Publications by authors named "Couchoud C"
Not all patients on dialysis want to be registered on the kidney transplantation (KT) waiting list and undergo transplantation. The aim of this convergent mixed methods study was to determine the features of patients refusing to be registered on the KT waiting list and the reasons. Quantitative data on all 2017-2019 incident 18-85-year-old dialysis patients, eligible for KT, were extracted from the REIN registry in France.
View Article and Find Full Text PDFFluid overload predicts morbidity and mortality in dialysis patients. Diuretics can reduce fluid overload, but their effects on morbi-mortality following inception remain ill-defined. To determine whether diuretics reduce mortality and hospitalization rates in incident dialysis patients in the first 2 years after inception.
View Article and Find Full Text PDFElderly predialysis care pathways and early morbidity-mortality upon start of dialysis.
Nephrol Dial Transplant
October 2024
Background And Hypothesis: The ageing of the population with advanced chronic kidney disease (CKD) increases the complexity of care pathways. Our aim was to identify subgroups of older people according to predialysis care pathways and describe their association with early morbidity-mortality after transition to dialysis.
Methods: This study included 22,128 incident dialysis patients aged ≥ 75 years during 2009-2017 from the French nationwide registry linked to the National Health Data System.
Aims: Cardiac conduction disorders are common in haemodialysis patients, with a relatively high rate of pacemaker implantations. Pacemaker-related complications, especially lead infections and central venous stenosis, pose significant challenges in this population. This study aims to compare single-chamber leadless pacemaker to single-chamber transvenous pacemakers in terms of survival and related complications in haemodialysis patients.
View Article and Find Full Text PDFArticle Synopsis
- A study called FABRYDIAL aimed to determine how common Fabry disease (FD) is among dialysis patients aged 18 to 74 in France, involving 124 dialysis centers and excluding cases of nephropathy unrelated to FD.
- Out of 6,032 targeted patients, 3,088 (73.6%) were included, with biochemical and genetic tests conducted on samples to identify potential cases of FD.
- The findings revealed a low prevalence of FD: 0.058% in males, 0% in females, and 0.035% overall, suggesting that while rare, signs of FD should be investigated in patients with unexplained kidney issues due to its serious implications if diagnosed early.
Introduction: In women receiving chronic dialysis, fertility is impaired. The objectives of this study were to estimate the incidence rate of pregnancies among women of childbearing age (15-50 years) receiving chronic dialysis from 2006 to 2020 in France, to describe the pregnancy outcomes and renal management during pregnancy.
Methods: This national observational, retrospective study was based on data from the French REIN registry matched with the National Health Data System.
Article Synopsis
- A study investigated how exposure to various air pollutants affects mortality in dialysis patients, using data from 90,373 patients in France between 2012 and 2020.
- The research found that higher pollution levels were linked to increased all-cause deaths and specifically higher rates of infectious mortality among these patients.
- Results indicate that air pollution could be a significant factor in the rising deaths related to chronic kidney disease (CKD) globally, with stronger effects observed in women and patients with fewer comorbidities.
Article Synopsis
- - The study explores how patients with chronic kidney disease (CKD) and nephrologists perceive kidney transplantation (KT) and the disease itself, using semi-structured interviews in France from a diverse patient group and nephrologists chosen by specific criteria.
- - Six key themes emerged from the interviews, including the emotional toll of CKD, the influence of healthcare relationships on acceptance of treatment, and differing perceptions of KT experiences between men and women.
- - Findings highlight that the experience of dialysis is often seen as restrictive, and the way patients view kidney transplants can be shaped by their past experiences and gender-related factors, particularly concerning psychological impacts and decisions around living donor transplants.
Article Synopsis
- The study investigates the link between social deprivation and the incidence of kidney replacement therapy (KRT) among children and young adults in France, showing a correlation between higher social deprivation and increased KRT rates.
- Analyzed data from 2010 to 2015, including 672 children who started KRT, revealing that 38.8% were from the most deprived areas, with higher incidence rates as deprivation increased.
- Results indicate that social health inequalities emerge even at the initiation of KRT, emphasizing the importance of addressing these inequalities in chronic kidney disease management.
Article Synopsis
- Home dialysis therapies like peritoneal dialysis (PD) and home hemodialysis (HHD) enhance patient quality of life but have low prevalence due to short technique survival times.
- A retrospective study analyzed data from over 17,000 patients in France to compare the risk of transferring to facility-based hemodialysis among those using autonomous PD, nurse-assisted PD, and HHD.
- The findings indicated no significant differences in transfer risks among the three modalities, suggesting that assisted PD may benefit a wider range of patients than previously thought, especially in France.
Article Synopsis
- Kidney allograft rejection can lead to graft failure and is complicated by immunosuppressive treatments that increase infection and cancer risks.
- A study was conducted to examine the effects of hydroxychloroquine on kidney transplant recipients who also have autoimmune diseases, as its impact on rejection was previously unknown.
- The research found no significant difference in rejection or graft failure rates between kidney transplant patients treated with hydroxychloroquine and matched controls, indicating that hydroxychloroquine does not help prevent rejection in these patients.
Article Synopsis
- The study aimed to estimate the prevalence of chronic kidney disease (CKD) in France using the RENALGO-EXPERT algorithm, focusing on healthcare consumption data from the French National Health claims database between 2018 and 2021.
- The results showed an increase in estimated CKD prevalence from 8.1% to 10.5% over the years, with the algorithm having a low positive predictive value (6.2%) and a high negative predictive value (99.1%).
- The findings highlight that while the algorithm can help identify CKD patients in typical care pathways, it has limitations in accurately detecting undiagnosed or early-stage patients, indicating a need for more comprehensive assessment methods
Time trends in preemptive kidney transplantation in Europe: an ERA registry study.
Nephrol Dial Transplant
November 2024
Article Synopsis
- Preemptive kidney transplantation leads to better outcomes than post-dialysis transplants, and this study analyzed trends in Europe from 2000 to 2019.
- A total of 20,251 adults received preemptive kidney transplants, with the percentage of these transplants increasing from 7% to 18% over the 19 years.
- Barriers to increasing preemptive transplants include donor shortages and late referrals, while suggestions to improve rates involve raising awareness and streamlining the donor and recipient work-up processes.
Article Synopsis
- - The study investigated how social deprivation affects patients on peritoneal dialysis (PD) in France, using data from a registry that tracked patients from 2017 to 2020.
- - It found that while the most deprived patients did not have a higher risk of death or combined events like death or transfer to hemodialysis (HD), they did face a greater risk of transferring to HD and had lower chances of getting a kidney transplant.
- - The analysis showed that social deprivation impacts access to kidney transplantation and increases the likelihood of transferring to HD, indicating disparities in treatment outcomes among different socioeconomic groups.
Article Synopsis
- * It analyzes data from 8,856 patients, finding that both men and women had similar rates of consultations and hospitalizations, but women consulted psychiatrists more often while men faced more hospitalizations for circulatory diseases.
- * Emergency dialysis start rates were equal at 30% for both sexes, with differences noted in the types of nephropathy associated with emergency starts, particularly highlighting that women had a greater likelihood of starting dialysis due to acute nephropathy.
Background: Access to kidney transplantation (KT) remains challenging for patients with end-stage kidney disease. This study assessed women's access to KT in France by considering comorbidities and neighbourhood social deprivation.
Methods: All incident patients 18-85 years old starting dialysis in France between 1 January 2017 and 31 December 2019 were included.
Background: Clinical trials of direct oral anticoagulants (DOAC) are scarce and inconclusive in patients who are receiving dialysis, for whom DOAC are not labelled in Europe. In a French nationwide registry study of patients on chronic dialysis, we compared the effectiveness and safety of off-label DOAC use vs approved vitamin K antagonist (VKA).
Methods: Data on patients on dialysis were extracted from the French Renal Epidemiology and Information Network (REIN) registry and merged with data from the French national healthcare system database (Système National des Données de Santé, SNDS).
Article Synopsis
- Smoking is a significant risk factor for chronic kidney disease (CKD) and increases complications in patients receiving dialysis in France, with a current smoking rate of around 11.6% as of 2020.
- A survey of nephrologists revealed that while most inquire about smoking habits and offer support, many seek additional training to effectively assist patients in quitting.
- Implementing targeted smoking cessation programs and enhanced training for nephrologists may help reduce smoking prevalence among patients in nephrology settings.
Article Synopsis
- The French Renal Epidemiology and Information Network (REIN) is a 20-year-old organization that collects data on chronic kidney disease for patients, nephrology teams, and health services across France.
- Recent analysis using data from 2012 to 2021 revealed stable rates of end-stage kidney disease (ESKD) despite rising diabetes rates, along with notable trends such as a decrease in emergency dialysis starts and an increase in home hemodialysis.
- The REIN registry provides valuable insights for healthcare planning in France, highlighting the need for improved data collection methods and addressing the increasing waiting times for kidney transplants.
Article Synopsis
- Recent research indicates that patients undergoing hemodialysis with an arteriovenous (AV) graft may experience higher hospitalization rates compared to those with an AV fistula, particularly regarding vascular access-related issues.
- The study analyzed data from nearly 18,800 patients in France who started hemodialysis with a catheter, utilizing advanced statistical models to account for factors like recurring hospitalizations and patient comorbidities.
- Results show that while AV grafts are linked to increased overall and cause-specific hospitalization rates, this association is less pronounced in patients with certain comorbid conditions, such as diabetes.
Study Question: Can we monitor post-oocyte retrieval infections in the French national health data system to complement the French ART vigilance system?
Summary Answer: Medico-administrative databases provide a more comprehensive view of post-oocyte retrieval infections and can be used to detect abnormal increases in frequency and outlier ART centers as a complementary tool to the ART vigilance system.
What Is Known Already: The various studies of ART complications are reassuring, showing relatively low overall complication rates. Nonetheless, the European Union has set up a vigilance system to monitor these complications.
Article Synopsis
- The study evaluates the effectiveness of the Healthcare Expenditures and Conditions Mapping (HECM) algorithm in identifying various health conditions, specifically for patients with end-stage kidney disease (ESKD) in France.
- A total of 5,971 patients were analyzed, finding that 81% were accurately identified as having ESKD in both datasets, with diabetes showing the highest accuracy.
- The HECM performed well overall but struggled with cancer identification, suggesting further validation is needed for broader use in different patient populations.
Article Synopsis
- The study investigates the impact of continuing or discontinuing immunosuppressive therapy (IT) after kidney allograft failure (KAF) on HLA-sensitization and patient mortality.
- It analyzes data from the French national registry, including 121 patients who returned to dialysis post-KAF, comparing those who continued IT with those who stopped it.
- Results indicate that continuing IT tends to lead to lower HLA-sensitization rates without increasing mortality risk among patients.
Article Synopsis
- Diuretics might help reduce fluid overload in patients before starting dialysis, and this study explored their impact on delaying dialysis necessity, conditions at the start of dialysis, and early mortality.
- Researchers analyzed data from over 59,000 patients who started dialysis between 2009 and 2015, categorizing them based on their exposure to diuretics over the previous year.
- Results showed that those continuously using diuretics had fewer emergency dialysis starts, required fewer central venous catheters, experienced lower hospitalization rates, and potentially had lower mortality in the first three months after starting dialysis compared to those who stopped or never used diuretics.