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International audience; IntroductionEn France en 2017, d’après les données du registre Réseau épidémiologique et information en néphrologie (REIN), 30 % des patients atteints d’insuffisance rénale chronique terminale (IRCT) avaient démarré l’hémodialyse en urgence. Le démarrage en urgence de la dialyse augmente le risque de morbidité et de mortalité et diminue la qualité de vie des patients. L’objectif était de décrire des types de parcours de soins pré-dialyse et d’identifier les facteurs associés au démarrage en urgence.MéthodesL’étude a été menée à partir des données du registre REIN appariées à celles du Système national des données de santé (SNDS). Les patients âgés de 18 ans et plus ayant démarré la dialyse en 2015 en France ont été inclus. Le parcours de soins deux ans avant le démarrage de la dialyse a été défini par huit variables clés du parcours de l’IRC. Une analyse des composantes multiples (ACM) sur ces variables a précédé une classification ascendante hiérarchique (CAH) afin de générer des types de parcours. Une régression logistique intégrant les caractéristiques des patients et les variables clés du parcours a été utilisée pour identifier les facteurs associés au démarrage en urgence.RésultatsParmi les 8856 patients inclus (taux d’appariement SNDS de 90,2 %), 2681 (30,3 %) avaient démarré la dialyse en urgence. La CAH a permis d’identifier huit types de parcours de soins différents, dont les taux de démarrage en urgence variaient de 11 % à 62 % et qui incluaient des patients de profils différents, notamment en âge et comorbidités (22 % à 56 % de diabétiques). Contrairement à l’absence de suivi néphrologique, l’absence de suivi avec le médecin généraliste n’était pas significativement associée au démarrage en urgence (OR=1,83 et 0,79, IC95 % [1,58–2,13] et [0,61–1,04] respectivement).Discussion/ConclusionEn croisant des données de registre et de recours aux soins, notre étude montre la diversité de parcours de soins des patients IRC que les caractéristiques de ces derniers expliquent en partie. Certains types de parcours suggèrent un besoin accru de dépistage de l’IRC et d’adressage au néphrologue plus précoces.

BackgroundElderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take.MethodsThis is a cross-sectional analysis of medication profiles of individuals aged ≥75 years with eGFR ResultsWe collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7–11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6 and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine.ConclusionWe showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.Trial registrationNCT02910908.

International audience; IntroductionL’appariement de bases de données massives et à échelle individuelle est de plus en plus utilisé, en particulier dans la recherche en santé. Dans un enjeu de transparence, certaines recommandations internationales invitent les chercheurs à décrire leurs méthodes d’appariement sur lesquelles de nombreuses études se basent. Le registre du Réseau épidémiologique et information en néphrologie (REIN) enregistre et suit tous les cas d’Insuffisance rénale chronique terminale traitée (IRCT) en France. Ce registre utilise depuis peu les données du Système national des données de santé (SNDS). L’objectif est de décrire et présenter la méthode d’appariement utilisée.MéthodesUne approche déterministe itérative a été développée pour apparier les patients ayant démarré un traitement de suppléance rénale (TS) entre 2014 et 2015. L’algorithme comprend 24 étapes successives et inclut comme variables d’appariement: l’âge, le sexe, la commune de résidence du patient au démarrage du TS, le centre du TS et les dates du premier TS et de décès. Une première validation de l’algorithme a été menée en croisant le statut diabétique des patients dans les deux bases et en examinant les caractéristiques des patients non appariés.RésultatsParmi les 22 073 patients ayant démarré un traitement de suppléance rénale entre 2014 et 2015, 19 223 (87,1 %) ont été appariés au SNDS. Les taux de concordance du statut diabétique des patients entre les deux bases étaient de 92 % pour les diabétiques et 89,4 % pour les non diabétiques. Les caractéristiques des patients non appariés étaient similaires à celles des appariés. On notait cependant une surreprésentation de patients non appariés qui avaient démarré le traitement de suppléance par dialyse péritonéale (18,4 % versus 9,2 % des patients appariés).Discussion/ConclusionPar rapport à une méthode probabiliste, cette méthode d’appariement, qui utilise des variables habituelles de registre, est plus rapide en temps de calcul et peu consommatrice en ressources. Malgré l’absence de validation par « gold-standard », elle ouvre de nouvelles perspectives de recherche sur l’insuffisance rénale chronique, notamment l’étude des parcours de soins.

Resume L’objectif de la presente etude etait de decrire la delivrance medicamenteuse des traitements immunosuppresseurs d’entretien, sur l’annee 2014, des patients ayant recu une transplantation renale en 2012, a partir des donnees du Systeme national des donnees de sante (SNDS) et de comparer ces resultats aux informations declarees dans la base nationale Cristal de suivi des receveurs. Pour chaque patient, etaient considerees toutes les delivrances pharmaceutiques d’immunosuppresseurs avec la date de delivrance, la substance active (principe actif) et sa presentation (nombre de comprimes, dosage). Parmi les 2463 patients adultes greffes en 2012 et toujours porteurs d’un greffon en 2014, 73 % avaient au moins une delivrance de tacrolimus monohydrate (TAC), 59 % de mycophenolate mofetil (MMF), 54 % de prednisone et 20 % de ciclosporine (CSA) en 2014. Les doses journalieres, mais non le nombre de comprimes par jour, diminuaient avec l’âge. L’association la plus frequente etait tacrolimus monohydrate-mycophenolate mofetil-corticoides dans 34 % des cas. L’utilisation d’inhibiteurs mTOR, rare dans l’ensemble (7 %) en 2014, etait plus frequente chez les 66–85 ans. Les associations ne differaient pas de facon importante selon le statut diabetique, pour les patients avec un rein de donneur de plus de 70 ans ou selon le nombre de mismatch. Par rapport a la declaration dans Cristal, les doses journalieres delivrees en pharmacie etaient respectivement similaires (tacrolimus), sous-estimees (mycophenolate) ou surestimees (ciclosporine). Cette etude confirme la difficulte d’apprehender la consommation medicamenteuse et ses variations sur la seule delivrance pharmaceutique ou sur une declaration ponctuelle, meme si cela permet d’avoir une vue assez globale sur les pratiques francaises.

Introduction: There is a need for treatment guidelines and prognostic factor identification in children with primary IgA nephropathy. We analyzed the causative effect of steroids and the applicability of the Oxford classification. Methods: A total of 82 consecutive children (mean 10.6 years; median follow-up 3.3 years) were reviewed; 21 patients (25.6%) presented with acute kidney injury, and 6 (7.3%) with nephrotic syndrome. Renal biopsies were scored for Oxford classification and podocytopathic features in 2 groups: a group treated with steroid therapy (some in association with cyclophosphamide) and supportive care (renin angiotensin system blockade) and a group treated by supportive care alone. Results: The 2 groups were not comparable because baseline clinical data were different. Estimated glomerular filtration rate (eGFR) in immunosupressive group significantly improved between M0 (at onset) and M6 (6 months after treatment) from 89.9 [61.2–114.5] to 110.5 [93.7–120] ml/min per 1.73 m2, P

To what extent access to, and allocation of kidney transplants and survival outcomes in patients aged ≥75 years have changed over time in Europe is unclear. We included patients aged ≥75-84 years (termed older adults) receiving renal replacement therapy in thirteen European countries between 2005-2014. Country differences and time trends in access to, and allocation of kidney transplants were examined. Survival outcomes were determined by Cox regression analyses. Between 2005-2014, 1,392 older adult patients received 1,406 transplants. Access to kidney transplantation varied from ~0% (Slovenia, Greece and Denmark) to ~4% (Norway and various Spanish regions) of all older adult dialysis patients, and overall increased from 0.3% (2005) to 0.9% (2014). Allocation of kidney transplants to older adults overall increased from 0.8% (2005) to 3.2% (2014). Seven-year unadjusted patient and graft survival probabilities were 49.1% (95% confidence interval, 95%CI: 43.6; 54.4) and 41.7% (95%CI: 36.5; 46.8) respectively, with a temporal trend towards improved survival outcomes. In conclusion, in the European dialysis population aged ≥75-84 years access to kidney transplantation is low, and allocation of kidney transplants remains a rare event. Though both are increasing with time and vary considerably between countries. The trend towards improved survival outcomes is encouraging. This information can aid informed decision-making regarding treatment options. This article is protected by copyright. All rights reserved

International audience; Aim: Daily haemodialysis improves patients' quality of life and blood purification, but its effect on survival remains controversial. The aim of this study was to analyze the association between daily haemodialysis and renal transplantation and survival in France.Methods: This was an observational cohort study based on the French REIN registry. All incident patients 18 years old who started daily haemodialysis in France between 2003 and 2012 were included. Using a propensity score, 575 patients on daily haemodialysis were matched with 1696 patients receiving thrice-weekly haemodialysis. Survival analysis was performed using the Cox model. Access to the renal transplant waiting list and renal transplantation were analyzed using the Fine and Gray model.Results: Daily haemodialysis was not independently associated with reduced access to transplant waiting list, whereas, major comorbidities remained associated with restricted waitlisting after multivariate analysis adjusted for confounding factors. After being waitlisted, the cumulative incidence of renal transplantation was lower for the daily haemodialysis than for the thrice-weekly haemodialysis group (SHR=0.72, 95%CI 0.56-0.91). The risk of death was significantly higher in the daily haemodialysis group (HRadjusted=1.58, 95%CI 1.4-1.8). Major comorbidities were associated with higher risk of death and lower likelihood of receiving a renal transplant during the follow-up period.Conclusion: Our study showed that in France, the likelihood of undergoing renal transplantation after being waitlisted was lower for patients on daily haemodialysis than those on thrice-weekly haemodialysis. Moreover, daily haemodialysis was associated with higher risk of death, even after taking into account age and all major comorbidities.

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 (Reseau Epidemiologie et Information en Nephrologie). 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.

Background Patients starting renal replacement therapy (RRT) for end-stage renal disease often present with one or more co-morbidities. This study explored the prevalence of co-morbidities in patients who started RRT in Europe during the period from 2005 to 2014. Methods Using data from patients aged 20 years or older from all 11 national or regional registries providing co-morbidity data to the European Renal Association - European Dialysis and Transplant Association Registry, we examined the prevalence of the following co-morbidities: diabetes mellitus (DM) (primary renal disease and/or co-morbidity), ischaemic heart disease (IHD), congestive heart failure (CHF), peripheral vascular disease (PVD), cerebrovascular disease (CVD) and malignancy. Results Overall, 70% of 7578 patients who initiated RRT in 2014 presented with at least one co-morbidity: 39.0% presented with DM, 25.0% with IHD, 22.3% with CHF, 17.7% with PVD, 16.4% with malignancy and 15.5% with CVD. These percentages differed substantially between countries. Co-morbidities were more common in men than in women, in older patients than in younger patients, and in patients on haemodialysis at Day 91 when compared with patients on peritoneal dialysis. Between 2005 and 2014 the prevalence of DM and malignancy increased over time, whereas the prevalence of IHD and PVD declined. Conclusions More than two-thirds of patients initiating RRT in Europe have at least one co-morbidity. With the rising age at the start of RRT over the last decade, there have been changes in the co-morbidity pattern: the prevalence of cardiovascular co-morbidities decreased, while the prevalence of DM and malignancy increased.

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.

Introduction Les fistules et pontages arterioveineux sont preferables aux catheters pour l’hemodialyse chronique, mais restent insuffisamment utilises. Des comparaisons geographiques sur les pratiques de creation des voies d’abord peuvent nous informer sur leur potentiel de deploiement. Description Nous avons utilise les donnees du Registre REIN couple au systeme national des donnees de sante (SNDS) pour identifier les creations de fistule et de pontage avant le demarrage de l’hemodialyse chez 40 901 patients incidents de 2010 a 2015. Methodes Nous avons utilise des modeles lineaires generalises mixtes pour explorer les variations de prevalence entre departements, apres ajustement sur l’âge, le sexe, le statut diabetique, l’inscription sur liste d’attente de greffe renale, le demarrage en urgence, le statut juridique de l’etablissement, et la densite territoriale en nephrologues et chirurgiens vasculaires. Resultats Les patients avaient un âge median etait de 71 ans, 64 % etaient des hommes, 43 % avaient un diabete, et 33 % avaient demarre la dialyse en urgence. La moitie des patients avaient eu une creation de fistule (49 %) ou de pontage (1,7 %), respectivement 5 (IIQ : 2–12) et 3 (1–8) mois, en mediane, avant le demarrage de l’hemodialyse. La prevalence ajustee de creation de fistules variait d’un facteur 2 entre les departements francais, et celle de creation de pontages, d’un facteur 56. Les prevalences ajustees de fistules et de pontages sont inversement correlees, a −0,62. Conclusion Il existe des variations geographiques dans les pratiques de creation de voie d’abord en France peu expliquees par les caracteristiques des patients, les conditions du demarrage de la dialyse ou l’offre de soins en nephrologues et chirurgiens vasculaires. La creation de pontages semble plus souvent se substituer que s’additionner a celles des fistules.

Introduction Le reperage des patients avec une MRC dans les bases medico-administratives est un enjeu important pour la Recherche et la Sante Publique, notamment pour l’identification des determinants de leurs trajectoires, l’evaluation de la qualite de leur prise en charge, et l’orientation des Politiques en Sante. Description Un groupe de travail REDSIAM compose d’epidemiologistes, de biostatisticiens et de nephrologues a ete constitue. Methodes Sur la base de dire d’experts, des items de consommation de soins de ville et hospitaliers disponibles dans le SNDS (Systeme national des donnees de sante) ont ete listes comme pouvant etre possiblement, probablement ou certainement associes avec une MRC. Il s’agit de medicaments, d’actes medicotechniques, d’examens de biologie, de diagnostics hospitaliers, de la specialite du prescripteur et de la declaration d’une affection longue duree. Un algorithme base sur des combinaisons et repetitions de ces items a ete construit afin de reperer les patients atteints d’une MRC. Resultats L’algorithme de reperage s’est affine progressivement suite a son application sur la cohorte REIN-appariee au SNDS et la base de donnees de la DRSM des Hauts de France. Une premiere validation externe sur la Cohorte FCCSS-appariee au SNDS (867 patients ayant eu un cancer avant l’âge de 21 ans) rapporte une sensibilite de 73,9 % et une specificite de 97,6 %. Une prochaine etape consistera a appliquer l’algorithme sur la base nationale SNDS afin d’estimer la prevalence de la MRC en population generale definie par cet algorithme. Conclusion Cette approche se heurte a plusieurs limites comme la prise en compte des medicaments et des actes lors des sejours hospitaliers, la delivrance pharmaceutique centralisee dans les EPAHD, le sous-groupe de patients peu consommateur de soins et la difficulte de reperer les stades precoces. La validation finale de l’algorithme sera faite a l’aide de cohortes externes qui disposent du DFG, d’une recherche de proteinurie et d’une extraction SNDS.

Introduction La dialyse a domicile reste peu developpee en France. Description L’objectif de ce travail est d’analyser les sources de variations et les facteurs associes a l’acces et au temps passe en dialyse a domicile. Methodes Les patients adultes traites par dialyse en France metropolitaine sur la periode 2017-2019 ont ete inclus. Leur temps passe dans chaque modalite de traitement (DP, HD domicile, HD en etablissement) et au sein de chaque reseau de dialyse (158 regroupements d’etablissements) a ete calcule a partir des donnees du registre REIN. Differents modeles mixtes ont permis d’analyser l’effet des caracteristiques des patients, de la commune de residence, du departement de residence et des reseaux de dialyse sur 3 indicateurs : le nombre de demarrage d’une dialyse a domicile sur le temps passe hors domicile (regression Poisson), la survenue d’un des evenements suivants, le deces, la conversion vers l’HD en etablissement et la transplantation renale (regression Poisson) et la proportion de temps a domicile sur le temps total passe en dialyse (regression binomiale). Resultats 7728 patients (9,8 % des patients) ont ete traites par dialyse a domicile pour un total de 120 594 mois (8,0 % du temps total) : 89 % par DP et 11 % par HD. L’âge, les comorbidites, l’anciennete des traitements et un environnement defavorise sont associes a un moindre acces a la dialyse a domicile, a plus de deces et moins de transplation. De plus grandes variations entre reseaux de dialyse ont ete observes pour le deces ou la conversion vers l’HD en etablissement que pour la transplantation, signant peut etre des pratiques differentes de maintien a domicile. L’offre d’autodialyse ne semble pas representer un frein. Conclusion Notre approche permet de quantifier la part relative des caracteristiques patients, de leur environnement et de l’offre de soins associees au traitement par dialyse a domicile. Elle permet d’envisager des pistes d’action.

Introduction Socioeconomic status is recognized as an important determinant of kidney health. We aimed to assess the association of social deprivation with different indicators at kidney replacement therapy (KRT) initiation in the French pediatric population. Description Data from the REIN registry. Methods All end-stage kidney disease (ESKD) patients who started KRT before 20 years old in France between 2002 and 2015 were included. We investigated different indicators at KRT initiation: KRT modality (dialysis vs. pre-emptive transplantation), dialysis modality (hemodialysis [HD] vs. peritoneal dialysis [PD]), urgent vs. planned start of dialysis, use of catheter vs. fistula for HD vascular access, and late referral to a nephrologist. An ecological index, the European Deprivation Index (EDI), was used as a proxy for social deprivation. Results In total, 1115 patients were included (males 59%, median age at dialysis 14.4 years, glomerular/vascular diseases 36.8%). The most deprived group represented 38.7% of the patients, suggesting that pediatric ESKD patients come from a more socially deprived background. Social deprivation was significantly associated with the initial modality of KRT. Patients from the most deprived areas were more likely to initiate KRT with dialysis (adjusted OR: 1.88; 95% CI: 1.15–3.07) than those from the least deprived areas, and more often with HD than with PD. Among HD patients, the odds of starting treatment in emergency with a catheter was two-fold higher for the most deprived compared to the least deprived children (adjusted OR: 2.08; 95% CI: 1.07–4.04). There was a trend towards later referral in patients from the most deprived areas. Conclusion Children from the most deprived areas have lower access to pre-emptive kidney transplantation, lower access to PD, have more urgent initiation of HD with a catheter, and tend to be later referred to a nephrologist.

This study looked at the management of diabetes patients during the year prior to the initiation of dialysis.For this observational study, data were extracted from the National Health Insurance database for general-scheme beneficiaries (77% of the French population). Diabetes patients were identified by at least three reimbursements for antidiabetic drugs in 2012, while the initiation of dialysis was identified by specific refunds in 2013.Of the 6412 patients initiating dialysis, 37% (n=2378) had diabetes (men: 61%, median age: 71 years, haemodialysis: 92%). Six months prior to dialysis, 68% had filled at least one prescription for insulin, 38% for other antidiabetics (25% glinides, 8% sulphonylureas, 8% metformin, 6% DPP-4 inhibitors), 69% for three or more classes of antihypertensive drugs and 55% for erythropoiesis-stimulating agents. Within 12 months to 1 month of dialysis, 81% were hospitalized, 28% with a main diagnosis of kidney disease. No nephrologist referral or hospitalization was identified at 6-0 months before dialysis in 6% of patients or in 24% at 12-7 months. One in five patients with diabetes consulted a private endocrinologist within 6 months of dialysis. An arteriovenous fistula was created 1 month before haemodialysis in 43% of patients.The quality of preparation for dialysis was variable despite frequent hospitalizations. These data illustrate the need to mobilize patients with diabetes, and for healthcare professionals to more effectively anticipate and coordinate dialysis.

Background Few studies have analysed the impact of chronic respiratory disease (CRD) on outcomes in dialysis. We therefore sought to describe patients with CRD and end-stage renal disease and their outcomes after dialysis start, compared with patients without CRD, focusing especially on causes of death, access to renal transplantation and causes of hospital admissions. Methods The study included 52 797 adults aged 18 years and older who began dialysis from 2008 to 2013 and are recorded in the French national REIN registry. Survival, specific mortality and access to the waiting list and to renal transplantation were analysed, with adjustment for various comorbidities and consideration of competitive risks. The numbers of hospitalizations and hospital days, together with their causes, were analysed through an indirect link between the REIN database and the national French hospital discharge database. Results The frequency of CRD at dialysis start was 12% and was associated with various other comorbidities, including obesity and tobacco use. After adjustment for those comorbidities, CRD remained associated with a higher risk of death [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.16-1.25]. Patients with CRD were 30% less likely to undergo transplantation (HR 0.67, 95% CI 0.6-0.7) than patients without CRD. Their risk of dying from a respiratory disease was 8.8 times higher; their risk of dying from infection was also higher. Patients with CRD had a higher rate of admissions and more hospital days, for all causes and for every cause, except cancer. Conclusions CRD was associated with higher risks of death and hospital admissions and with lower likelihoods of being wait-listed for and undergoing renal transplantation. Increasing clinical awareness by patients and doctors and encouragement of spirometry use should promote more accurate clinical diagnosis and better preventive care for CRD.

Introduction L’atteinte renale est frequente au cours des AAV et peut conduire a une IRCT. Le maintien des immunosuppresseurs en IRCT pour prevenir les rechutes extrarenales est debattu. Description Comparer, chez les patients AAV incidents en dialyse chronique en France, le risque de rechute de la maladie, de complications infectieuses et cardiovasculaires avant et apres mise en dialyse, et determiner la proportion de patients inactifs au cours du temps. Methodes Etude retrospective incluant les patients AAV du registre REIN incidents en dialyse en 2008–2012 et apparies aux donnees du SNDS (systeme national des donnees de sante). Diagnostic d’AAV : codage SNDS. Rechute severe (exclusion de la 1re poussee d’AAV), complication cardiovasculaire ou infectieuse : necessitant une hospitalisation (SNDS). Rechute non severe : majoration des corticoides/immunosuppresseurs (SNDS) sans hospitalisation. Patient inactif : pas de chimiotherapie depuis ≥ 6 mois, pas de traitement immunosuppresseur, corticotherapie ≤ 7,5 mg/jour ; pas de poussee dans les 6 mois suivants. Resultats Inclusion de 229 patients (66,4 ans, 88 F/141 H, 142 GPA/87 PAM), AAV diagnostiquee depuis 1,7 an a la mise en dialyse. Suivis en dialyse 3,2 ans : 29 % transplantes, 50 % decedes (32 % de cause infectieuse, 22 % de cause cardiovasculaire et 5 % d’une poussee d’AAV). Rechutes totales : 0,57/patients/annees avant vs 0,07 apres dialyse (p Complications cardiovasculaires : 0,13/patients/annees avant vs 0,30 apres (p Infections : 0,16/patients/annees avant vs 0,29 apres (NS) ; 1,55 vs 3,22 jours d’hospitalisation (p Evolution de la proportion de patients inactifs : analyse en cours. Conclusion Resultats en faveur d’une extinction des AAV en dialyse, avec majoration des risques cardiovasculaire et infectieux, plaidant pour une epargne des immunosuppresseurs dans cette population. Resultats du PHRC MASTER-ANCA en attente.

In France, the method of financing is mainly based on the quantity of care produced. The fixed-rate financing of patients with chronic kidney disease at stage IV or V introduces the notion of payment to quality. Part of the quality assessment will focus on the patients' feelings about their care. The objective of this paper is to assess these indicators used in nephrology, markers in their own right of the quality of care. The patients reported outcomes measures considering the impact of illness or care and the Patient Reported Experience Measures considering their perception of their experience with the health care system or care pathway, are broader than quality of life. These PROs are measured using standardized and validated questionnaires, generic or specific. The Standardised Outcomes in Nephrology initiative has shown that PROs, too often neglected in favor of biological criteria, are instead favored by patients. In the context of a broad deployment of monitoring the quality of life for the purpose of evaluation of care, outside research protocol, the Commission recommends one of the following 2 tools: EuroQol 5D and 12-Item Short Form Health Survey, a compromise between feasibility and relevance and e-SATIS given its great use in health facilities, with an annual follow-up.

Background Several models have been proposed to predict kidney graft failure in adult recipients but none in younger recipients. Our objective was to propose a dynamic prediction model for graft failure in young kidney transplant recipients. Methods We included 793 kidney transplant recipients waitlisted before the age of 18 years who received a first kidney transplantation before the age of 21 years in France in 2002–13 and survived >90 days with a functioning graft. We used a Cox model including baseline predictors only (sex, age at transplant, primary kidney disease, dialysis duration, donor type and age, human leucocyte antigen matching, cytomegalovirus serostatus, cold ischaemia time and delayed graft function) and two joint models also accounting for post-transplant estimated glomerular filtration rate (eGFR) trajectory. Predictive performances were evaluated using a cross-validated area under the curve (AUC) and R2 curves. Results When predicting the risk of graft failure from any time within the first 7 years after paediatric kidney transplantation, the predictions for the following 3 or 5 years were accurate and much better with the joint models than with the Cox model (AUC ranged from 0.83 to 0.91 for the joint models versus 0.56 to 0.64 for the Cox model). Conclusion Accounting for post-transplant eGFR trajectory strongly increased the accuracy of graft failure prediction in young kidney transplant recipients.

International audience; In patients with tuberous sclerosis complex (TSC), renal complications are not limited to bleeding angiomyolipoma (AML); although rare, end-stage renal disease (ESRD) may occur. New treatments (e.g., mammalian target of rapamycin (m-Tor) inhibitors) for AML might influence the epidemiology of ESRD in patients with TSC. In France, 99 patients with TSC from the Renal Epidemiology and Information Network (REIN) registry and having undergone renal replacement therapy (RRT) between 2002 and 2016 were included in the present study. Additional data were collected from the patients’ medical charts. The mean ± standard deviation age at RRT initiation was 48.4 ± 16.4 and 73.8% had a neurologic impairment. Fifty-four patients underwent kidney transplantation after an average of 23 ± 12.3 months on dialysis. Among the 61 patients with additional data the most common renal lesion was AML 26.2% of the patients had isolated AML, and 26.2% had AML and renal cysts, 65.6% of patients had undergone nephrectomy, and 16.4% had undergone at least one embolization. None of the patients had been treated with an m-Tor inhibitor before dialysis. The graft survival rate was 92.5% at 5 years and 70.2% at 10 years. The present cohort study is the first to have assessed TSC patients on RRT from a national registry. Nephrectomy or embolization due to AML was the leading cause of ESRD in our cohort. By reducing the size of the AML, m-tor inhibitors might lower the risk of complications and thus reduce the number of patients with TSC requiring RRT. © 2020, Italian Society of Nephrology.

BackgroundThis study aims to develop a method to estimate the potential of preemptive kidney transplantation (PKT) by identifying patients who were transplanted after a dialysis period (non-preemptive kidney transplantation (NPKT)) despite being medically suitable for PKT.MethodsAll children (

Background Management of potassium disorders in patients on haemodialysis (HD) is complex. We studied prescription patterns of dialysate potassium and potassium binders, and their associations with patient survival. Methods This national registry-based study included 25 629 incident adult patients alive after 3 months of HD from 2010 through 2013 and followed-up through 31 December 2014. We used Cox proportional hazard models to estimate multiadjusted mortality hazard ratios (HRs) associated with time-dependent exposure to facility-level dialysate potassium concentrations and patient-level potassium binder exposure. Results Almost all dialysis units used, and generally most often, dialysate potassium concentrations of 2 mmol/L. During this period, use of concentrations Conclusions Diversity in facility-level use of dialysate potassium concentrations and potassium binder use at an appropriate dose appear to be associated with better survival in HD patients.

Poisson regression is a powerful tool for the analysis of incidence rates from cohort survival studies and facilitates simple, straightforward analyses of temporal patterns that may be difficult to assess with other methods. The Kaplan-Meier method, the logrank test, and the Cox model each have their respective parallels in grouped data analysis: instantaneous hazards, the hazard ratio for grouped data, and Poisson regression, grouped by intervals. This approach makes it possible to present the instantaneous speed of occurrence of events that may be more significant for clinicians and to consider more easily some constraints like parameters according to time (like time dependent variables or a time-dependent effect, neither of which are included in the conventional Cox model). However the application of Poisson regression requires that data on individual subjects be organized into event-time tables stratified by time and other factors of interest. This approach therefore requires the use of a large-scale database when small time intervals or many adjustment variables are necessary.

International audience; IntroductionL’utilisation d’un score permettant de prédire la mortalité, est très utile dans la prise de décision entre le démarrage de la dialyse ou d’un traitement conservateur chez les patients poly-pathologiques.MéthodesL’objectif était d’étudier l’intérêt de l’utilisation des données médico-administratives, en plus des données REIN dans la construction d’un score de comorbidités, prédictif de la mortalité toutes causes à 1 an, chez les patients en insuffisance rénale chronique terminale (IRCT). Les données REIN ont été appariées aux données du système national des données de santé (SNDS). Notre score de comorbidités a été construit à partir de la population incidente en dialyse en 2015, préalablement divisée en 2 pour respectivement construire et valider le score. Plusieurs modèles ont été testés et comparés avant d’identifier le score le plus performant : Rennes score. Enfin, le Rennes score a été comparé aux scores de Wright et de Charlson.Résultats obtenus ou attendusLa performance pronostique du score construit à partir des données REIN appariées aux données SNDS n’est pas supérieure à celle du score issue uniquement des données REIN (Rennes score). Le Rennes score inclut : albumine

International audience; IntroductionEn France, d’après le registre REIN, environ 30 % des patients atteints d’IRCT démarrent l’hémodialyse en urgence. Un tel démarrage augmente le risque de morbidité et de mortalité et diminue la qualité de vie. L’objectif était de comparer le parcours de soins pré-dialyse de ces patients avec celui des patients ayant bénéficié d’une 1re dialyse programmée.MéthodesLes patients ≥ 18 ans ayant démarré la dialyse en 2015 en France ont été inclus. Les données du REIN ont été appariées à celles du Système national des données de santé (SNDS). Les caractéristiques individuelles, les hospitalisations (nombre, durée et diagnostic principal) et le recours aux généralistes et aux néphrologues durant l’année précédant la 1re dialyse ont été comparés entre les deux groupes (démarrage en urgence vs. programmé).Résultats obtenus ou attendusParmi les 8964 patients inclus, 30,6 % avaient démarré la dialyse en urgence. Durant l’année précédant la 1re dialyse, le nombre médian de séjours était inférieur chez ces patients (1 vs. 2, p = 0,001) mais la durée moyenne d’un séjour était plus longue (8,1 jours vs. 5,8 jours, p < 0,001). Le nombre moyen de consultations avec un néphrologue était moindre chez les patients démarrant en urgence (2,5 vs. 4,5, p < 0,001) mais pas différent pour les consultations avec un généraliste (9,7 vs. 9,3, p = 0,064).ConclusionCette étude inédite du parcours de soins, grâce à l’appariement du registre REIN et du SNDS, a permis de montrer que les patients démarrant la dialyse de manière programmée étaient plus fréquemment suivis par des néphrologues et préparés à la dialyse. Cependant, dans les 2 groupes, beaucoup de patients avaient un suivi rapproché avec les généralistes. La comparaison du parcours de ces patients avec celui recommandé par la Haute Autorité de santé est en cours. Une étude qualitative impliquant patients, néphrologues et généralistes, approfondira la question d’adressage et les raisons médicales de ce suivi.

International audience; The prognosis of sickle cell disease (SCD) patients who need dialysis is poor, but experience with kidney transplantation is limited. This study assessed the characteristics of 36 SCD patients undergoing renal transplantation. Immediate post-surgical complications occurred in 25% of cases. Cytomegalovirus and bacterial infections were frequently observed. Twelve patients died after a median follow-up period of17-4 months. Overall patient survival was significantly lower in SCD than in the control group without significant difference for overall death-censored graft sur-vival. Our data suggest that renal transplantation should be systematically considered in SCD patients with end-stage renal disease.

International audience; INTRODUCTION: According to the French Renal Epidemiology and Information Network (REIN) registry data, in 2016, 32% of incident dialyzed patients started dialysis in emergency. The notion of emergency dialysis is defined as a first dialysis session performed immediately (within 24 hours) after the nephrologist’s assessment due to a life-threatening risk. Starting dialysis in emergency (ES) is associated with poorer outcome compared to a planned start (PS). Higher risk of morbidity and mortality, decreased quality of life for the patient as well as an increased cost for the health care system. The aim of this study was to compare the pre-dialysis care trajectory between ES and PS patients.METHODS: Data from the French REIN registry linked with the French national health database (SNIIRAM) were used. Patients aged 18 years old and older who started dialysis in 2015 in France were included. Individual characteristics at dialysis initiation, inpatient stays (number, duration and diagnosis), as well as consultations with general practitioners and nephrologists during the year before dialysis start were compared between ES and PS patients. The inpatient stays during which the dialysis started were not included in the comparison.RESULTS: Among the 10667 patients who started dialysis in 2015 in France, 9627 (90,2%) were linked to the SNIIRAM. The context of the first dialysis (ES or PS) was known for 9052 (84,9%) patients. Among them, 2769 (30,6%) had started dialysis in emergency. These patients had more comorbidities than the patients starting in a planned manner (for example, 19 % of ES patients had 3 or more cardio-vascular diseases versus 12,6 % of PS patients, p

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle–income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide.

International audience; This study investigated geographic variations of access to renal transplantation using three outcomes (access to the transplant waiting list, access to renal transplantation after waitlisting and access to renal transplantation after dialysis start). Associations of patient-related and regional variables with the studied outcomes were assessed using a Cox shared frailty model and a Fine and Gray model. At the study endpoint (December 31, 2015), 26.3% of all 18-90-year-old patients who started dialysis in the 22 mainland and 4 overseas French regions in 2012 (n=9312) were waitlisted and 15.1% received a kidney transplant. The geographic disparities of access to renal transplantation varied according to the studied outcome. Patients from the Ile-de-France region had the highest probability of being waitlisted, but were less likely to receive a kidney transplant. Two regional factors were associated with the access to the waiting list and to renal transplantation from dialysis start the incidence of preemptive kidney transplantation and of ESRD. The use of different outcomes to evaluate access to kidney transplantation could help healthcare policy-makers to select the most appropriate interventions for each region in order to reduce treatment disparities.

BACKGROUND Access to forms of dialysis, kidney transplantation (Tx) and comprehensive conservative management (CCM) for patients with end-stage kidney disease (ESKD) varies across European countries. Attitudes of nephrologists, information provision and decision-making may influence this access and nephrologists may experience several barriers when providing treatments for ESKD. METHODS We surveyed European nephrologists and kidney transplant surgeons treating adults with ESKD about factors influencing modality choice. Descriptive statistics were used to compare the opinions of professionals from European countries with low-, middle- and high-gross domestic product purchasing power parity (GDP PPP). RESULTS In total, 681 professionals from 33 European countries participated. Respondents from all GDP categories indicated that ∼10% of patients received no information before the start of renal replacement therapy (RRT) (P = 0.106). Early information provision and more involvement of patients in decision-making were more frequently reported in middle- and high-GDP countries (P

Purpose: Although a population's senescence rate is classically measured as the increase in mortality rate with age on a logarithmic scale, it may be more accurately measured as the increase on a linear scale. Patients on dialysis, who suffer from accelerated senescence, exhibit a smaller increase in their mortality rate on a logarithmic scale, but a larger increase on a linear scale than patients with a functioning kidney transplant. However, this comparison may be biased by population heterogeneity. Methods: Follow-up data on 323,308 patients on dialysis and 91,679 patients with a functioning kidney transplant were derived from the ERA-EDTA Registry. We measured the increases in their mortality rates using Gompertz frailty models that allow individual variation in this increase. Results: According to these models, the senescence rate measured as the increase in mortality rate on a logarithmic scale was smaller in patients on dialysis, while the senescence rate measured as the increase on a linear scale was larger in patients on dialysis than patients with a functioning kidney transplant. Conclusions: Also when accounting for population heterogeneity, a population's senescence rate is more accurately measured as the increase in mortality rate on a linear scale than a logarithmic scale. (C) 2016 Elsevier Inc. All rights reserved.

Introduction Aucune etude basee sur des donnees observationnelles en transplantation renale n’a reussi a imiter un essai clinique ou les patients seraient randomises entre la decision d’acceptation ou de refus d’une proposition de greffon renal. La premiere limite methodologique d’une telle etude est le caractere dependant du temps de l’exposition, rendant complexe la definition d’un temps d’origine pour les patients non exposes. La seconde limite est la violation de l’hypothese de positivite et ainsi de la comparabilite des groupes au moment de la survenue de l’exposition a cause de facteurs de confusion dependants du temps. Ces deux limites empechent l’utilisation de methodes basees sur les scores de propension classiques. L’une des possibilites est l’utilisation de scores de propension dependants du temps. Notre objectif est d’evaluer le benefice d’accepter la transplantation renale par rapport au fait de rester en dialyse en mimant un essai clinique par l’emploi d’une methode basee sur les scores de propension dependants du temps. Methode Au total, 23 231 patients inclus dans le registre francais REIN inscrits sur liste d’attente de transplantation entre 2005 et 2016 ont ete inclus. Le critere de jugement principal est le deces. Par un appariement sur un score de propension dependant du temps, nous avons obtenu 10 707 paires de patients comparables et differant uniquement sur le bras de traitement : transplantes (groupe « accepter ») ou restant en dialyse (groupe « refus »). Resultats Le temps d’origine etait le temps d’appariement, c’est-a-dire le pseudo temps de randomisation dans l’essai clinique imite. Le temps median de suivi est de 3,5 annees. A 10 ans de suivi, l’esperance de vie etait de 8,8 ans (IC95 % : 8,7 a 8,9) dans le groupe « accepter » contre 8,2 ans (IC95 % : 8,1 a 8,3) dans le groupe « refus ». Cela correspond a un gain d’esperance de vie de 6,8 mois (IC95 % : 5,5 a 8,2) soit une mort evitee pour 12 transplantations acceptees a 10 ans. Conclusion Notre etude a estime pour la premiere fois le gain d’esperance de vie apportee par l’acceptation d’une proposition de transplantation renale par rapport au refus. Cela confirme que la transplantation renale est le meilleur traitement disponible pour l’insuffisance renale chronique terminale. Par ailleurs, nous avons demontre que cette methode simple peut etre utilisee pour estimer l’effet marginal d’une exposition dependante du temps.

Introduction La transplantation renale pediatrique presente des specificites, notamment chez les receveurs les plus jeunes. A ce jour, aucun modele predictif de survie du greffon n’existe chez les jeunes receveurs pour aider a la selection du donneur. Description Notre objectif etait de developper et valider un modele predictif de survie du greffon a partir d’une cohorte internationale de jeunes receveurs pediatriques. Nous avons inclus les transplantations renales avant l’âge de 5 ans dans 5 pays (France, Etats-Unis, Royaume-Uni, Australie, Nouvelle-Zelande), entre 2005 et 2018. Methodes Un modele de Cox a ete utilise a partir des donnees americaines pour creer le modele predictif. La discrimination du modele (C-statistique) et la calibration ont ete evaluees de facon interne puis externe sur les donnees non americaines. Resultats Au total, 2543 transplantations renales ont ete inclues. La survie renale globale a 10 ans etait de 80,0 % (IC95 % = 77,7 %–82,2 %). Etant donne l’interaction entre l’âge du receveur et certains predicteurs, deux modeles ont ete developpes, selon l’âge du receveur (± 36 mois), incluant : rapport de surface corporelle donneur/receveur, duree d’ischemie froide, poids du donneur et matching immunologique. L’effet du matching immunologique augmentait avec l’âge du receveur tandis que la morphologie jouait un role predictif preponderant chez les jeunes patients. Les C-statistiques sur la cohorte de developpement etaient de 0,63 (IC95 % = 0,57–0,68) et 0,65 (IC95 % = 0,59–0,71). La Fig. 1 presente la discrimination au cours du suivi et la calibration a 10 ans sur la cohorte de validation. Conclusion Nous confirmons la bonne survie renale des patients transplantes avant l’âge de 5 ans. Nous avons developpe et valide, a partir de predicteurs pre-transplantation, des modeles predictifs de perte de greffon ou de deces applicables en pratique clinique.

[This corrects the article DOI: 10.1093/ckj/sfaa029.][This corrects the article DOI: 10.1093/ckj/sfaa029.].

Background Acute kidney injury requiring dialysis (AKI-D) is associated with high mortality. Information about its epidemiology is nonetheless sparse in some countries. The objective of this study was to assess its epidemiology and prognosis in metropolitan France. Methods Using the French hospital discharge database, the study focused on adults hospitalized in metropolitan France between 2009 and 2014 and diagnosed with AKI-D according to the codes of the French common classification of medical procedures. Crude and standardized incidence rates (SIR) by gender and age were calculated. We explored the changes in patients’ characteristics, modalities of renal replacement therapy (RRT), in-hospital care, and mortality, along with their determinants. Trends over time in the SIR for AKI-D, its principal diagnoses, and comorbidities were analyzed with joinpoint models. Results Between 2009 and 2014, the AKI-D SIR increased from 475 (95% CI, 468 to 482) to 512 per million population (95% CI, 505 to 519). AKI-D was twice as high in men as women. Median age was 68 years. Over the study period, the AKI-D SIR steadily increased in all age groups, particularly in the elderly. The most common comorbidities were cardio-cerebrovascular diseases (64.8%), pulmonary disease (42.2%), CKD (33.8%), and diabetes (26.0%); all of these except CKD increased significantly over time. In 2009, heart failure (17.2%), sepsis (17.0%), AKI (13.0%), digestive diseases (10.7%), and shock (6.6%) were the most frequent principal diagnoses, with a significant increase in heart failure and digestive diseases. The proportion of patients with at least one ICU stay and continuous RRT increased from 80.3% to 83.9% and from 56.9% to 61.8% (p

More than 30% of the world population will develop chronic kidney disease (CKD) during their life. More than 10% of the world population live with CKD and, therefore, are at higher risk of cardiovascular events, acute kidney injury episodes, progression to end-stage renal disease, and death. Risk factors of kidney disease occurrence may be intrinsic in a “patient at risk” or be related to a “situation at risk.” Primary prevention among the identified risk groups must be organized to decrease the risk of kidney disease appearance. Moreover, many risk factors also contribute to kidney damage progression in patients with CKD, and, therefore, they also are the target of secondary prevention. Because of restricted funding, the issue of unequal access to treatment, in particular to renal replacement therapy, explain most of the geographical differences observed.

The French Renal Epidemiology and Information Network (REIN) registry started in 2002 with the goal to provide a tool to evaluate renal replacement therapy (RRT) practices and outcomes, to provide data for research and to support public health decisions related to end-stage renal disease ESRD. This summary presents the incidence and prevalence of RRT including kidney transplantation and wait-listing activity in 2017, and patients' survival and trends over 5 years. In 2017, 11 543 patients started RRT for ESRD, that is, incidence of 172 pmp. Between 2012 and 2017, the incidence of RRT increased by 1% per year [CI 95% (0.0; +2.0)]. On 31 December 2017, 87 275 patients were receiving RRT, that is, prevalence of 1294 pmp, 55% on dialysis, 45% with a functioning transplant. In 2017, 3782 kidney transplantations have been performed including 16% from a living donor, 13% being retransplantations and 15% pre-emptive transplantations. The median time on the waiting list was 19.7 months when only taking into account active waiting periods on the list. In 2017, 5280 new patients were registered on the renal transplant waiting list (i.e. 78.7 pmp). The number of patients considered as 'inactive' represented 45% of the patients on the list.

Background Previous US studies have indicated that haemodialysis with ≥6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients. Methods We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association–European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5–4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders. Results From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62–0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71–0.90)]. Conclusions EHD is associated with better survival in European patients treated with haemodialysis three times weekly.

Socioeconomic status is an important determinant of health. Its impact on kidney transplantation outcome has been studied among adults but data in children are scarce, especially in Europe. Here, we investigate the association between the level of social deprivation (determined by the continuous score European Deprivation Index) and graft failure risk in pediatric kidney transplant recipients. All patients listed under 18 years of age who received a first kidney transplant between 2002 and 2014 in France were included. Of 1050 kidney transplant recipients (males 59%, median age at transplantation 13.2 years, preemptive transplantation 23%), 211 graft failures occurred within a median followup of 5.9 years. Thirty-seven percent of these patients belong to the most deprived quintile, suggesting that deprivation is more frequent in pediatric patients with end-stage kidney disease (ESKD) than in the general population. Five- and ten-year graft survival were 85% and 69%, respectively, in the most deprived quintile vs. 90% and 83%, respectively, in the least deprived quintile. At any time after transplantation, patients in the most deprived quintile had almost a two-fold higher hazard of graft failure compared with the least deprived quintile, after adjustment for age at renal replacement therapy, duration of dialysis, primary kidney disease, and rural/urban living environment (hazard ratio 1.99; 95% confidence interval 1.20-3.28). The hazard of graft failure did not differ significantly between girls and boys. Thus, our findings suggest a lower socioeconomic status is independently associated with poor graft outcome in pediatric kidney transplantation.

Introduction Le suivi des donneurs vivants de rein (DVR) dans le registre national (CRISTAL-DV) est limite par l’exhaustivite des informations saisies apres le don, notamment a distance du don. L’objectif de cette etude est de reperer les DVR dans le Systeme national des donnees de sante (SNDS) pour completer leur suivi et analyser leur parcours de soin de facon passive. Methodes Le nombre de greffes realisees entre 2014 et 2017 a partir de DVR est calcule grâce a CRISTAL-DV. Il est compare aux patients du PMSI codes avec un acte specifique de prelevement de rein en vue de don (JAFA013, JAFC003). Resultats Se baser uniquement sur les deux actes sus-cites ne permet pas de retrouver le nombre attendu de donneurs. Les actes de chirurgie renale (JAFA015, JAFA017, JAFA018, JAFA020) avec un diagnostic principal DVR (Z524) ont permis de completer la recherche. En revanche, l’exclusion des sujets avec des antecedents non compatibles avec le don d’un rein a ete necessaire pour augmenter la specificite de la selection. Au final, sur les 2249 greffes renales a partir de DVR adultes realisees (source CRISTAL-DV), seules 1700 ont pu etre detectees dans le PMSI (source SNDS). Le chainage avec le DCIR n’a ensuite ete possible que pour 1434 DVR. La difficulte a reperer et chainer les DVR s’explique en partie par la presence de DVR etrangers (10 % des DVR) mais demeure inexpliquee pour certains etablissements. Discussion/Conclusion La population des DVR est particuliere car a la fois quantifiable de maniere exhaustive dans un registre national et identifiable dans le PMSI avec un acte specifique permettant un remboursement adapte. L’effort de recueil des suivis post-don, la qualite du codage dans le PMSI et du chainage PMSI-SNDS ne permettent pas aujourd’hui un suivi suffisant. Sous condition d’une amelioration de la qualite du codage, le SNDS permettrait de suivre le devenir de ces personnes apres le don (hors regimes speciaux et etrangers).

Following publication of the original article [1], the authors reported that all of the authors' names were processed incorrectly so that their given and family names were interchanged.

International audience; Our objectives were to evaluate kidney transplantation survival benefit in people aged ≥70 who were receiving renal replacement therapy (RRT) and to identify their risk factors for posttransplant mortality. This study included all patients in the national French Renal Epidemiology and Information Network registry who started RRT between 2002 and 2013 at age ≥70. Mortality risk was compared between patients with transplants; on the waiting list; and on dialysis matched for age, gender, comorbidities, and time on dialysis. Of the 41 716 elderly patients starting RRT, 1219 (2.9%) were on the waiting list and 877 (2.1%) underwent transplantation during the follow-up. Until month 3, transplant patients had a risk of death triple that of the wait-listed group. Although the risk was halved at month 9, the perioperative risk was still not offset by month 36. Compared with matched dialysis patients (n = 2183), transplant patients were not at significantly increased perioperative risk and had a lower mortality risk starting at month 3. Risk factors for posttransplant mortality were diabetes, cardiovascular comorbidities, and dialysis duration >2 years. Among older dialysis patients, 20% had neither cardiovascular comorbidity nor diabetes. Systematic early assessment of the eligibility of elderly patients for kidney transplantation is recommended to expand registration to patients with poor survival on dialysis and no cardiovascular comorbidity.

Background An easy to use prediction model for long-term renal patient survival, based on only four predictors (age, primary renal disease, sex, and therapy at 90 days after the start of renal replacement therapy (RRT)), has been developed in the Netherlands. To assess the usability of this model for use in Europe, we externally validated the model in ten European countries. Methods Data from the ERA-EDTA (European Renal Association - European Dialysis and Transplant Association) Registry were used. Ten countries that reported individual patient data to the registry on patients starting RRT in the period of 1995-2005 were included. Patients under 16 years of age and/or with missing predictor variable data were excluded. The external validation of the prediction model was evaluated for the 10-year (primary endpoint), 5- and 3-year survival predictions by assessing the calibration and discrimination outcomes. Results We used a dataset of 136,304 patients from 10 countries. The calibration in the large and calibration plots for 10 deciles of predicted survival probabilities showed average differences of 1.5%, 3.2% and 3.4% in observed versus predicted 10-, 5-, and 3-year survival, with some small variation on country-level. The C-index, indicating the discriminatory power of the model, was 0.71 in the complete ERA-EDTA Registry cohort and varied according to country level between 0.70 and 0.75. Conclusions A prediction model for long-term renal patient survival developed in a single country, based on only four easily available variables, has a comparably adequate performance in a wide range of other European countries.

Essentials Mortality due to bleeding vs. arterial thrombosis in dialysis patients is unknown. We compared death causes of 201 918 dialysis patients with the general population. Dialysis was associated with increased mortality risks of bleeding and arterial thrombosis. Clinicians should be aware of the increased bleeding and thrombosis risks. Summary: Background Dialysis has been associated with both bleeding and thrombotic events. However, there is limited information on bleeding as a cause of death versus arterial thrombosis as a cause of death. Objectives To investigate the occurrence of bleeding, myocardial infarction and stroke as causes of death in the dialysis population as compared with the general population. Methods We included 201 918 patients from 11 countries providing data to the ERA-EDTA Registry who started dialysis treatment between 1994 and 2011, and followed them for 3 years. Age-standardized and sex-standardized mortality rate ratios for bleeding, myocardial infarction and stroke as causes of death were calculated in dialysis patients as compared with the European general population. Associations between potential risk factors and these causes of death in dialysis patients were investigated by calculating hazard ratios (HRs) with 95% confidence intervals (CIs) by the use of Cox proportional-hazards regression. Results As compared with the general population, the age-standardized and sex-standardized mortality rate ratios in dialysis patients were 12.8 (95% CI 11.9–13.7) for bleeding as a cause of death (6.2 per 1000 person-years among dialysis patients versus 0.3 per 1000 person-years in the general population), 13.4 (95% CI 13.0–13.9) for myocardial infarction (22.5 versus 0.9 per 1000 person-years), and 12.4 (95% CI 11.9–12.9) for stroke (14.3 versus 0.7 per 1000 person-years). Conclusion Dialysis patients have highly increased risks of death caused by bleeding and arterial thrombosis as compared with the general population. Clinicians should be aware of the increased mortality risks caused by these conditions.

Background End-stage renal disease (ESRD) patients even without known cardiovascular (CV) disease have high mortality rates. Whether neurohormonal blockade treatments improve outcomes in this population remains unknown. The aim of this study was to assess the effect of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), β-blockers or both in all-cause mortality rates in incident ESRD patients without known CV disease starting renal replacement therapy (RRT) between 2009 and 2015 in the nationwide Réseau Epidémiologie et Information en Néphrologie registry. Methods Patients with known CV disease and those who started emergency RRT, stopped RRT or died within 6 months were excluded. Propensity score matching models were used. The main outcome was all-cause mortality. Results A total of 13 741 patients were included in this analysis. The median follow-up time was 24 months. When compared with matched controls without antihypertensive treatment, treatment with ACEi/ARBs, β-blockers and ACEi/ARBs + β-blockers was associated with an event-rate reduction per 100 person-years: ACEi/ARBs 7.6 [95% confidence interval (CI) 7.1–8.2] versus matched controls 9.5 (8.8–10.1) [HR 0.76 (95% CI 0.69–0.84)], β-blocker 7.1 (6.6–7.7) versus matched controls 9.5 (8.5–10.2) [HR 0.72 (0.65–0.80)] and ACEi/ARBs + β-blockers 5.8 (5.4–6.4) versus matched controls 7.8 (7.2–8.4) [HR 0.68 (0.61–0.77)]. Conclusions Neurohormonal blocking therapies were associated with death rate reduction in incident ESRD without CV disease. Whether these relationships are causal will require randomized controlled trials.