Geographical access to hemodialysis: an analysis of patient choices / Accès géographique à l'hémodialyse : une analyse sur les choix des patients

Introduction: Patients do not always go to the facility closest to their home. Description: A study was carried out in Provence-Alpes Côtes d'Azur (PACA) on patients' preferences to mobilize the hemodialysis offer. Methods: The data were extracted from the REIN Registry. Potential access was compared with actual access. A survey was carried out among a sample of patients travelling an additional distance of more than 25 km. Results: About a quarter of the patients did not travel to the nearest facility. Of these, 16.3% travelled an additional distance of over 25 km. Patients' choices were determined by the relationship of trust with the team that first set up dialysis, followed by their desire to be followed in a multi-purpose facility. Discussion: While distance remained the decisive factor, human factors were cited in the majority of cases to explain the bypass. Conclusion: The links between the first team and the next one should be strengthened.

Introduction: Les patients ne se rendent pas toujours dans l'établissement le plus proche de leur domicile. Description: Une étude a été réalisée en Provence-Alpes Côtes d'Azur (PACA) sur les préférences des patients à mobiliser l'offre d'hémodialyse. Méthodes: Les données ont été extraites du Registre REIN. L'accès potentiel a été comparé à l'accès réalisé. Une enquête a été effectuée auprès d'un échantillon de patients parcourant une distance supplémentaire supérieure à 25 km. Résultats: Environ un quart des patients ne se rendait pas dans la structure la plus proche. Parmi eux, 16,3 % parcouraient un trajet supplémentaire supérieur à 25 km. Les choix des patients étaient déterminés par la relation de confiance avec l'équipe de la première mise en place de dialyse, puis par le souhait d'être suivis dans une structure polyvalente. Discussion: Si la distance restait le facteur décisif, les facteurs humains étaient majoritairement cités. Conclusion: Il faudrait renforcer les liens entre la première équipe et celle qui prend la suite.

REIN: a tool at the service of health monitoring, exemple of the SARS-Cov-2 / REIN, un outil au service de la veille sanitaire : exemple de l'épidémie au SARS-CoV-2

On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of its role in health monitoring, the following key messages were retained. The recent health crisis showed the adaptability and agility of the registry. Thanks to a human network that has been established and organised for many years, and the possibility of rapidly developing the collection system, the registry was able to provide information about the number of dialysis patients infected with the new SARS-Cov-2 from 30 March 2020. The use of REIN as a decision support and health monitoring tool in these times of empirical decisions has emerged as a strategic issue.

À l'occasion des 20 ans du REIN (Réseau Epidémiologie et Information en Néphrologie), un travail de synthèse sur les apports du registre a été mené. Sur la question de son rôle dans la veille sanitaire, les messages clés suivants ont été retenus. La crise sanitaire récente a permis de montrer l'adaptabilité et l'agilité du registre. Grâce à un réseau humain en place et organisé depuis de nombreuses années et la possibilité de faire évoluer rapidement le système de recueil, le registre a été en mesure de fournir dès le 30 mars 2020 des informations sur le nombre de personnes dialysées infectées par le nouveau SARS-Cov-2. L'utilisation de REIN comme outil de veille sanitaire et d'aide à la décision en ces temps de décisions empiriques est apparue comme un enjeu stratégique.

[Evaluation of ambulance transport relevance of dialysis patients in the PACA region (France), and estimation of savings by the Health Insurance]. / Évaluation de la pertinence des transports par ambulance des patients dialysés en région PACA, et estimation des économies réalisables par l'Assurance maladie.

INTRODUCTION: Patient transport represents the second largest item of cost of dialysis after hospitalization. A significant proportion of patients transported by ambulance are self-sufficient for walking. DESCRIPTION: A study was carried out in the PACA region (France) to analyse the profile of patients transported by ambulance and self-sufficient for walking and then to evaluate the savings for the Health Insurance. METHODS: A triangulation of data was carried out using data from haemodialysis patients recorded in the French REIN Registry in 2017 and data from two surveys: one of a sample of patients transported by ambulance and autonomous in walking, and the other of 62 nephrologists. RESULTS: The data from the REIN register allowed us to estimate that 44 % of patients transported by ambulance are self-sufficient for walking. Our study allowed us to estimate that 2/3 of patients transported by ambulance, self-sufficient for walking, have a reason for being transported by ambulance; for the third without a reason, the health insurance savings would amount to €2 million per year with a reclassification of their transport as seated transport. The survey of prescribers showed that there are exemptions justified by a temporary deterioration in health and/or housing conditions, but also by the lack of seated transport. CONCLUSION: One third of the patients, transported by ambulance and self-sufficient for walking, would have an inappropriate transport. This would be explained by the fluctuating state of health of the patients and would also linked to the lack of seated transportation. Savings are possible and depend in part on improved management of the supply.

[Role of the French national registry REIN in the health monitoring of patients with end-stage chronic renal failure infected with SARS-CoV-2: Organization and initial data]. / Le rôle du registre national REIN en France dans la veille sanitaire des patients en insuffisance rénale chronique terminale infectés par le SARS-CoV-2 : organisation et premières données.

The REIN registry is a national registry held by the French Biomedicine Agency. Its objective is the epidemiological monitoring of patients with end-stage chronic renal failure. This registry, backed by its expertise and its national network, has been able to very quickly set up epidemiological monitoring of chronic dialysis and/or transplant patients affected by SARS-CoV-2. The first results show a relatively low frequency of COVID-19 in dialysis patients (4.9%) contrary to what one might have feared. The frequency of SARS-CoV-2 infection in kidney transplant patients is 1.8% nationwide. All regions of France have not been affected in the same way. The prevalence of COVID-19 patients varied by region, reaching up to 10%. The probability of being affected was higher in men and diabetic patients. At October 19, among 3209 infected patients (dialysis and transplant), 573 died from a cause related to SARS-CoV-2. The case fatality in diagnosed cases was 18%. A weekly newsletter has been set up by the Biomedicine Agency using information transmitted by all of the epidemiological support units in the registry. The REIN registry was able to adapt to become a reactive health monitoring tool.

End-stage renal disease treated in Provence-Alpes Côte d'Azur: 12-years follow-up and forecast to the year 2030.

BACKGROUND: This study describes the time trend of renal replacement therapy for end-stage renal disease (ESRD) in the Provence-Alpes Côte d'Azur region (PACA) between 2004 and 2015, and forecasts up to 2030. METHODS: A longitudinal study was conducted on all ESRD patients treated in PACA and recorded in the French Renal Epidemiology and Information Network (REIN) during this period. Time trends and forecasts to 2030 were analyzed using Poisson regression models. RESULTS: Since 2004, the number of new patients has steadily increased by 3.4% per year (95% CI, 2.8-3.9, p < 0.001) and the number of patients receiving RRT has increased by 3.7% per year (RR 1.037, 95% CI: 1.034-1.039, p < 0.001). If these trends continue, the PACA region will be face with 7371 patients on dialysis and 3891 with a functional renal transplant who will need to be managed in 2030. The two most significant growth rates were the percentage of obese people (RR 1.140, 95% CI: 1.131-1.149, p < 0.001) and those with diabetes (RR 1.070, 95% CI; 1.064-1.075, p < 0.001). CONCLUSION: This study highlights the increase in the number of ESRD patients over 12 years, with no prospect of stabilization. These findings allow us to anticipate the quality and quantity of care offered and to propose more preventive measures to combat obesity and diabetes.