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Kazes I, Solignac J, Lassalle M, Mercadal L, Couchoud C. Twenty years of the French Renal Epidemiology and Information Network. Clin Kidney J 2024; 17:sfad240. [PMID: 38186909 PMCID: PMC10768769 DOI: 10.1093/ckj/sfad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background The French Renal Epidemiology and Information Network (REIN) is 20 years old. It is not just a national data registry, but rather an epidemiological and informational network serving patients with chronic kidney disease, nephrology teams and health services. Methods The past 10-year trends of the incidence and prevalence of renal replacement therapy by dialysis or kidney transplantation and waitlist activity are presented. To detect potential significant changes in trends from 2012 and 2021, a Joinpoint regression model was used. Results The overall incidence of treated end-stage kidney disease (ESKD) was 169 per million population (pmp) in 2021. It was stable despite an increase in the incidence of diabetes. We found a decreasing trend in the proportion of patients starting dialysis in an emergency but an increase in those starting haemodialysis (HD) with a temporary catheter. Peritoneal dialysis decreased by 1.7% each year, whereas home HD, although involving only 1% of dialysis patients, increased by 10% each year. For patients not treated at home, the median time to drive from the patient's home to the dialysis unit was 17 min. The proportion of patients on the transplantation waitlist at the start of dialysis increased from 7% to 12%. Among the 111 263 new ESKD patients from 2012 to 2021, 8% received a first transplant at 1 year and 20% at 5 years. Among kidney transplant recipients, the mean time on the waitlist increased from 13.8 to 22.6 months. Living donor transplants increased in frequency, representing 15% of kidney transplants. Conclusions Data from the REIN registry allow for the evaluation of needs and provide a planning tool for French authorities. The progressive implementation of automatic data retrieval from dialysis informatics charts might alleviate the burden of data collection. Furthermore, the research activity the REIN engenders, resulting in renewed confidence by health authorities in the dynamism of French nephrology, allows for an optimistic outlook for the REIN.
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Affiliation(s)
- Isabelle Kazes
- Service de Néphrologie, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Justine Solignac
- Service de Néphrologie, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Mathilde Lassalle
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Lucile Mercadal
- Service de Néphrologie, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
| | - Cécile Couchoud
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
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Desmarets M, Ayav C, Diallo K, Bayer F, Imbert F, Sauleau EA, Monnet E. Fine-scale geographic variations of rates of renal replacement therapy in northeastern France: Association with the socioeconomic context and accessibility to care. PLoS One 2020; 15:e0236698. [PMID: 32722704 PMCID: PMC7386572 DOI: 10.1371/journal.pone.0236698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/12/2020] [Indexed: 11/25/2022] Open
Abstract
Background The strong geographic variations in the incidence rates of renal replacement therapy (RRT) for end-stage renal disease are not solely related to variations in the population's needs, such as the prevalence of diabetes or the deprivation level. Inequitable geographic access to health services has been involved in different countries but never in France, a country with a generous supply of health services and where the effect of the variability of medical practices was highlighted in an analysis conducted at the geographic scale of districts. Our ecological study, performed at the finer scale of townships in a French area of 8,370,616 inhabitants, investigated the association between RRT incidence rates, socioeconomic environment and geographic accessibility to healthcare while adjusting for morbidity level and medical practice patterns. Methods Using data from the Renal Epidemiology and Information Network registry, we estimated age-adjusted RRT incidence rates during 2010–2014 for the 282 townships of the area. A hierarchical Bayesian Poisson model was used to examine the association between incidence rates and 18 contextual variables describing population health status, socioeconomic level and health services characteristics. Relative risks (RRs) and 95% credible intervals (95% CrIs) for each variable were estimated for a 1-SD increase in incidence rate. Results During 2010–2014, 6,835 new patients ≥18 years old (4231 men, 2604 women) living in the study area started RRT; the RRT incidence rates by townships ranged from 21 to 499 per million inhabitants. In multivariate analysis, rates were related to the prevalence of diabetes [RR (95% CrI): 1.05 (1.04–1.11)], the median estimated glomerular filtration rate at dialysis initiation [1.14 (1.08–1.20)], and the proportion of incident patients ≥ 85 years old [1.08 (1.03–1.14)]. After adjusting for these factors, rates in townships increased with increasing French deprivation index [1.05 (1.01–1.08)] and decreased with increasing mean travel time to reach the closest nephrologist [0.92 (0.89–0.95]). Conclusion These data confirm the influence of deprivation level, the prevalence of diabetes and medical practices on RRT incidence rates across a large French area. For the first time, an association was found with the distance to nephrology services. These data suggest possible inequitable geographic access to RRT within the French health system.
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Affiliation(s)
- Maxime Desmarets
- CIC-1431 INSERM, CHU Besançon, Université de Franche-Comté, Besançon, France
- UMR1098 RIGHT, Université Bourgogne Franche-Comté, EFS, INSERM, Besançon, France
| | - Carole Ayav
- CIC-1433 Epidémiologie Clinique, INSERM, CHRU Nancy, Université de Lorraine, Nancy, France
| | - Kadiatou Diallo
- CIC-1431 INSERM, CHU Besançon, Université de Franche-Comté, Besançon, France
| | - Florian Bayer
- Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Frédéric Imbert
- Observatoire Régional de la Santé d'Alsace, Strasbourg, France
| | - Erik André Sauleau
- Laboratoire de Biostatistique, ICube UMR CNRS 7357, Université de Strasbourg, Strasbourg, France
| | - Elisabeth Monnet
- CIC-1431 INSERM, CHU Besançon, Université de Franche-Comté, Besançon, France
- * E-mail:
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van den Brand JAJG, Pippias M, Stel VS, Caskey FJ, Collart F, Finne P, Heaf J, Jais JP, Kramar R, Massy ZA, De Meester J, Traynor JP, Reisæter AV, Wetzels JFM, Jager KJ. Lifetime risk of renal replacement therapy in Europe: a population-based study using data from the ERA-EDTA Registry. Nephrol Dial Transplant 2017; 32:348-355. [PMID: 28031344 DOI: 10.1093/ndt/gfw392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/04/2016] [Indexed: 01/01/2023] Open
Abstract
Background Upcoming KDIGO guidelines for the evaluation of living kidney donors are expected to move towards a personal risk-based evaluation of potential donors. We present the age and sex-specific lifetime risk of renal replacement therapy (RRT) for end-stage renal disease in 10 European countries. Methods We defined lifetime risk of RRT as the cumulative incidence of RRT up to age 90 years. We obtained RRT incidence rates per million population by 5-year age groups and sex using data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, and used these to estimate the cumulative incidence of RRT, adjusting for competing mortality risk. Results Lifetime risk of RRT varied from 0.44% to 2.05% at age 20 years and from 0.17% to 1.59% at age 70 years across countries, and was twice as high in men as in women. Lifetime RRT risk decreased with age, ranging from an average of 0.77% to 0.44% in 20- to- 70-year-old women, and from 1.45% to 0.96% in 20- to- 70-year-old men. The lifetime risk of RRT increased slightly over the past decade, more so in men than in women. However, it appears to have stabilized or even decreased slightly in more recent years. Conclusions The lifetime risk of RRT decreased with age, was lower in women as compared with men of equal age and varied considerably throughout Europe. Given the substantial differences in lifetime risk of RRT between the USA and Europe, country-specific estimates should be used in the evaluation and communication of the risk of RRT for potential living kidney donors.
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Affiliation(s)
- Jan A J G van den Brand
- Department of Nephrology, Radboud Institute of Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria Pippias
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Fergus J Caskey
- Medical Director, UK Renal Registry, Southmead Hospital, Bristol, UK.,Honorary Senior Lecturer, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Frederic Collart
- Nephrology and Dialysis Department, Brugmann Universitry Hospital, Brussels, Belgium
| | - Partik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Jean-Philippe Jais
- Université Paris Descartes, INSERM UMRS 1138 Team 22, APHP, Hôpital Necker Enfants Malades, Biostatistics Unit, Paris, France
| | - Reinhard Kramar
- Austrian Dialysis and Transplant Registry, Rohr im Kremstal, Austria
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré Univeristy Hospital, Boulogne Billancourt/Paris, France.,INSERM, U-1018 Team 5 (EpReC, Renal and Cardiovascular Epidemiology), CESP, Villejeuf, France
| | - Johan De Meester
- Department of Nephrology and Dialysis and Hypertension, Dutch-Speaking Belgian Renal Registry Sint-Niklaas, Belgium
| | | | - Anna Varberg Reisæter
- The Norwegian Renal Registry, Department of Nephrology, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Olso, Norway
| | - Jack F M Wetzels
- Department of Nephrology, Radboud Institute of Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
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Castledine C. Racial Disparity in Access to Home Therapies—We Have the Power to Change. Perit Dial Int 2017; 37:4-5. [DOI: 10.3747/pdi.2016.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bikbov B, Bieber B, Andrusev A, Tomilina N, Zemchenkov A, Zhao J, Port F, Robinson B, Pisoni R. Hemodialysis practice patterns in the Russia Dialysis Outcomes and Practice Patterns Study (DOPPS), with international comparisons. Hemodial Int 2016; 21:393-408. [DOI: 10.1111/hdi.12503] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/29/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Boris Bikbov
- Department of Nephrology, A.I.Evdokimov Moscow State University of Medicine and Dentistry; Moscow Russian Federation
- Department of Nephrology Issues of Transplanted Kidney; Academician V.I.Shumakov Federal Research Center of Transplantology and Artificial Organs; Moscow Russian Federation
| | - Brian Bieber
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
| | - Anton Andrusev
- Department of Nephrology, A.I.Evdokimov Moscow State University of Medicine and Dentistry; Moscow Russian Federation
- Moscow City Nephrology Center, City Clinical Hospital #52 of Moscow City Health Department; Moscow Russian Federation
| | - Natalia Tomilina
- Department of Nephrology, A.I.Evdokimov Moscow State University of Medicine and Dentistry; Moscow Russian Federation
- Department of Nephrology Issues of Transplanted Kidney; Academician V.I.Shumakov Federal Research Center of Transplantology and Artificial Organs; Moscow Russian Federation
- Moscow City Nephrology Center, City Clinical Hospital #52 of Moscow City Health Department; Moscow Russian Federation
| | - Alexander Zemchenkov
- Department of Nephrology and Dialysis, I.P.Pavlov First St-Petersburg State Medical University; St. Petersburg Russia
| | - Junhui Zhao
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
| | - Friedrich Port
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
| | - Bruce Robinson
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
| | - Ronald Pisoni
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
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Chesnaye NC, Schaefer F, Groothoff JW, Caskey FJ, Heaf JG, Kushnirenko S, Lewis M, Mauel R, Maurer E, Merenmies J, Shtiza D, Topaloglu R, Zaicova N, Zampetoglou A, Jager KJ, van Stralen KJ. Disparities in treatment rates of paediatric end-stage renal disease across Europe: insights from the ESPN/ERA-EDTA registry. Nephrol Dial Transplant 2015; 30:1377-85. [PMID: 25839740 DOI: 10.1093/ndt/gfv064] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Considerable disparities exist in the provision of paediatric renal replacement therapy (RRT) across Europe. This study aims to determine whether these disparities arise from geographical differences in the occurrence of renal disease, or whether country-level access-to-care factors may be responsible. METHODS Incidence was defined as the number of new patients aged 0-14 years starting RRT per year, between 2007 and 2011, per million children (pmc), and was extracted from the ESPN/ERA-EDTA registry database for 35 European countries. Country-level indicators on macroeconomics, perinatal care and physical access to treatment were collected through an online survey and from the World Bank database. The estimated effect is presented per 1SD increase for each indicator. RESULTS The incidence of paediatric RRT in Europe was 5.4 cases pmc. Incidence decreased from Western to Eastern Europe (-1.91 pmc/1321 km, P < 0.0001), and increased from Southern to Northern Europe (0.93 pmc/838 km, P = 0.002). Regional differences in the occurrence of specific renal diseases were marginal. Higher RRT treatment rates were found in wealthier countries (2.47 pmc/€10 378 GDP per capita, P < 0.0001), among those that tend to spend more on healthcare (1.45 pmc/1.7% public health expenditure, P < 0.0001), and among countries where patients pay less out-of-pocket for healthcare (-1.29 pmc/11.7% out-of-pocket health expenditure, P < 0.0001). Country neonatal mortality was inversely related with incidence in the youngest patients (ages 0-4, -1.1 pmc/2.1 deaths per 1000 births, P = 0.10). Countries with a higher incidence had a lower average age at RRT start, which was fully explained by country GDP per capita. CONCLUSIONS Inequalities exist in the provision of paediatric RRT throughout Europe, most of which are explained by differences in country macroeconomics, which limit the provision of treatment particularly in the youngest patients. This poses a challenge for healthcare policy makers in their aim to ensure universal and equal access to high-quality healthcare services across Europe.
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Affiliation(s)
| | - Franz Schaefer
- Division of Paediatric Nephrology, University of Heidelberg Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC, Amsterdam, Netherlands
| | | | - James G Heaf
- Department of Nephrology, University of Copenhagen, Herlev, Denmark
| | | | | | - Reiner Mauel
- Department of Pediatric Nephrology, University of Gent, Gent, Belgium
| | | | - Jussi Merenmies
- Department of Pediatric Nephrology and Transplantation, University of Helsinki, Helsinki, Finland
| | - Diamant Shtiza
- Department of Pediatrics Nephrology Unit, University Hospital Centre 'Mother Tereza', Tirana, Albania
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University, Ankara, Turkey
| | | | - Argyroula Zampetoglou
- Department of Pediatric Nephrology, 'A. and P. Kyriakou' Children's Hospital, Athens, Greece
| | - Kitty J Jager
- ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, Netherlands
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Ghahramani N, Wang C, Sanati-Mehrizy A, Tandon A. Perception about transplant of rural and urban patients with chronic kidney disease; a qualitative study. Nephrourol Mon 2014; 6:e15726. [PMID: 24783174 PMCID: PMC3997949 DOI: 10.5812/numonthly.15726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/05/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is a worldwide public health problem with increasing incidence and prevalence and associated expenses. Objectives: To explore different perceptions of rural and urban patients with chronic kidney disease (CKD) about kidney transplant. Patients and Methods: We conducted four focus groups, each including 5 or 6 patients with stage 5 CKD or end stage renal disease living in a rural or urban area. Open-ended questions probed patient familiarity with kidney transplant, perceptions of benefits of kidney transplant, perceived barriers to kidney transplant, and views about living donation. All the sessions were recorded and professionally transcribed. Responses were pooled, de-identified, and analyzed using qualitative thematic content analysis. Results: Urban patients were more likely to receive supplementary information and being strongly encouraged by their nephrologists to seek transplant. All participants acknowledged “independence” as the main advantage of transplantation. Increased freedom to travel and improved life expectancy were mentioned only among the urban groups. The main themes in all groups regarding perceived barriers to transplant were the tedious pre-transplant testing and workup expenses. Among rural groups, there was a perception that distance from transplant centers impedes transplant evaluation. Religious reasons favoring and opposing transplant were mentioned by participants in a rural group. Some members contended that since illness is God’s will, we should not change it. Others in the same group argued that “God is not ready for us to give up”. Praise and gratitude for the living donor were expressed in all groups, but concerns about donor’s outcome were discussed only within the rural groups. In discussing preference about known or anonymous donors, members of an urban group mentioned favoring an anonymous donor, citing unease with a sense of life-long indebtedness. Conclusions: Observed differences in perceptions among rural and urban patients about aspects of transplant may contribute to geographic disparities in transplant. The findings could be helpful to guide future individualized, culturally sensitive educational interventions about transplant for patients with CKD.
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Affiliation(s)
- Nasrollah Ghahramani
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, USA
- Corresponding author: Nasrollah Ghahramani, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, USA. Tel: +1-7175318156, Fax: +1-7175316776, E-mail:
| | - Chloe Wang
- Pennsylvania State University College of Medicine, Hershey, USA
| | | | - Ankita Tandon
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, USA
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Boyd J, Mackinnon MWB, Severn A, Traynor JP, Whitworth CE, Metcalfe W. The delivery of renal replacement therapy in Scotland--why the geographic variation? QJM 2013; 106:1077-85. [PMID: 23974056 DOI: 10.1093/qjmed/hct176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The incidence of patients starting renal replacement therapy (RRT) for established renal failure (ERF) in Scotland has fallen from 2005 to 2011 due to a reduction in older patients starting RRT; there are significant differences between NHS Health board areas. AIM To understand the apparent inequality in provision of RRT between NHS board areas in Scotland. DESIGN Retrospective population analysis of Scottish renal registry (SRR) data, population statistics and quality outcomes framework summary statistics. RESULTS The incidence of patients starting RRT for ERF in Scotland fell from 123 per million population (pmp) in 2005 to 96 pmp in 2011. The incidence of ≥75 year olds fell from 406 to 274 pmp. There are significant differences between NHS board areas when standardized for age and social deprivation. There is no relationship between the population prevalence of CKD as reported by QOF and the incidence of RRT for ERF. Those areas with high incidence rates of ≥75 year olds have higher 90-day [Spearman's rank correlation: coefficient = 0.662; P = 0.03] and 1-year [Spearman's rank correlation: coefficient = 0.776; P = 0.003] mortality rates. CONCLUSION The significant variation in provision of RRT for ERF between Scottish NHS Board areas is not explained by age or social deprivation. There is evidence of change in practice towards RRT for patients aged ≥75 years but variation between NHS Board areas. This disparity must be further investigated to ensure equity of access to RRT for those who will benefit from it, and to non-dialytic care for those who would not.
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Affiliation(s)
- J Boyd
- Renal Unit, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK.
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Caskey FJ, Jager KJ. A population approach to renal replacement therapy epidemiology: lessons from the EVEREST study. Nephrol Dial Transplant 2013; 29:1494-9. [PMID: 24166464 DOI: 10.1093/ndt/gft390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The marked variation that exists in renal replacement therapy (RRT) epidemiology between countries and within countries requires careful systematic examination if the root causes are to be understood. While individual patient-level studies are undoubtedly important, there is a complementary role for more population-level, area-based studies--an aetiological approach. The EVEREST Study adopted such an approach, bringing RRT incidence rates, survival and modality mix together with macroeconomic factors, general population factors and renal service organizational factors for up to 46 countries. This review considers the background to EVEREST, its key results and then the main methodological lessons and their potential application to ongoing work.
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Affiliation(s)
- Fergus J Caskey
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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