Geographic Variations in the Risk of Emergency First Dialysis for Patients with End Stage Renal Disease in the Bretagne Region, France

Abstract

Emergency first dialysis start considerably increases the risk of morbidity and mortality. Our objective was to identify the geographic variations of emergency first dialysis risk in patients with end-stage renal disease in the Bretagne region, France. The spatial scan statistic approach was used to determine the clusters of municipalities with significantly higher or lower risk of emergency first dialysis. Patient data extracted from the REIN registry (sociodemographic, clinical, and biological characteristics) and indicators constructed at the municipality level, were compared between clusters. This analysis identified a cluster of municipalities in western Bretagne with a significantly higher risk (RR = 1.80, p = 0.044) and one cluster in the eastern part of the region with a significantly lower risk (RR = 0.59, p < 0.01) of emergency first dialysis. The degree of urbanization (the proportion of rural municipalities: 76% versus 66%, p < 0.001) and socio-demographic characteristics (the unemployment rate: 11% versus 8%, p < 0.001, the percentage of managers in the labor force was lower: 9% versus 13% p < 0.001) of the municipalities located in the higher-risk cluster compared with the lower-risk cluster. Our analysis indicates that the patients’ clinical status cannot explain the geographic variations of emergency first dialysis incidence in Bretagne. Conversely, where patients live seems to play an important role.

The Pre-Dialysis Care Trajectory of Chronic Kidney Disease Patients and the Start of Dialysis in Emergency: A Mixed Method Study Protocol

“…A previous spatial analysis in the Bretagne region of France found that the western and eastern parts of this region have higher and lower risk of ES, respectively [34]. These geographical areas will be our investigation field.…”

Social Deprivation Is Associated With Lower Access to Pre-emptive Kidney Transplantation and More Urgent-Start Dialysis in the Pediatric Population

“…31 It has been shown that geographic clusters of municipalities at high risk of urgent start of dialysis in adults were actually less urbanized and had lower socio-demographic background than areas at lower risk. 32 In three other studies also using EDI, social deprivation was associated with a lower peritoneal dialysis uptake 33 and with a decreased access to pre-emptive kidney transplant 34 , the most deprived adults were less likely to be on self-care dialysis. 35 One of our main findings is that children who were living in a more deprived area were more likely to initiate KRT with dialysis, with a clear social gradient.…”

Incremental and Personalized Hemodialysis Start: A New Standard of Care

“…49 It is also worth noticing that the prevalence of patients without previous follow-up was in the lower range recorded in France (about 30%), and that over 60% of the cases had follow-up of at least one year before the start of HD. 50,51 Likewise, the prevalence of new patients who started dialysis with a peritoneal dialysis modality was well above the French range (23% versus 6.3%). 35 The systematic introduction of an iHD schedule, associated with the possibility of reducing the number of dialysis sessions for patients who had started on a standard schedule (dHD), was not associated with lower survival.…”