Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study.

Determinants of nonfunctional arteriovenous (AV) access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter.

Vascular access conversion and patient outcome after hemodialysis initiation with a nonfunctional arteriovenous access: a prospective registry-based study.

Background: Little is known about vascular access conversion and outcomes for patients starting hemodialysis with nonfunctional arteriovenous (AV) access. We assessed mortality risk associated with nonfunctional AV access at hemodialysis initiation, taking subsequent changes in vascular access into account.

Methods: We studied the 53,092 incident adult hemodialysis patients included in the French REIN registry from 2005 through 2012.

Economic impact of a modification of the treatment trajectories of patients with end-stage renal disease.

Background: This study assumed that some patients currently treated at hospital-based haemodialysis centres can be treated with another renal replacement therapy (RRT) modality without any increase in mortality risk and sought to evaluate the monthly cost impact of replacing hospital-based haemodialysis, for which fees are highest, by different proportions of other modalities.

Methods: We used a deterministic model tool to predict the outcomes and trajectories of hypothetical cohorts of incident adult end-stage renal disease (ESRD) patients for 15 years of RRT (10 different modalities). Our estimates were based on data from 67 258 patients in the REIN registry and 65 662 patients in the French national health insurance information system.

Survival advantage of hemodialysis relative to peritoneal dialysis in patients with end-stage renal disease and congestive heart failure.

Peritoneal dialysis (PD) has been proposed as a therapeutic option for patients with end-stage renal disease and associated congestive heart failure (CHF). Here, we compare mortality risks in these patients by dialysis modality by including all patients who started planned chronic dialysis with associated congestive heart failure and were prospectively enrolled in the French REIN Registry. Survival was compared between 933 PD and 3468 hemodialysis (HD) patients using a Kaplan-Meier model, Cox regression, and propensity score analysis.

Confounding factors for early death in incident end-stage renal disease patients: Role of emergency dialysis start.

Hemodialysis (HD) has been associated with higher 1-year mortality than peritoneal dialysis (PD) after dialysis start. Confounding effects of late referral, emergency dialysis start, or start with central venous catheter on this association have never been studied concomitantly. Survival was studied among the 495 incident dialysed patients in our department from 1995 to 2006 and followed at least 1 year until December 31, 2007.

Age and comorbidity may explain the paradoxical association of an early dialysis start with poor survival.

Starting patients on dialysis early has been increasing in incidence in several countries. However, some studies have questioned its utility, finding a counter-intuitive effect of increased mortality when dialysis was started at a higher estimated glomerular filtration rate (eGFR). To examine this issue in more detail we measured mortality hazard ratios associated with Modification of Diet in Renal Disease eGFR at dialysis initiation for 11,685 patients from the French REIN Registry, with sequential adjustment for a number of covariates.

A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease.

Aim: The aim of this study was to develop and validate a prognostic score for 6-month mortality in elderly patients starting dialysis for end-stage renal disease.

Methods: Using data from the French Rein registry, we developed a prognostic score in a training sample of 2500 patients aged 75 years or older who started dialysis between 2002 and 2006, which we validated in a similar sample of 1642 patients. Multivariate logistic regression with 500 bootstrap samples allowed us to select risk factors from 19 demographic and baseline clinical variables.

[Specificities of the methodology of survival analysis in dialysis patients].

Epidemiological and observational studies are needed in nephrology for evidence-based medical decision and global knowledge of renal patients. Using strong methodology, such studies are useful to formulate hypotheses for further explanatory studies or clinical trials. Survival analysis of dialysis patients are based on the usual and robust Kaplan-Meier and Cox regression methods.

Associations between comorbidities, treatment choice and outcome in the elderly with end-stage renal disease.

Background: New patients treated for end-stage renal disease are increasingly elderly: in France, 38% are 75 years or older. The best treatment choices for the elderly are still debated.

Methods: We studied case-mix factors associated with choice of initial dialysis modality and 2-year survival in the 3512 patients aged 75 years or older who started dialysis between 2002 and 2005 and were included in the French REIN registry.

Effect of age, gender, and diabetes on excess death in end-stage renal failure.

Life expectancy is short in elderly individuals with end-stage renal failure (ESRF). This study aimed to compare mortality in patients with ESRF versus the general population (GP) to assess the evolution of excess mortality by age, gender, nephropathy, and dialysis modality after first dialysis. All incident adult dialysis patients from January 1,1999, to December 31, 2003, who lived in Rhône-Alpes Region (France) were included and followed up to death or December 31, 2005.

Poor prognosis of heart transplant patients with end-stage renal failure.

Background: Chronic kidney disease (CKD) and end-stage renal failure (ESRF) are major complications after a heart transplant. The aim of this study is to compare survival in heart transplant (HT) vs non-heart transplant (non-HT) patients starting dialysis.

Methods: Survival was studied among the 539 newly dialysed patients between 1 January 1995 and 31 December 2005 in our Department.

The renal epidemiology and information network (REIN): a new registry for end-stage renal disease in France.

The French Renal Epidemiology and Information Network (REIN) registry began in 2002 to provide a tool for public health decision support, evaluation and research related to renal replacement therapies (RRT) for end-stage renal disease (ESRD). It relies on a network of nephrologists, epidemiologists, patients and public health representatives, coordinated regionally and nationally. Continuous registration covers all dialysis and transplanted patients.

A multicentre study of registration on renal transplantation waiting list of the elderly and patients with type 2 diabetes.

Background: Studies in the USA have shown that some patients (African-Americans, women, the elderly and diabetics) were less likely to receive renal transplants. In order to identify patient characteristics modifying the likelihood of being wait-listed, we studied registration on renal transplantation waiting list (WLR) focusing on elderly (age > or =60 years) and on patients with type 2 diabetes (D2) in three departments of nephrology in the Rhône-Alpes county in France.

Methods: In a cohort of 549 patients who reached end-stage renal disease (ESRD) between 1995 and 1998 in these units, we analysed the rates of pre-transplant evaluation (PTE), the duration of PTE, the rates of exclusion from transplantation by PTE and the rates of WLR.