Couchoud Cécile, Arnaud Del Bello, Lobbedez Thierry, Blanchard Sylvie, Chantrel François, Maurizi-Balzan Jocelyne, Moranne Olivier
REIN Registry, Agence de la biomédecine, Saint Denis La Plaine, France.
Nephrology Unit, University Hospital, Toulouse, France.
Nephrology (Carlton). 2017 Aug;22(8):598-608. doi: 10.1111/nep.12822.
Palliative care is seldom proposed to patients with end-stage renal disease (ESRD) despite a mortality rate and disease burden as high as among cancer patients. The aim of this study is to analyze the access of palliative care-related hospitalization in the management of patients on dialysis in France, by describing the characteristics of these hospitalizations, the clinical status of the concerned patients, and the use of palliative care in those stopping dialysis.
The French Renal Epidemiology and Information Network (REIN) registry includes data about 51 834 patients aged 20 years and older who began dialysis from 1 January 2008 to 31 December 2013, and were followed longitudinally until that date. Linkage to the anonymized national hospital discharge database allowed us to analyse hospitalizations associated with palliative care.
During the follow-up period, 1865 patients (3.6%) had a palliative care-related hospitalization corresponding to a total of 3382 hospitalizations. Lower levels of serum albumin, active cancer, and impaired mobility were each independently associated with the probability of at least one such hospitalization. During the same period 4540 patients withdrew from dialysis (9% of the patients), 10% of them had a palliative care-related hospitalization.
This study suggests that among ESRD patients, only a few resorted to palliative care-related hospitalization, even those withdrawing from dialysis. Cooperation between nephrologists and physicians trained in palliative care should be improved at least to the extent necessary to identify patients who should be referred to palliative care. Our study also highlights the need for more information on the current access to any kind of supportive care for dialysis patients.
尽管终末期肾病（ESRD）患者的死亡率和疾病负担与癌症患者一样高，但很少有人向他们提供姑息治疗。本研究的目的是通过描述这些住院治疗的特征、相关患者的临床状况以及停止透析患者的姑息治疗使用情况，分析法国透析患者管理中与姑息治疗相关的住院治疗情况。
法国肾脏流行病学和信息网络（REIN）登记处包含了2008年1月1日至2013年12月31日开始透析且年龄在20岁及以上的51834名患者的数据，并对其进行了纵向随访直至该日期。与匿名的国家医院出院数据库建立联系，使我们能够分析与姑息治疗相关的住院情况。
在随访期间，1865名患者（3.6%）有与姑息治疗相关的住院治疗，共计3382次住院。血清白蛋白水平较低、患有活动性癌症和行动不便各自都与至少一次此类住院的可能性独立相关。在同一时期，4540名患者停止透析（占患者总数的9%），其中10%的患者有与姑息治疗相关的住院治疗。
本研究表明，在ESRD患者中，即使是那些停止透析的患者，也只有少数人接受了与姑息治疗相关的住院治疗。肾脏病医生和接受过姑息治疗培训的医生之间的合作至少应改善到能够识别应转介至姑息治疗的患者的必要程度。我们的研究还强调需要更多关于透析患者目前获得任何形式支持性护理的信息。
