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Pre-dialysis care trajectories of patients with end-stage kidney disease starting dialysis in emergency in France

Abstract : Emergency dialysis start (EDS) is frequent for patients with Chronic Kidney Disease (CKD). To improve CKD management, new trajectory-based care policies are currently being introduced both in France and in the US. This study describes the different types of pre-dialysis care trajectories and factors associated with EDS. Adults patients who started dialysis in France in 2015 were included. Individual clinical and healthcare consumption data were retrieved from the French national End-Stage Kidney Disease (ESKD) registry (REIN) and the national health insurance information system database (SNDS), respectively. Hierarchical Clustering on Principal Component (HCPC) was used to identify groups of patients with the same healthcare consumption profile during the 2 years before dialysis start. Logistic regression analysis was used to identify factors associated with EDS. Among the 8856 patients included in the analysis, 2681 (30.3%) had EDS. HCPC identified six types of pre-dialysis care trajectories in which EDS rate ranged from 13.8% to 61.8%. After adjustment for the patients’ characteristics, less frequent or lack of follow-up with a nephrologist was associated with higher risk of EDS (OR=1.32, 95% CI: 1.17-1.50 and OR=1.83, 95% CI: 1.58-2.12), but not follow-up with a general practitioner. The care trajectories during the 2 years before dialysis start were heterogeneous and patients with a lesser or lack of follow-up with a nephrologist were more likely to start dialysis in emergency, regardless of the frequency of follow-up by a GP. New CKD policies should include actions to strengthen CKD screening and referral to nephrologists.
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https://hal.ehesp.fr/hal-02986830
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Submitted on : Tuesday, November 3, 2020 - 12:07:44 PM
Last modification on : Thursday, November 5, 2020 - 10:01:16 AM

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Maxime Raffray, Cécile Vigneau, Cécile Couchoud, Sahar Bayat. Pre-dialysis care trajectories of patients with end-stage kidney disease starting dialysis in emergency in France. Kidney International Reports, Elsevier, 2020, ⟨10.1016/j.ekir.2020.10.026⟩. ⟨hal-02986830⟩

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