SP678 Study of the Pre-dialysis Care Trajectory of End-Stage Renal Disease Patients Starting Dialysis in Emergency in France - Université de Rennes Accéder directement au contenu
Poster De Conférence Année : 2019

SP678 Study of the Pre-dialysis Care Trajectory of End-Stage Renal Disease Patients Starting Dialysis in Emergency in France

Résumé

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<0,001). During the year prior dialysis initiation, ES patients had a slightly lower mean number of inpatient stays (1,82 versus 1,96 for PS patients, p = 0,002) but stayed longer hospitalized throughout the year (15 days versus 12 days for PS patients, p < 0,001). The most frequent diagnosis for ES patients was “congestive heart failure” (8 % of the total inpatient stays) whereas the most frequent one for PS patients was “preparatory care for dialysis” (20,8 % of the total inpatient stays). Moreover, ES patients had less consultations with a nephrologist (1,6 versus 3 for PS patients, p < 0,001) as well as with a general practitioner (5,6 vs 6, p = 0,002). CONCLUSIONS: Patients who started dialysis in emergency had more comorbidities at baseline than those who started dialysis in a planned manner. In the year before dialysis start, they were less frequently hospitalized than patients with a planned start and for different reasons but had a longer mean duration of hospital stay throughout the year. The ES patients consulted less frequently general practitioners and nephrologists.
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Dates et versions

hal-02279994 , version 1 (05-09-2019)

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Maxime Raffray, Adélaide Pladys, Fei Gao, Cécile Couchoud, Sahar Bayat, et al.. SP678 Study of the Pre-dialysis Care Trajectory of End-Stage Renal Disease Patients Starting Dialysis in Emergency in France. ERA-EDTA, Jun 2019, Budapest, France. 34 (Supplement_1), 2019, ⟨10.1093/ndt/gfz103.SP678⟩. ⟨hal-02279994⟩
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