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Adoli LK, Campeon A, Chatelet V, Couchoud C, Lobbedez T, Bayer F, Vabret E, Daugas E, Vigneau C, Jais JP, Bayat-Makoei S. Experience of Chronic Kidney Disease and Perceptions of Transplantation by Sex. JAMA Netw Open 2024; 7:e2424993. [PMID: 39083269 PMCID: PMC11292447 DOI: 10.1001/jamanetworkopen.2024.24993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/03/2024] [Indexed: 08/03/2024] Open
Abstract
Importance The pathway to kidney transplantation (KT) begins with the patient's acceptance of this surgical procedure after discussion with the nephrologist. The patients' perceptions of the disease and of KT may influence their willingness to undergo transplantation. Objective To describe patients' experiences of kidney disease and their perceptions of KT and the nephrologists' perceptions of the patient experience. Design, Setting, and Participants This qualitative study collected data through semistructured interviews with patients with chronic kidney disease and nephrologists in the Bretagne, Île-de-France and Normandie regions, France. Researchers involved in the study in each region purposely selected 99 patients with chronic kidney disease who initiated dialysis in 2021, based on their age, sex, dialysis facility ownership, and also 45 nephrologists, based on their sex and years of experience. Data analysis was performed from January to October 2023. Main Outcomes and Measures Themes were identified using inductive thematic analysis. Specific characteristics of men and women as well as the nephrologist's views for each theme were described. Results This study included 42 men and 57 women (56 [57%] aged 60 years or older) who started dialysis in 2021 and 45 nephrologists (23 women and 22 men). Six major themes were identified: (1) burden of chronic kidney disease on patients and their families, (2) health care professional-patient relationship and other factors that modulate chronic kidney disease acceptance, (3) dialysis perceived as a restrictive treatment, (4) patients' representation of the kidney graft, (5) role of past experiences in KT perception, and (6) dualistic perception of KT. In some cases, women and nephrologists indicated that women's perceptions and experiences were different than men's; for example, the disease's psychological impact and the living donor KT refusal were mainly reported by 8 women. Conclusions and Relevance Patients' past experience of chronic kidney disease in general and of KT in particular, as well as their relationship with their family and nephrologist, were substantial determinants of KT perception in this qualitative study. Targeted policies on these different factors might help to improve access to KT, and more research is needed to understand whether there are sex-based disparities.
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Affiliation(s)
- Latame Komla Adoli
- Univ Rennes, EHESP, CNRS, INSERM, Arènes – UMR 6051, RSMS – U1309, Rennes, France
| | | | - Valérie Chatelet
- U1086 INSERM, Anticipe, Centre De Lutte Contre Le Cancer François Baclesse, Centre Universitaire Des Maladies Rénales, Caen, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN) Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Thierry Lobbedez
- U1086 INSERM, Anticipe, Centre De Lutte Contre Le Cancer François Baclesse, Centre Universitaire Des Maladies Rénales, Caen, France
| | - Florian Bayer
- Renal Epidemiology and Information Network (REIN) Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Elsa Vabret
- Univ Rennes, EHESP, CNRS, INSERM, Arènes – UMR 6051, RSMS – U1309, Rennes, France
| | - Eric Daugas
- Inserm U1149 Université Paris Cité Assistance Publique-Hôpitaux De Paris Service De Néphrologie Hôpital Bichat- Paris, Paris, France
| | - Cécile Vigneau
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Jean-Philippe Jais
- Unité de Biostatistique, Hôpital Necker-Enfants Malades, AP-HP; Institut Imagine; Université Paris-Cité, Paris, France
| | - Sahar Bayat-Makoei
- Univ Rennes, EHESP, CNRS, INSERM, Arènes – UMR 6051, RSMS – U1309, Rennes, France
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Bonnin P, Kuntz S, Caillard S, Chakfé N, Lejay A. Aortobifemoral Bypass in Kidney Transplant Candidates: A Ten-Year Experience. Transpl Int 2024; 37:12085. [PMID: 38379606 PMCID: PMC10878425 DOI: 10.3389/ti.2024.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
In patients with severe aorto-iliac calcifications, vascular reconstructions can be performed in order to allow kidney transplantation. The aim of this study was to analyze the outcomes of kidney transplant candidates who underwent an aortobifemoral bypass (ABFB) for aorto-iliac calcifications. A retrospective study including all kidney transplant candidates who underwent an ABFB between 2012 and 2022 was performed. Primary outcome was 30-day morbidity-mortality after ABFB. Secondary outcome was accessibility to kidney transplant waiting list. Twenty-two ABFBs were performed: 10 ABFBs in asymptomatic patients presenting severe aorto-iliac circumferential calcifications without hemodynamic consequences, and 12 ABFBs in symptomatic patients in whom aorto-iliac calcifications were responsible for claudication or critical limb threatening ischemia. Overall 30-day mortality was 0%. Overall 30-day morbidity was 22.7%: 1 femoral hematoma and 1 retroperitoneal hematoma requiring surgical drainage in the asymptomatic group, and 2 digestive ischemia requiring bowel resection and 1 femoral hematoma requiring surgical drainage in the symptomatic group. Among the 22 patients, 20 patients could access to kidney waiting list and 8 patients underwent a kidney transplantation, including 3 living-donor transplantations. Aorto-iliac revascularization can be an option to overcome severe calcifications contraindicating kidney transplantation.
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Affiliation(s)
- Pascaline Bonnin
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- Gepromed, Strasbourg, France
| | - Sophie Caillard
- Department of Nephrology and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- Gepromed, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- Gepromed, Strasbourg, France
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Prezelin-Reydit M, Lobbedez T, Lassalle M. [REIN: a tool for the benefit of renal transplantation]. Nephrol Ther 2023; 18:40-45. [PMID: 37638507 DOI: 10.1016/s1769-7255(22)00566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of access to renal transplantation for ESKD patients, the following key messages were retained. The registry of the REIN includes data about kidney transplant and dialysis. It thus allows evaluating the access to kidney transplant in France based on the needs of the population with stage 5 CKD treated by renal replacement therapy. The data produced by the registry is complementary to the data in the report of the Agence de la biomédecine (Agency of Biomedicine) based on the activity of the transplant centres and the population of registered patients waiting for a transplant. The proportion of preemptive transplant (transplant without prior recourse to dialysis) as well as that of preemptive registration (before starting dialysis) have increased since 2012 but remain low. The proportion of preemptive transplant as the first replacement therapy remains low and stable over time at around 3 to 4%. The access to the waiting list and the transplant varies depending on the age and co-morbidities of the patients (diabetes, obesity) as well as on the region. The rates of registration on the kidney transplant waiting list at the time of initiation of dialysis and at 1 year from the start have been increasing since 2012, irrespective of the patients’ characteristics, though it remains low in elderly, diabetic and severely obese patients. This is partly the result related to the publication of the HAS (French National Authority for Health) recommendations in 2015 and the publications on the disparities in access to transplants established thanks to the REIN registry. The causes of non-registration at the time of initiation of dialysis have changed over time with some patients not registering for contraindication steadily decreasing since 2012. Thanks to several studies conducted using data from the registry, the variations in access to the list could be explained, partly, by the health condition of the dialysis population as well as by the socio-economic context and differences in practices according to dialysis networks. The median waiting time for a kidney transplant has been gradually increasing since 2012, with a delta of about 8 months between 2012 and 2020. However, the waiting time between the initiation of dialysis and the transplant has increased less significantly. The probability of receiving a first kidney transplant depends on the age, diabetic status and obesity of the patient, and has remained stable over time.
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Affiliation(s)
| | - Thierry Lobbedez
- Service de néphrologie, Centre hospitalo-universitaire de Caen, Caen, France
| | - Mathilde Lassalle
- Coordination nationale REIN, Agence de la biomédecine, Saint-Denis-La Plaine, France
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Paris L, Calvar E, Morello R, Lecouf A, Beaumier M, Lobbedez T, Châtelet V. Perception of social inequities in the access to the kidney transplant waiting list by nephrology trainees: a national survey. BMC Nephrol 2022; 23:394. [PMID: 36482319 PMCID: PMC9733200 DOI: 10.1186/s12882-022-03017-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Social inequalities in health are responsible for disparities in access to the kidney transplant waiting list (KTWL). The perception of disparities by nephrologists has consequences for the registration on the KTWL. The purposes of our study were to assess the perception of the factors implicated in the disparities in access to the KTWL by nephrology trainees and to assess the quality of the questionnaire. METHODS A questionnaire was developed to assess the perception of the determinants of the inequities in access to waitlisting. Continuous variables were described by median, 1st and 3rd quartiles. Categorical variables were described by frequencies and percentages. A principal component analysis and a hierarchical cluster analysis were performed to approach the correlation between the variables. A scree plot and a factor analysis were performed to determine the dimensions of the questionnaire. The internal consistency was estimated by Cronbach's coefficient. RESULTS The response rate was 98/110 (89%). The determinants of inequities in the access to KTWL not perceived by the nephrology trainees were "female sex", "income level" and "the centre provision to adapt the information to all of the patients" (18,3%, 36,7, 47% respectively). "Age", "being born abroad", "place of living", "education level", "transplant centre", "the health care provider" were determinants of disparities perceived by most of the trainees (85,7%, 75,5%, 82,6%, 78,6%, 73,5% et 78,5% respectively). Items related to the transplant centre were positively correlated, as well as "being born abroad", "education level" and "income level". The Cronbach's coefficient was 0,60. CONCLUSION Social inequalities in health are partially perceived by nephrology trainees. A teaching session could raise nephrologists' awareness of this issue and could help reduce the impact of these disparities on the course of ESKD (end-stage kidney disease) patients.
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Affiliation(s)
- Lucile Paris
- grid.411149.80000 0004 0472 0160Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la Côte de Nacre, 14 033 Caen Cedex 9, France ,Normandie Université, Unicaen, UFR de Médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France
| | - Eve Calvar
- grid.411149.80000 0004 0472 0160Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la Côte de Nacre, 14 033 Caen Cedex 9, France ,Normandie Université, Unicaen, UFR de Médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France ,U1086 INSERM – ANTICIPE – Centre Régional de Lutte Contre le Cancer, François Baclesse, Caen, France
| | - Rémy Morello
- grid.411149.80000 0004 0472 0160Plateforme de Méthodologie, CHU de Caen, Avenue de la Côte de Nacre, Niveau 3, CS 30001, 14033 Caen Cedex 9, France
| | - Angélique Lecouf
- grid.411149.80000 0004 0472 0160Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la Côte de Nacre, 14 033 Caen Cedex 9, France
| | - Mathilde Beaumier
- grid.411149.80000 0004 0472 0160Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la Côte de Nacre, 14 033 Caen Cedex 9, France ,Normandie Université, Unicaen, UFR de Médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France ,U1086 INSERM – ANTICIPE – Centre Régional de Lutte Contre le Cancer, François Baclesse, Caen, France
| | - Thierry Lobbedez
- grid.411149.80000 0004 0472 0160Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la Côte de Nacre, 14 033 Caen Cedex 9, France ,Normandie Université, Unicaen, UFR de Médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France ,U1086 INSERM – ANTICIPE – Centre Régional de Lutte Contre le Cancer, François Baclesse, Caen, France
| | - Valérie Châtelet
- grid.411149.80000 0004 0472 0160Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la Côte de Nacre, 14 033 Caen Cedex 9, France ,Normandie Université, Unicaen, UFR de Médecine, 2 rue des Rochambelles, 14032 Caen Cedex, France ,U1086 INSERM – ANTICIPE – Centre Régional de Lutte Contre le Cancer, François Baclesse, Caen, France
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Baroux N, Le Mee M, Haidar F. [Access to the kidney transplantation waiting list for peritoneal dialysis patients in New-Caledonia and Wallis and Futuna]. Nephrol Ther 2022; 18:491-497. [PMID: 36163236 DOI: 10.1016/j.nephro.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 10/07/2021] [Accepted: 01/11/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Since 2012, a deceased donor kidney transplant program exists for dialysis patients living in New-Caledonia in collaboration with Royal Prince Alfred Hospital in Sydney, Australia. This program has reduced the time spent out-of-territory for a renal transplantation and has reduced the economic burden of end stage renal disease in New-Caledonia. We have realised a photography of kidney transplants evaluation for patients in peritoneal dialysis in New-Caledonia and Wallis and Futuna. The first aim was to describe access to kidney transplants evaluation for dialysis patients. A second aim was to compare patients with a conformed kidney transplant evaluation and patients without transplant evaluation with no obvious reasons identified. METHOD All patients in peritoneal dialysis in New-Caledonia and Wallis and Futuna at the 2018, 31st july were included. A standardised form was filled by two nephrologists. The computerised shared medical record was used to collect information. A kidney transplant evaluation was adequate for patients registered on transplant waiting list, patients with medical contraindications identified or patients with evaluation exams begun less than 6 months. RESULTS In total, 61 patients were included. The average age was 62 years old. The chronic kidney disease care average time was 6.7 years and the dialysis average time was 2.0 years. Among them, 11 (18 %) were registered on the waiting list, 26 (43 %) had at least one kidney transplant medical contraindication, 3 (5 %) had begun transplant exam since less than 6 months and 21 (34 %) had no transplant exam begun or transplant exam begun since more than 6 months without medical contraindication identified. Among those 21 patients, the three most common reasons were a faulty programming transplant exam (67 %; n = 14), a remote living place (48 %; n = 10) and an intercurrent health event (29 %; n = 6). Among patients living in Noumea and suburbs, 74 % had a conformed transplant evaluation against 44 % in patients living outside Noumea and suburbs (P = 0.058). Nearly one in two patients not on the waiting list had have no information about kidney graft or the information was not recorded in the medical record. CONCLUSION This study showed two main factors of a non-conformed transplantation evaluation: living outside Noumea and suburbs and a non-efficient planning of pre-transplant assessment exams. There is also a lack of information to the patient. These risk factors for late registration and non-registration must be considered by the healthcare teams. This study will provide a point of reference to assess the impact of actions to improve access to renal transplantation deployed in New-Caledonia.
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Affiliation(s)
- Noémie Baroux
- Résir, Réseau de l'insuffisance rénale de Nouvelle-Calédonie, 98800 Nouméa, Nouvelle-Calédonie; Atir NC, Association pour le traitement et la prévention de l'insuffisance rénale de Nouvelle-Calédonie, 98805 Dumbéa Sur Mer, Nouvelle-Calédonie.
| | - Marin Le Mee
- Résir, Réseau de l'insuffisance rénale de Nouvelle-Calédonie, 98800 Nouméa, Nouvelle-Calédonie; Atir NC, Association pour le traitement et la prévention de l'insuffisance rénale de Nouvelle-Calédonie, 98805 Dumbéa Sur Mer, Nouvelle-Calédonie
| | - Fadi Haidar
- Résir, Réseau de l'insuffisance rénale de Nouvelle-Calédonie, 98800 Nouméa, Nouvelle-Calédonie; Atir NC, Association pour le traitement et la prévention de l'insuffisance rénale de Nouvelle-Calédonie, 98805 Dumbéa Sur Mer, Nouvelle-Calédonie; Service de néphrologie et hypertension, département de médecine, hôpitaux universitaires de Genève, 1211 Genève 14, Suisse; Service de transplantation, département de chirurgie, hôpitaux universitaires de Genève, 1211 Genève 14, Suisse
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Couchoud C, Bayer F, Rabilloud M, Ayav C, Bayat S, Bechade C, Brunet P, Gomis S, Savoye E, Moranne O, Lobbedez T, Ecochard R. Effect of age and care organization on sources of variation in kidney transplant waiting list registration. Am J Transplant 2021; 21:3608-3617. [PMID: 34008288 DOI: 10.1111/ajt.16694] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 01/25/2023]
Abstract
Despite national guidelines, medical practices and kidney transplant waiting list registration policies may differ from one dialysis/transplant unit to another. Benefit risk assessment variations, especially for elderly patients, have also been described. The aim of this study was to identify sources of variation in early kidney transplant waiting list registration in France. Among 16 842 incident patients during the period 2016-2017, 4386 were registered on the kidney transplant waiting list at the start of, or during the first year after starting, dialysis (26%). We developed various log-linear mixed effect regression models on three levels: patients, dialysis networks, and transplant centers. Variability was expressed as variance from the random intercepts (± standard error). Although patient characteristics have an important impact on the likelihood of registration, the overall magnitude of variability in registration was low and shared by dialysis networks and transplant centers. Between-transplant center variability (0.23 ± 0.08) was 1.8 higher than between-dialysis network variability (0.13 ± 0.004). Older age was associated with a lower probability of registration and greater variability between networks (0.04, 0.20, & 0.93 in the 18-64, 65-74, and 75-84 age groups). Targeted interventions should focus on elderly patients and/or certain regions with greater variability in waiting list access.
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Affiliation(s)
- Cécile Couchoud
- REIN registry, Agence de la biomédecine, Saint-Denis La Plaine, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Université Lyon I, Villeurbanne, France
| | - Florian Bayer
- REIN registry, Agence de la biomédecine, Saint-Denis La Plaine, France
| | - Muriel Rabilloud
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Université Lyon I, Villeurbanne, France.,Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Carole Ayav
- INSERM, CIC, Epidémiologie Clinique, CHRU-Nancy, Nancy, France
| | - Sahar Bayat
- EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, Université Rennes, Rennes, France
| | | | - Philippe Brunet
- Nephrology Department, APHM University Hospital, Marseille, France
| | - Sebastien Gomis
- Nephrology Department, Lille University Hospital, Lille, France
| | - Emilie Savoye
- Direction Prélèvement Greffe Organes-Tissus, Agence de la biomédecine, Saint-Denis La Plaine, France
| | - Olivier Moranne
- Nephrology-Dialysis-Apheresis Department, Nîmes University Hospital, Nîmes, France
| | | | - Rene Ecochard
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Université Lyon I, Villeurbanne, France.,Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
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Abstract
PURPOSE OF REVIEW Renal transplantation offers the chance for patients with end-stage renal disease (ESRD) to have a significantly longer, healthier and better quality life compared with remaining on dialysis. Inequities have been demonstrated at multiple points in the transplantation pathway. In this review, the factors contributing to inequity in access to renal transplantation will be explored from a European perspective. RECENT FINDINGS Despite improvements in patient assessment and revision of organ-offering schemes, there remain persistent inequities in access to the waiting list, allocation of a deceased donor transplant, receiving a living donor transplant and achieving preemptive transplantation. Older age, lower socioeconomic status and health literacy are key factors that continue to impact equity of access to transplantation. SUMMARY A number of modifiable factors have been identified affecting access to transplantation, Increased patient education together with a better access to and promotion of living donation may help address some of these inequities.
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Affiliation(s)
- Diana A Wu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh
| | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
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