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- Dimensions of Nephrology in France -

ESRF - Etiologies - Dialysis - Transplantation - Registry

Epidemiology of End-Stage Renal Failure (ESRF)

Thanks to Dr Guillaume Bobrie
President of the Committee of Epidemiology
of the Société de Néphrologie

Prevalence is two-fold higher in the "Départements d'Outre-Mer"

The number of dialysed patients increases 5 to 6 % each year, especially in the elderly, type 2 diabetic patients or cardiovascular diseases (atheroma, hypertension)

Incidence of ESRF is lower in France as compared with Belgium, Spain and germany (not far from 150 pmp) - and 3 times lower than in United States.

(ref. Sicom 2001, Landais)

Very more recently (October 2003), the first results of the national registry R.E.I.N., obtained in four regions and then extrapolated to the whole country, suggest a prevalence of the treated ESRF of 798 pmp (47 496 patients) and a standardized incidence of 122 pmp.

(not yet published - presented at the Meeting of the SN/SFD, Nancy 2003)

Distribution of causal nephropathy

There is no registry of ESRF in France till now. The Projet R.E.I.N. is about to begin (see further). The last evaluation of ESRF by EDTA-ERA was performed in 1995 and the rate of response was only 70 %. However, the distribution of causal nephropathy may be estimated by an epidemiologic and prospective study realized in Ile-de-France in 1998 under the sponsorship of the "Société de Néphrologie" (Jungers)

Distribution of causal nephropathy in primodialysed patients (n=1006)
and age of the patients at beginning of dialysis

(Jungers)

Distribution of Dialysis Patients (HD / CAPD)

Thanks to Pr Josette Pengloan
President of the Committee of Dialysis
of the Société de Néphrologie

Methods of dialysis are unequally distributed among the different administrative regions of France. Peritoneal dialysis for example is unsufficiently used in many regions. Some patients have to be dialysed far from their home. Today the selection of a ressource is more subordinate to the available centres and facilities than the choice of the patient for a method of dialysis. The management of dialysis is performed by regional hospitalization agencies (ARH - Agences Régionales de l'Hospitalisation) and though SROS (Schéma régional d'Organisation des Soins) - See Public Health

As results of the french registre R.E.I.N. are not yet available, there are only approximations about the distribution of dialysis patients.

The study about epidemiology of ESRF in Ile-de-France (Jungers) gives some ideas concerning the distribution of patients between different methods of dialysis.

A recent investigation (March 2002), realized by the "Direction de l'Hospitalisation et de l'Organisation des Soins" (DHOS), gives some more accurate and up to date data. Out of 23 157 patients, only 1 045 were on PD (4.5%); 23% of them were treated by automated PD) (Chanard).

The "Registre de Dialyse Péritonéale de Langue Française" ( RDPLF - Verger) shows the following distribution among methods of DP :
- CAPD : 75 %
- APD : 25 %

Demography of Tranplant Patients in France

Thanks to Pr Maryvonne Hourmant
President of the Committee of Transplantation
of the Société de Néphrologie

The number of patients suffering from chronic renal failure is increasing beacause of the ageing of the population and there is a lack of grafts. The rate of harvested donors is 20 per million population (pmp). Some countries like Spain have much higher rates than in France.

Some data about renal grafts for the years 2001-2002 :

(Sicom 2001)

for more information and deatailed data, see the site of the " Etablissement Français des Greffes (EfG) "
and also

" Tableaux de bord de la greffe renale en France en 1998 - Analyse regionale des ressources et des besoins "
by the Committee of Transplantation de la societe de Néphrologie and the EfG.

3 Mo

Registry

RDPLF

The " Registre de Dialyse Péritonéale de Langue Française " is a well functioning database for Peritoneal Dialysis which joins five French-speaking countries. It has its own journal. The site offers many utilities and tools for nephrologists.

CRISTAL

is the database of the Etablissement Français des Greffes designed to manage harvesting and waiting lists. It contains all the medical data of organ donors, pre-transplant characteristics of recipients and post-transplant parameters.

PROJET R.E.I.N.

The " Réseau Epidémiologie et Information en Néphrologie " is a wide project of national registry initiated in 2000. It is database focused on the management of terminal renal failure, oriented towards public health strategy. The project is shared by the patients and health professionnals, actors, managers and institutions involved in renal failure and public health. The aim is to contribute to the elaboration of strategies of prevention, modalities of care in terms of quality, efficacy and economic control.
This target is based upon a thight collaboration, on both regional and national levels, between nephrologists, Health Insurance (Caisse Nationale d'Assurance Maladie), Health Ministery, intitutions involved (Institut de veille Sanitaire), research organisms (INSERM), universities. The Etablissement Français des Greffes was entrusted with the project by the Health Ministery.

(Lettre du REIN, Stengel)

SN/QM 2003