Showing papers by "Cécile Couchoud published in 2008"

From registry data collection to international comparisons: examples of haemodialysis duration and frequency

Abstract: Background. The purpose of this study was to investigate haemodialysis (HD) dose practice patterns in different European countries in the light of the European Best Practice Guidelines (EBPG) and to study the associations of patient characteristics and country with weekly dialysis duration. Methods. Renal registries in Europe were asked to contribute to the study with individual patient data on weekly HD duration, number of HD sessions a week and last measured Kt/V Additional items were age, sex, date of first renal replacement therapy (RRT), dry weight, height, HD modality, HD technique, diabetes status and vascular access type. Multivariate logistic regression was used to study the probability of receiving HD for < 12 h per week. Results. Seven registries contributed data on 26 136 patients on HD on 31 December 2005. Eighty-three percent of the patients received HD for at least 12 h per week as recommended by the EBPG (range 49.0-97.3% across countries). Multivariate analysis showed significant differences across countries concerning the risk of receiving < 12 h. Other risk factors included age (older), sex (female), BMI (low) and duration of RRT (shorter). Diabetes was associated with longer total HD duration. Conclusion. This study shows a great international variability in weekly HD duration and some discrepancies between current practices and the EBPG. It also points out the difficulty of obtaining and comparing Kt/V values under current registry practices.

Variability in case mix and peritoneal dialysis selection in fifty-nine French districts.

Abstract: In France, the use of peritoneal dialysis (PD) as the first-choice treatment varies greatly between districts, as it is already known to do between countries. Baseline clinical factors associated w...

Assessment of urea removal in haemodialysis and the impact of the European Best Practice Guidelines.

Abstract: Background. Dialysis adequacy, assessed by urea kinetics, isanimportantdeterminantofpatientoutcome,andistherefore an important clinical performance indicator. In this perspective, renal registry data may be useful to compare practices across countries. To serve that purpose available data should be comparable and preferably collected using a standardized procedure. The aim of this study, initiated by the European Renal Association–European Dialysis and Transplantation Association (ERA–EDTA) QUality European STudies (QUEST) initiative, was to make an inventory of the different methods used to determine urea kinetic measurements in the light of the European Best Practice Guidelines. Methods. Via their national and regional registries, European haemodialysis centres were invited to complete a questionnaire regarding their practice of measuring dialysis adequacy. Results. Fourteen regional or national registries among 51 sent back 255 questionnaires. Great variability in the methodology to assess Kt/V was observed. The urea reduction ratio (URR) was used alone by 37% (in association 46%) of dialysis centres, spKt/V by 25% (35%) and online clearance by 4% (12%), whereas only 10% (13%) used eKt/V, as recommended by EBPG. Forty percent of centres measuredurearemovallessthanonceamonth,6%ofwhich never measured urea removal and 9% only every 6 months or less frequently.

[Renal Epidemiology and Information Network: 2006 annual report].

Abstract: In 2006, 6,509 patients with end-stage renal disease living in 16 regions covering 48(M) inhabitants (79% of the French population), started renal replacement therapy (dialysis or preemptive graft): median age was 71 years; 3% had a preemptive graft. The overall crude annual incidence rate of renal replacement therapy for end-stage renal disease was 137 per million population (pmp) in 16 regions that met exhaustivity, with significant differences in sex and age-adjusted incidence across regions (107 to 179 pmh). At initiation, more than one patient out of two had at least one cardiovascular disease and 37% diabetes (88% Type 2 non-insulin-dependent diabetes). On December 31, 2006, 25,774 patients living in these 16 regions were on dialysis: median age was 69.5 years. On December 31, 19,491 patients were living with a functioning graft: median age was 53 years. The overall crude prevalence rate of dialysis was 536 pmp in 15 regions. The overall crude prevalence rate of renal graft was 409 pmp in 15 regions. The overall crude prevalence rate of renal replacement therapy for end-stage renal disease was 945 pmp in 15 regions, with significant differences in age-adjusted prevalence across regions (765 to 1061 pmh). In the 2002-06 cohort of 18,264 incident patients, the overall one-year survival rate was 82%, 72% at 2 years and 63% at 3 years. Survival decreased with age, but remained above 50% at 2 years in patients older than 75 at RRT initiation. Among the 6,321 new patients starting dialysis in 2006 in the 16 regions, 6% had a BMI lower than 18.5 kg/m(2) and 17% a BMI higher than 30. At initiation, 62% had a haemoglobin value lower than 11g/l and 9% an albumin value lower than 25g/l. The first haemodialysis was started in emergency in 30% of the patients and with a catheter in 48%. On December 31, 2006, 8% treated in the dialysis units of the 16 regions received peritoneal dialysis, of which 38% were treated with automated peritoneal dialysis. 95% of the patients on haemodialysis had 3 sessions per week, with a median duration of 4 hours. In 2006, 2,144 patients received a renal graft. On December 31, 2006, 4,838 patients were on the waiting list for a renal graft in the transplantation centres of the 16 regions.

Evaluation and determinants of underprescription of erythropoiesis stimulating agents in pre-dialysis patients with anaemia.

Abstract: BACKGROUND: Inadequate anaemia correction (haemoglobin (Hb) <11 g/dl without receiving an erythropoiesis-stimulating agent (ESA) is common in pre-dialysis patients, but little is known about its determinants. We used data from the French end-stage renal disease (ESRD) registry to investigate these determinants and the patients' anaemia status 1 year after starting dialysis. METHODS: Pre-dialysis anaemia care was studied in 6,271 incident ESRD patients from 13 regions, who were first treated between 2003 and 2005. Data included pre-dialysis Hb measure and ESA use, patient's condition and modalities of dialysis initiation. Anaemia status at 1 year was studied in 925 patients from four regions who started dialysis in 2003 and 2004, were still on dialysis one year later, and had completed the annual registry data form. RESULTS: Overall, 34.7% of the patients had inadequate pre-dialysis anaemia correction, with variations across regions from 21.1 to 43.2%. Inadequate anaemia correction decreased from 38.0% in 2003 to 33.2% in 2005. It was less likely in patients with diabetic or polycystic kidney disease and more likely in those with malignancy, unplanned haemodialysis, and low glomerular filtration rate or low serum albumin at dialysis initiation. One year after starting dialysis, inadequate correction concerned only 2.6% of the patients. Hb level had risen from 10.3 g/dl in pre-dialysis to 11.7 g/dl, but remained lower in those with inadequate pre-dialysis correction. CONCLUSION: Despite improvement over time, inadequate correction with ESAs remains high in pre-dialysis patients in contrast with those on dialysis. As the timing of dialysis initiation is uncertain, continuous management of anaemia is requested.