survival was higher for PD patients in 2003-07 (HR: 0.91, 95% CI: 0.88-0.95). Both PD (HR: 0.95, 95% CI: 0.91-1.00) and HD technique survival (HR: 0.93, 95% CI: 0.87-0.99) improved in 2003-07 compared with 1993-97., Conclusions: Although initiating RRT on PD was associated with favourable patient survival when compared with starting on HD treatment, PD was often not selected as initial dialysis modality. Over time, we observed a significant decline in PD use and a stabilization in HD use. These observations were explained by the lower incidence rate of PD and HD and the increase in pre-emptive transplantation., (© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
- Published
- 2016
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7. Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry.
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Vogelzang JL, van Stralen KJ, Noordzij M, Diez JA, Carrero JJ, Couchoud C, Dekker FW, Finne P, Fouque D, Heaf JG, Hoitsma A, Leivestad T, de Meester J, Metcalfe W, Palsson R, Postorino M, Ravani P, Vanholder R, Wallner M, Wanner C, Groothoff JW, and Jager KJ
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Infections etiology, Kidney Failure, Chronic therapy, Kidney Transplantation adverse effects, Male, Middle Aged, Neoplasms etiology, Registries, Risk Factors, Survival Rate, Young Adult, Infections mortality, Kidney Failure, Chronic mortality, Neoplasms mortality, Renal Dialysis adverse effects, Renal Dialysis mortality, Renal Replacement Therapy adverse effects, Renal Replacement Therapy mortality
- Abstract
Background: Infections and malignancies are the most common non-cardiovascular causes of death in patients on chronic renal replacement therapy (RRT). Here, we aimed to quantify the mortality risk attributed to infections and malignancies in dialysis patients and kidney transplant recipients when compared with the general population by age group and sex., Methods: We followed 168 156 patients included in the ERA-EDTA registry who started RRT in 1993-2007 until 1 January 2012. Age- and cause-specific mortality rates per 1000 person-years (py) and mortality rate ratios (MRRs) compared with the European general population (WHO) were calculated. To identify risk factors, we used Cox regression., Results: Infection-related mortality was increased 82-fold in dialysis patients and 32-fold in transplant recipients compared with the general population. Female sex, diabetes, cancer and multisystem disease were associated with an increased risk of infection-related mortality. The sex difference was most pronounced for dialysis patients aged 0-39 years, with women having a 32% (adjusted HR 1.32 95% CI 1.09-1.60) higher risk of infection-related mortality than men. Mortality from malignancies was 2.9 times higher in dialysis patients and 1.7 times higher in transplant recipients than in the general population. Cancer and multisystem disease as primary causes of end-stage renal disease were associated with higher mortality from malignancies., Conclusion: Infection-related mortality is highly increased in dialysis and kidney transplant patients, while the risk of malignancy-related death is moderately increased. Young women on dialysis may deserve special attention because of their high excess risk of infection-related mortality. Further research into the mechanisms, prevention and optimal treatment of infections in this vulnerable population is required., (© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
- Published
- 2015
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8. Dialysis modality choice in diabetic patients with end-stage kidney disease: a systematic review of the available evidence.
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Couchoud C, Bolignano D, Nistor I, Jager KJ, Heaf J, Heimburger O, and Van Biesen W
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- Humans, Kidney Failure, Chronic etiology, Outcome Assessment, Health Care, Choice Behavior, Diabetes Complications, Kidney Failure, Chronic therapy, Peritoneal Dialysis, Renal Dialysis
- Abstract
Background: Diabetes is the leading cause of end-stage kidney disease (ESKD). Because of conflicting results in observational studies, it is still subject to debate whether in diabetic patients the dialysis modality selected as first treatment (haemodialysis or peritoneal dialysis) may have a major impact on outcomes. We therefore aimed at performing a systematic review of the available evidence., Methods: MEDLINE, EMBASE and CENTRAL databases were searched until February 2014 for English-language articles without time or methodology restrictions by highly sensitive search strategies focused on diabetes, end-stage kidney disease and dialysis modality. Selection of relevant studies, data extraction and analysis were performed by two independent reviewers., Results: Twenty-five observational studies (23 on incident and 2 on prevalent cohorts) were included in this review. Mortality was the only main outcome addressed in large cohorts. When considering patient survival, results were inconsistent and varied across study designs, follow-up period and subgroups. We therefore found no evidence-based arguments in favour or against a particular dialysis modality as first choice treatment in patients with diabetes and ESKD. However, peritoneal dialysis (PD) as first choice seems to convey a higher risk of death in elderly and frail patients., Conclusions: The available evidence derived from observational studies is inconsistent. Therefore evidence-based arguments indicating that HD or PD as first treatment may improve patient-centred outcomes in diabetics with ESKD are lacking. In the absence of such evidence, modality selection should be governed by patient preference, after unbiased patient information., (© The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
- Published
- 2015
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9. Characteristics and treatment course of patients older than 75 years, reaching end-stage renal failure in France. The PSPA study.
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Moranne O, Couchoud C, and Vigneau C
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- Aged, Aged, 80 and over, Disease Management, Female, Frail Elderly, France, Glomerular Filtration Rate physiology, Humans, Kidney Failure, Chronic epidemiology, Kidney Failure, Chronic mortality, Kidney Failure, Chronic physiopathology, Prognosis, Prospective Studies, Renal Dialysis, Kidney Failure, Chronic therapy
- Abstract
Background: The age of patients with end-stage renal disease is increasing in Europe and United States. In France, patients older than 75 years represent 40% of the patients who start renal replacement therapy (dialysis or renal transplantation). In these elderly patients with many comorbidities, the benefit of dialysis remains controversial. To provide clear information to patients about diagnosis, prognosis, and all treatment options, more data are needed on their clinical characteristics, therapeutic projects, and outcome., Methods: Researchers present here the ongoing Parcours de Soins des PersonnesAgées (PSPA) multicenter prospective study, which includes 581 patients with a mean age of 82±5 years and an estimated glomerular filtration rate (by sMDRD) of 14±4ml/min/1.73m(2) without dialysis., Results: Despite a high prevalence of associated comorbidities, most of the patients are autonomous, living at home. Less than 10% are followed jointly by a nephrologist and a geriatrician. At inclusion, postponed dialysis decision due to stable estimated glomerular filtration rate was reported in 43%, 17% of the patients are under evaluation, the decision to start dialysis was chosen in 24% of the patients, nondialysis decision was decided in 16%., Conclusions: Geriatricians' expertise may help nephrologists to identify patients at high risk of early death for who nondialysis care may be discussed. They also may be more able to evaluate and anticipate the impact of such restricting treatments. A multidisciplinary approach of these old and frail patients' needs to be reinforced.
- Published
- 2012
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10. International Quotidian Dialysis Registry: annual report 2009.
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Nesrallah GE, Suri RS, Moist LM, Cuerden M, Groeneweg KE, Hakim R, Ofsthun NJ, McDonald SP, Hawley C, Caskey FJ, Couchoud C, Awaraji C, and Lindsay RM
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- Humans, International Cooperation, Treatment Outcome, Kidney Failure, Chronic epidemiology, Kidney Failure, Chronic therapy, Registries, Renal Dialysis
- Abstract
The International Quotidian Dialysis Registry (IQDR) is a global initiative designed to study practices and outcomes associated with the use of hemodialysis regimens of increased frequency and/or duration. Several small studies suggest that compared with conventional hemodialysis (HD), short-daily, nocturnal, and long conventional HD regimens may improve surrogate endpoints and quality of life. However, methodologically robust comparisons on hard outcomes are sorely lacking. The IQDR represents the first-ever attempt to aggregate long-term follow-up data from centers utilizing alternative HD regimens worldwide, and will have adequate statistical power to examine the effects of these regimens on multiple clinical endpoints, including mortality. To date, the IQDR has enrolled patients from Canada, the United States, Australia, and New Zealand, with plans in place to begin linking with additional commercial databases and national registries. This fifth annual report of the IQDR describes (1) a proposed governance structure that will facilitate international collaboration, stakeholder input and funding; (2) data sources and participating registries; (3) recruitment to date and patient baseline characteristics; and (4) an agenda for future research.
- Published
- 2009
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11. Impact of nephrology care trajectories pre-CKD stage 5 on initiation of kidney replacement therapy in children
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Parmentier, Cyrielle, Lassalle, Mathilde, Berard, Etienne, Harambat, Jerome, Couchoud, Cecile, Hogan, Julien, Service de néphrologie et pédiatrie générale [CHU Trousseau], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Agence de la biomédecine [Saint-Denis la Plaine], Centre Hospitalier Universitaire de Nice (CHU Nice), CHU Bordeaux [Bordeaux], AP-HP Hôpital universitaire Robert-Debré [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
- Subjects
Administrative database ,Renal Replacement Therapy ,Pediatric kidney transplantation ,Nephrology ,Renal Dialysis ,Care trajectories ,Stage 5 chronic kidney disease ,Humans ,Kidney Failure, Chronic ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Renal Insufficiency, Chronic ,Child ,Emergency dialysis start - Abstract
International audience; BACKGROUND: To improve pre-emptive kidney transplantation (PKT) in children and limit starting dialysis in an emergency, we aimed to describe nephrology care trajectories pre-CKD stage 5. METHODS: We included all children in France who, between 2010 and 2016, started kidney replacement therapy (KRT): standard dialysis (reference group) and emergency dialysis or PKT. We identified four pre-CKD stage 5 nephrology care trajectories before KRT that were extracted from the national exhaustive medical-administrative database and used logistic regression to explore associations between patient characteristics, care trajectories, and KRT initiation. RESULTS: Six hundred forty-three pediatric patients started KRT in France; 406 started dialysis and 30.5% emergency dialysis. The "optimal" care trajectory encompassed 179 patients, 82.7% with at least 18 months nephrology follow-up. Conversely, the "no care" trajectory encompassed 118 patients with no nephrology follow-up before KRT. The "severe" trajectory encompassed 128 patients; 93% hospitalized more than once a year and 18% in an intensive care unit. Finally, the "irregular" trajectory encompassed 127 patients, 77% and 46% with irregular laboratory monitoring and CKD drug delivery, respectively. With the "optimal" trajectory as the reference, probability of emergency dialysis was higher with the "irregular" and "no care" trajectories (odds ratio 3.02 [95% confidence interval 1.18-7.66] and 26.5 [10.8-64.8], respectively), and PKT was reduced with the "severe" trajectory (0.43 [0.23-0.82]). CONCLUSION: We identified a group of patients with irregular follow-up who may benefit the most from interventions aiming at improving adherence to treatment and earlier diagnosis of their CKD to improve access to PKT. A higher resolution version of the Graphical abstract is available as Supplementary information.
- Published
- 2021
12. Deleterious effects of dialysis emergency start, insights from the French REIN registry
- Author
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Michel, Alain, Pladys, Adélaide, Bayat, Sahar, Couchoud, Cecile, Hannedouche, Thierry, Vigneau, Cécile, CHU Pontchaillou [Rennes], École des Hautes Études en Santé Publique [EHESP] (EHESP), Institut de Génétique et Développement de Rennes (IGDR), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Registre REIN, Agence de la biomédecine [Saint-Denis la Plaine], Service de néphrologie et hémodialyse [CHU de Strasbourg], CHU Strasbourg, Service de néphrologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Troccaz, Olivier, Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], and Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
- Subjects
Male ,Emergency Medical Services ,Survival ,Emergency start ,lcsh:RC870-923 ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Renal Dialysis ,Humans ,Registries ,ESRD ,Aged ,Outcome ,Aged, 80 and over ,Correction ,Middle Aged ,lcsh:Diseases of the genitourinary system. Urology ,[SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Survival Rate ,Treatment Outcome ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Kidney Failure, Chronic ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Female ,France ,Dialysis ,Follow-Up Studies - Abstract
International audience; Background: Emergency start (ES) of dialysis has been associated with worse outcome, but remains poorly documented. This study aims to compare the profile and outcome of a large cohort of patients starting dialysis as an emergency or as a planned step in France.Methods: Data on all patients aged 18 years or older who started dialysis in mainland France in 2012 or in 2006 were collected from the Renal Epidemiology and Information Network and compared, depending on the dialysis initiation condition: ES or Planned Start (PS). ES was defined as a first dialysis within 24 h after a nephrology visit due to a life-threatening event. Three-year survival were compared, and a multivariate model was performed after multiple imputation of missing data, to determine the parameters independently associated with three-year survival.Results: In 2012, 30.3% of all included patients (n = 8839) had ES. Comorbidities were more frequent in the ES than PS group (≥ 2 cardiovascular diseases: 39.2% vs 28.8%, p < 0.001). ES was independently associated with worse three-year survival (57% vs. 68.2%, p = 0.029, HR 1.10, 95% CI 1.01–1.19) in multivariate analysis. Among ES group, a large part had a consistent previous follow-up: 36.4% of them had ≥3 nephrology consultations in the previous year. This subgroup of patients had a particularly high comorbidity burden. ES rate was stable between 2006 and 2012, but some proactive regions succeeded in reducing markedly the ES rate.Conclusion: ES remains frequent and is independently associated with worse three-year survival, demonstrating that ES deleterious impact is never overcome. This study shows that a large part of patients with ES had a previous follow-up, but high comorbidity burden that could favor acute decompensation with life-threatening conditions before uremic symptoms appearance. This suggests the need of closer end-stage renal disease follow-up or early dialysis initiation in these high-risk patients.
- Published
- 2018
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