EHESP, CNRS, INSERM, Arènes - UMR 6051, RSMS - U1309 -, University Rennes, 35000, Rennes, France.
Arènes-UMR 6051, ISSAV, EHESP, CNRS, 35000, Rennes, France.
Sci Rep. 2024 Nov 24;14(1):29106. doi: 10.1038/s41598-024-80775-7.
Not all patients on dialysis want to be registered on the kidney transplantation (KT) waiting list and undergo transplantation. The aim of this convergent mixed methods study was to determine the features of patients refusing to be registered on the KT waiting list and the reasons. Quantitative data on all 2017-2019 incident 18-85-year-old dialysis patients, eligible for KT, were extracted from the REIN registry in France. Qualitative data were collected through semi-structured interviews with patients on dialysis and nephrologists from the Bretagne, Île-de-France and Normandie French regions. The binary logistic regression method was used to identify factors/reasons associated with registration refusal and an inductive thematic analysis was performed on qualitative data. The quantitative analysis included data of 10,512 patients (mean age = 57.5 years). Among them, 860 (8.18%) refused to be registered on the KT waiting list. The multivariate analysis showed that women were 83% more likely to refuse registration compared with men. The qualitative analysis included 21 patients and 11 nephrologists. The integration of the results from the quantitative and qualitative analyses allowed identifying some factors associated with the registration refusal. Most of these factors converged across analyses. These included age, sex/gender, autonomy on dialysis and comorbidities. The integration of the results highlighted some divergence concerning sex/gender and autonomy and an area of expansion related to comorbidities. In conclusion, the patient age, sex/gender and comorbidities appear to play an important role in the refusal to be registered on the waiting list. Interventions focused on these factors might help to improve KT accessibility in France.
并非所有接受透析治疗的患者都希望被登记在肾脏移植（KT）等候名单上并接受移植。本收敛混合方法研究的目的是确定拒绝登记在 KT 等候名单上的患者的特征和原因。从法国 REIN 登记处提取了所有符合条件的 2017-2019 年 18-85 岁透析患者的 2017-2019 年的所有数据。通过对布列塔尼、法兰西岛和诺曼底地区的透析患者和肾病学家进行半结构化访谈收集定性数据。使用二元逻辑回归方法确定与拒绝登记相关的因素/原因，并对定性数据进行归纳主题分析。定量分析包括 10512 名患者的数据（平均年龄为 57.5 岁）。其中 860 人（8.18%）拒绝登记在 KT 等候名单上。多变量分析表明，与男性相比，女性拒绝登记的可能性高 83%。定性分析包括 21 名患者和 11 名肾病学家。定量和定性分析结果的综合分析确定了一些与登记拒绝相关的因素。这些因素中的大多数在分析中都趋同。这些因素包括年龄、性别/性别、透析自主权和合并症。结果的综合分析突出了一些与性别/性别和自主权有关的分歧，并扩展到与合并症有关的领域。总之，患者年龄、性别/性别和合并症似乎在拒绝登记等候名单方面起着重要作用。针对这些因素的干预措施可能有助于提高法国的 KT 可及性。
