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Impact of nephrology care trajectories pre-CKD stage 5 on initiation of kidney replacement therapy in children

dc.rights.licenseopenen_US
dc.contributor.authorPARMENTIER, Cyrielle
dc.contributor.authorLASSALLE, Mathilde
dc.contributor.authorBERARD, Etienne
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorHARAMBAT, Jerome
IDREF: 110567358
dc.contributor.authorCOUCHOUD, Cecile
dc.contributor.authorHOGAN, Julien
dc.date.accessioned2022-03-11T12:44:03Z
dc.date.available2022-03-11T12:44:03Z
dc.date.issued2022-02-10
dc.identifier.issn0931-041xen_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/136442
dc.description.abstractEnBACKGROUND: To improve pre-emptive kidney transplantation (PKT) in children and limit starting dialysis in an emergency, we aimed to describe nephrology care trajectories pre-CKD stage 5. METHODS: We included all children in France who, between 2010 and 2016, started kidney replacement therapy (KRT): standard dialysis (reference group) and emergency dialysis or PKT. We identified four pre-CKD stage 5 nephrology care trajectories before KRT that were extracted from the national exhaustive medical-administrative database and used logistic regression to explore associations between patient characteristics, care trajectories, and KRT initiation. RESULTS: Six hundred forty-three pediatric patients started KRT in France; 406 started dialysis and 30.5% emergency dialysis. The "optimal" care trajectory encompassed 179 patients, 82.7% with at least 18 months nephrology follow-up. Conversely, the "no care" trajectory encompassed 118 patients with no nephrology follow-up before KRT. The "severe" trajectory encompassed 128 patients; 93% hospitalized more than once a year and 18% in an intensive care unit. Finally, the "irregular" trajectory encompassed 127 patients, 77% and 46% with irregular laboratory monitoring and CKD drug delivery, respectively. With the "optimal" trajectory as the reference, probability of emergency dialysis was higher with the "irregular" and "no care" trajectories (odds ratio 3.02 [95% confidence interval 1.18-7.66] and 26.5 [10.8-64.8], respectively), and PKT was reduced with the "severe" trajectory (0.43 [0.23-0.82]). CONCLUSION: We identified a group of patients with irregular follow-up who may benefit the most from interventions aiming at improving adherence to treatment and earlier diagnosis of their CKD to improve access to PKT. A higher resolution version of the Graphical abstract is available as Supplementary information.
dc.language.isoENen_US
dc.subject.enPediatric kidney transplantation
dc.subject.enCare trajectories
dc.subject.enEmergency dialysis start
dc.subject.enStage 5 chronic kidney disease
dc.subject.enAdministrative database
dc.title.enImpact of nephrology care trajectories pre-CKD stage 5 on initiation of kidney replacement therapy in children
dc.typeArticle de revueen_US
dc.identifier.doi10.1007/s00467-022-05467-8en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed35146540en_US
bordeaux.journalPediatric Nephrologyen_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamLEHA_BPHen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03605918
hal.version1
hal.date.transferred2022-03-11T12:44:05Z
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
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