Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, Paris, France.
REIN Registry, Agence de la Biomedecine, La Plaine, Saint-Denis, France.
Pediatr Nephrol. 2022 Oct;37(10):2427-2436. doi: 10.1007/s00467-022-05467-8. Epub 2022 Feb 10.
To improve pre-emptive kidney transplantation (PKT) in children and limit starting dialysis in an emergency, we aimed to describe nephrology care trajectories pre-CKD stage 5.
We included all children in France who, between 2010 and 2016, started kidney replacement therapy (KRT): standard dialysis (reference group) and emergency dialysis or PKT. We identified four pre-CKD stage 5 nephrology care trajectories before KRT that were extracted from the national exhaustive medical-administrative database and used logistic regression to explore associations between patient characteristics, care trajectories, and KRT initiation.
Six hundred forty-three pediatric patients started KRT in France; 406 started dialysis and 30.5% emergency dialysis. The "optimal" care trajectory encompassed 179 patients, 82.7% with at least 18 months nephrology follow-up. Conversely, the "no care" trajectory encompassed 118 patients with no nephrology follow-up before KRT. The "severe" trajectory encompassed 128 patients; 93% hospitalized more than once a year and 18% in an intensive care unit. Finally, the "irregular" trajectory encompassed 127 patients, 77% and 46% with irregular laboratory monitoring and CKD drug delivery, respectively. With the "optimal" trajectory as the reference, probability of emergency dialysis was higher with the "irregular" and "no care" trajectories (odds ratio 3.02 [95% confidence interval 1.18-7.66] and 26.5 [10.8-64.8], respectively), and PKT was reduced with the "severe" trajectory (0.43 [0.23-0.82]).
We identified a group of patients with irregular follow-up who may benefit the most from interventions aiming at improving adherence to treatment and earlier diagnosis of their CKD to improve access to PKT. A higher resolution version of the Graphical abstract is available as Supplementary information.
为了提高儿童的预防性肾移植（PKT）并限制紧急情况下开始透析，我们旨在描述 CKD 5 期前的肾脏科护理轨迹。
我们纳入了 2010 年至 2016 年期间在法国开始肾脏替代治疗（KRT）的所有儿童：标准透析（参照组）和紧急透析或 PKT。我们从全国详尽的医疗管理数据库中提取了 KRT 前 4 个 CKD 5 期的肾脏科护理轨迹，并使用逻辑回归来探讨患者特征、护理轨迹与 KRT 启动之间的关联。
法国有 643 名儿科患者开始 KRT；406 名患者开始透析，其中 30.5%为紧急透析。“最佳”护理轨迹包括 179 名患者，其中 82.7%至少有 18 个月的肾脏科随访。相反，“无护理”轨迹包括 118 名患者，他们在 KRT 前没有进行肾脏科随访。“严重”轨迹包括 128 名患者；93%的患者每年住院 1 次以上，18%的患者入住重症监护病房。最后，“不规则”轨迹包括 127 名患者，其中 77%和 46%的患者实验室监测和 CKD 药物输送不规则。以“最佳”轨迹为参照，“不规则”和“无护理”轨迹的紧急透析概率更高（优势比 3.02[95%置信区间 1.18-7.66]和 26.5[10.8-64.8]），“严重”轨迹的 PKT 减少（0.43[0.23-0.82]）。
我们发现了一组随访不规律的患者，他们可能最受益于旨在提高治疗依从性和更早诊断 CKD 的干预措施，以改善 PKT 的获得。一个更高分辨率的图表摘要版本可以在补充信息中找到。
