Evaluating access to renal transplantation in Lorraine using conventional biostatistical methods and data mining methods

La transplantation est considérée comme la technique de suppléance de la fonction rénale la plus performante et la plus efficiente. Nous avons étudié l’accès à la transplantation rénale au sein du réseau NEPHROLOR en Lorraine. La totalité des insuffisants rénaux chroniques terminaux bénéficiant d’un traitement de suppléance entre le 1/07/1997 et le 30/06/2003 et résidant en Lorraine (1725 patients) ont été inclus. Notre étude a mis en évidence la prédominance des facteurs médicaux dans l’accès à la liste et à la greffe au sein de NEPHROLOR. Toutefois, les patients pris en charge par le centre où les transplantations étaient réalisées avaient plus de chance d’être inscrit sur la liste. Cette étude a aussi montré le bénéfice de transplantation rénale en terme de survie y compris chez les patients âgés de plus de 60 ans. Par ailleurs, la survie des patients était significativement associée aux variables utilisées par les néphrologues pour l’accès à la liste. Tout ceci valide le processus de sélection des candidats potentiels à la greffe rénale au sein de NEPHROLOR. Cependant, il existe un potentiel d’amélioration de l’accès à la liste d’attente de transplantation rénale, puisque les néphrologues des centres ne pratiquant pas la transplantation pourraient élargir leur sélection de candidats potentiels à la greffe rénale. L’utilisation d’un algorithme décisionnel représentant la probabilité d’inscription sur la liste, en fonction des caractéristiques de base du patient, au moment de l’enregistrement initial du patient dans le système d’information du réseau NEPHROLOR pourrait dynamiser et optimiser le processus d’inscription sur la liste et améliorer l’accès à la greffe rénale.Among renal replacement therapy techniques, transplantation is associated with longer survival and lower long-term cost. We studied access to renal transplantation in NEPHROLOR network of care in the French administrative region Lorraine. All incident patients beginning renal replacement therapy in NEPHROLOR between July 1, 1997 and June 30, 2003 (1725 patients) were included in the study. In Lorraine, access to renal transplant waiting list and to transplantation after registration on the list was primarily associated with medical determinants. Nevertheless, patients followed up in the nephrology department performing transplantation were more likely to be placed on the waiting list. After taking into account comorbidities, transplantation was associated with longer survival even among elderly patients (> 60 years). Moreover, patients’ survival was associated with medical determinants of access to renal transplant waiting list. These facts validate the current care process of registration on the waiting list in Lorraine. However, access to the waiting list in the NEPHROLOR network can be improved by encouraging nephrology facilities without transplantation to extend the selection criteria of transplant candidates. Data mining algorithms can represent the probability of being registered on the list based on the patient’s characteristics. Using such an algorithm at the first registration of patient in NEPHROLOR information system could optimize the renal transplant registration process and improve access to renal transplantation in NEPHROLOR

Étude de l'accès à la transplantation rénale en Lorraine par méthodes biostatistiques conventionnelles et par fouille de données

La transplantation est considérée comme la technique de suppléance de la fonction rénale la plus performante et la plus efficiente. Nous avons étudié l accès à la transplantation rénale au sein du réseau NEPHROLOR en Lorraine. La totalité des insuffisants rénaux chroniques terminaux bénéficiant d un traitement de suppléance entre le 1/07/1997 et le 30/06/2003 et résidant en Lorraine (1725 patients) ont été inclus. Notre étude a mis en évidence la prédominance des facteurs médicaux dans l accès à la liste et à la greffe au sein de NEPHROLOR. Toutefois, les patients pris en charge par le centre où les transplantations étaient réalisées avaient plus de chance d être inscrit sur la liste. Cette étude a aussi montré le bénéfice de transplantation rénale en terme de survie y compris chez les patients âgés de plus de 60 ans. Par ailleurs, la survie des patients était significativement associée aux variables utilisées par les néphrologues pour l accès à la liste. Tout ceci valide le processus de sélection des candidats potentiels à la greffe rénale au sein de NEPHROLOR. Cependant, il existe un potentiel d amélioration de l accès à la liste d attente de transplantation rénale, puisque les néphrologues des centres ne pratiquant pas la transplantation pourraient élargir leur sélection de candidats potentiels à la greffe rénale. L utilisation d un algorithme décisionnel représentant la probabilité d inscription sur la liste, en fonction des caractéristiques de base du patient, au moment de l enregistrement initial du patient dans le système d information du réseau NEPHROLOR pourrait dynamiser et optimiser le processus d inscription sur la liste et améliorer l accès à la greffe rénale.Among renal replacement therapy techniques, transplantation is associated with longer survival and lower long-term cost. We studied access to renal transplantation in NEPHROLOR network of care in the French administrative region Lorraine. All incident patients beginning renal replacement therapy in NEPHROLOR between July 1, 1997 and June 30, 2003 (1725 patients) were included in the study. In Lorraine, access to renal transplant waiting list and to transplantation after registration on the list was primarily associated with medical determinants. Nevertheless, patients followed up in the nephrology department performing transplantation were more likely to be placed on the waiting list. After taking into account comorbidities, transplantation was associated with longer survival even among elderly patients (> 60 years). Moreover, patients survival was associated with medical determinants of access to renal transplant waiting list. These facts validate the current care process of registration on the waiting list in Lorraine. However, access to the waiting list in the NEPHROLOR network can be improved by encouraging nephrology facilities without transplantation to extend the selection criteria of transplant candidates. Data mining algorithms can represent the probability of being registered on the list based on the patient s characteristics. Using such an algorithm at the first registration of patient in NEPHROLOR information system could optimize the renal transplant registration process and improve access to renal transplantation in NEPHROLOR.NANCY1-Bib. numérique (543959902) / SudocSudocFranceF

Individual and neighborhood socioeconomic disparities in high blood pressure in France.

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Social deprivation reduced registration for kidney transplantation through markers of nephrological care: a mediation analysis

International audienceOBJECTIVES: We assessed the direct and indirect effect of social deprivation mediated by modifiable markers of nephrological follow-up on registration on the renal transplantation waiting-list. STUDY DESIGN AND SETTINGS: From the Renal Epidemiology and Information Network, we included French incident dialysis patients eligible for a registration evaluation between January 2017 and June 2018. Mediation analyses were conducted to assess effects of social deprivation estimated by quintile 5 (Q5) of the European Deprivation Index on registration defined as wait-listing at dialysis start or within the first 6 months. RESULTS: Among the 11655 included patients, 2410 were registered. Q5 had a direct effect on registration (OR 0.82 [0.80-0.84]) and an indirect effect mediated by emergency start dialysis (OR 0.97 [0.97-0.98]), hemoglobin < 11 g/dL and/or lack of EPO (OR 0.96 [0.96-0.96]) and albumin < 30 g/L (OR 0.98 [0.98-0.99]). CONCLUSION: Social deprivation was directly associated with a lower registration on the renal transplantation waiting-list but its effect was also mediated by markers of nephrological care, suggesting that improving the follow-up of the most deprived patients should help to reduce disparities in access to transplantation

Prevalence of chronic kidney disease in France: methodological considerations and pitfalls with the use of Health claims databases

International audienceBackground Health policy-making require careful assessment of CKD epidemiology to develop efficient and cost-effective care strategies. The aim of the present study was to use the RENALGO-EXPERT algorithm to estimate the global prevalence of CKD in France. Methods An expert group developed the RENALGO-EXPERT algorithm based on healthcare consumption. This algorithm has been applied to the French National Health claims database (SNDS), where no biological test findings are available in order to estimate a national CKD prevalence for the years 2018–2021. The CONSTANCES cohort (+ 219 000 adults aged 18–69 with one CKD-EPI eGFR) was used to discuss the limit of using health claims data. Results Between 2018 and 2021, the estimated prevalence in the SNDS increased from 8.1% to 10.5%. The RENALGO-EXPERT algorithm identified 4.5% of the volunteers in the CONSTANCES as CKD. The RENALGO-EXPERT algorithm had a PPV of 6.2% and NPV of 99.1% to detect an eGFR<60 ml/min/1.73m². Half of 252 false positive cases (ALGO +, eGFR > 90) had been diagnosed with kidney disease during hospitalization, and the other half based on healthcare consumption suggestive of a ‘high-risk’ profile. 95% of the 1661 false negatives (ALGO -, eGFR < 60) had an eGFR between 45 and 60 ml/min, ½ had medication and 2/3 a biological exams possibly linked to CKD. Half of them had a hospital stay during the period but none had a diagnosis of kidney disease. Conclusions Our result is in accordance with other estimations of CKD prevalence in the general population. Analysis of diverging cases (FP and FN) suggests using health claims data has inherent limitations. Such algorithm is able to identify patients whose care pathway is close to the usual and specific CKD pathways. It does not identify patients who have not been diagnosed or whose care is inappropriate or at early stage with stable GFR