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Adoli LK, Campeon A, Chatelet V, Couchoud C, Lobbedez T, Bayer F, Vabret E, Daugas E, Vigneau C, Jais JP, Bayat-Makoei S. Experience of Chronic Kidney Disease and Perceptions of Transplantation by Sex. JAMA Netw Open 2024; 7:e2424993. [PMID: 39083269 PMCID: PMC11292447 DOI: 10.1001/jamanetworkopen.2024.24993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/03/2024] [Indexed: 08/03/2024] Open
Abstract
Importance The pathway to kidney transplantation (KT) begins with the patient's acceptance of this surgical procedure after discussion with the nephrologist. The patients' perceptions of the disease and of KT may influence their willingness to undergo transplantation. Objective To describe patients' experiences of kidney disease and their perceptions of KT and the nephrologists' perceptions of the patient experience. Design, Setting, and Participants This qualitative study collected data through semistructured interviews with patients with chronic kidney disease and nephrologists in the Bretagne, Île-de-France and Normandie regions, France. Researchers involved in the study in each region purposely selected 99 patients with chronic kidney disease who initiated dialysis in 2021, based on their age, sex, dialysis facility ownership, and also 45 nephrologists, based on their sex and years of experience. Data analysis was performed from January to October 2023. Main Outcomes and Measures Themes were identified using inductive thematic analysis. Specific characteristics of men and women as well as the nephrologist's views for each theme were described. Results This study included 42 men and 57 women (56 [57%] aged 60 years or older) who started dialysis in 2021 and 45 nephrologists (23 women and 22 men). Six major themes were identified: (1) burden of chronic kidney disease on patients and their families, (2) health care professional-patient relationship and other factors that modulate chronic kidney disease acceptance, (3) dialysis perceived as a restrictive treatment, (4) patients' representation of the kidney graft, (5) role of past experiences in KT perception, and (6) dualistic perception of KT. In some cases, women and nephrologists indicated that women's perceptions and experiences were different than men's; for example, the disease's psychological impact and the living donor KT refusal were mainly reported by 8 women. Conclusions and Relevance Patients' past experience of chronic kidney disease in general and of KT in particular, as well as their relationship with their family and nephrologist, were substantial determinants of KT perception in this qualitative study. Targeted policies on these different factors might help to improve access to KT, and more research is needed to understand whether there are sex-based disparities.
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Affiliation(s)
- Latame Komla Adoli
- Univ Rennes, EHESP, CNRS, INSERM, Arènes – UMR 6051, RSMS – U1309, Rennes, France
| | | | - Valérie Chatelet
- U1086 INSERM, Anticipe, Centre De Lutte Contre Le Cancer François Baclesse, Centre Universitaire Des Maladies Rénales, Caen, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN) Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Thierry Lobbedez
- U1086 INSERM, Anticipe, Centre De Lutte Contre Le Cancer François Baclesse, Centre Universitaire Des Maladies Rénales, Caen, France
| | - Florian Bayer
- Renal Epidemiology and Information Network (REIN) Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Elsa Vabret
- Univ Rennes, EHESP, CNRS, INSERM, Arènes – UMR 6051, RSMS – U1309, Rennes, France
| | - Eric Daugas
- Inserm U1149 Université Paris Cité Assistance Publique-Hôpitaux De Paris Service De Néphrologie Hôpital Bichat- Paris, Paris, France
| | - Cécile Vigneau
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Jean-Philippe Jais
- Unité de Biostatistique, Hôpital Necker-Enfants Malades, AP-HP; Institut Imagine; Université Paris-Cité, Paris, France
| | - Sahar Bayat-Makoei
- Univ Rennes, EHESP, CNRS, INSERM, Arènes – UMR 6051, RSMS – U1309, Rennes, France
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Audry B, Savoye E, Pastural M, Bayer F, Legeai C, Macher MA, Kerbaul F, Jacquelinet C. The new French kidney allocation system for donations after brain death: Rationale, implementation, and evaluation. Am J Transplant 2022; 22:2855-2868. [PMID: 36000787 DOI: 10.1111/ajt.17180] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/01/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
In recent decades, the allocation policies of many countries have moved from center-based to patient-based approaches. The new French kidney allocation system (KAS) of donations after brain death for adult recipients, implemented in 2015, was principally designed to introduce a unified allocation score (UAS) to be applied locally for one kidney and nationally for the other and to replace regional borders by a new geographical model. The new KAS balances dialysis duration and waiting time to compensate for listing delays and provides more effective longevity matching between donors and recipients with better HLA and age matching. We report these changes, with their rationale and main results. Results show improved HLA matching for young recipients and more rapid access to transplant for older recipients. Young recipients also had better access to transplantation. Transplant access decreased for recipients aged 60-69 and required tuning of KAS parameters. In conclusion, our results strongly indicate that national or adequately broad geographic allocation areas, combined with multiplicative interactions between allocation criteria, permit multivariate optimization of organ allocation and thus improve national kidney sharing and balance HLA matching and age matching, at the price of longer cold ischemic times and more logistical constraints than with local allocation.
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Adoli L, Raffray M, Châtelet V, Vigneau C, Lobbedez T, Gao F, Bayer F, Campéon A, Vabret E, Laude L, Jais JP, Daugas E, Couchoud C, Bayat S. Women's Access to Kidney Transplantation in France: A Mixed Methods Research Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13524. [PMID: 36294104 PMCID: PMC9603645 DOI: 10.3390/ijerph192013524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Kidney transplantation is the best renal replacement therapy (medically and economically) for eligible patients with end-stage kidney disease. Studies in some French regions and in other countries suggest a lower access to the kidney transplant waiting listing and also to kidney transplantation, once waitlisted, for women. Using a mixed methods approach, this study aims to precisely understand these potential sex disparities and their causes. The quantitative study will explore the geographic disparities, compare the determinants of access to the waiting list and to kidney transplantation, and compare the reasons and duration of inactive status on the waiting list in women and men at different scales (national, regional, departmental, and census-block). The qualitative study will allow describing and comparing women's and men's views about their disease and transplantation, as well as nephrologists' practices relative to the French national guidelines on waiting list registration. This type of study is important in the current societal context in which the reduction of sex/gender-based inequalities is a major social expectation.
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Affiliation(s)
- Latame Adoli
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
| | - Maxime Raffray
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
| | - Valérie Châtelet
- U1086 INSERM, Anticipe, Centre de Lutte Contre le Cancer François Baclesse, Centre Universitaire des Maladies Rénales, 14000 Caen, France
| | - Cécile Vigneau
- IRSET (Institut de Recherche en Santé, Environnement et Travail), Université de Rennes, Chu Rennes, INSERM, EHESP, UMR_s 1085, 35000 Rennes, France
| | - Thierry Lobbedez
- U1086 INSERM, Anticipe, Centre de Lutte Contre le Cancer François Baclesse, Centre Universitaire des Maladies Rénales, 14000 Caen, France
| | - Fei Gao
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
| | - Florian Bayer
- Renal Epidemiology and Information Network (Rein) Registry, Biomedecine Agency, Saint-Denis-la-Plaine, 93212 Paris, France
| | - Arnaud Campéon
- Arènes–UMR 6051, ISSAV, EHESP, CNRS, 35000 Rennes, France
| | - Elsa Vabret
- Service de Néphrologie, Chu Rennes, 35000 Rennes, France
| | - Laëtitia Laude
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
| | - Jean-Philippe Jais
- Unité de Biostatistique, Hôpital Necker-Enfants Malades, AP-HP, Institut Imagine, Université Paris-Cité, 75015 Paris, France
| | - Eric Daugas
- INSERM U1149, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Service de Néphrologie, Hôpital Bichat, 75018 Paris, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (Rein) Registry, Biomedecine Agency, Saint-Denis-la-Plaine, 93212 Paris, France
| | - Sahar Bayat
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
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Verdier JF, Boyer S, Chalmin F, Jeribi A, Egasse C, Maggi MF, Auvray P, Yalaoui T. Response to three doses of the Pfizer/BioNTech BNT162b2 COVID-19 vaccine: a retrospective study of a cohort of haemodialysis patients in France. BMC Nephrol 2022; 23:189. [PMID: 35585512 PMCID: PMC9116059 DOI: 10.1186/s12882-022-02751-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/28/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The mortality rate associated with coronavirus disease 2019 (COVID-19) is high among haemodialyzed patients. We sought to describe the serological status of haemodialysis patients having received up to three doses of BNT162b2 mRNA vaccine, and to identify factors associated with a poor humoral response. METHODS We performed a retrospective, observational study of patients attending a dialysis centre in Antibes, France. One or two of each patient's monthly venous blood samples were assayed for anti-spike (S1) immunoglobulin G (IgG). RESULTS We included 142 patients, of whom 124 remained COVID-19-negative throughout the study. Among these COVID-19-negative patients, the humoral immune response rate (defined as an anti-S1 IgG titre ≥1.2 U/ml) was 82.9% after two injections and 95.8% after three injections, and the median [interquartile range] titre increased significantly from 7.09 [2.21; 19.94] U/ml with two injections to 93.26 [34.25; 176.06] U/ml with three. Among patients with two injections, the mean body mass index and serum albumin levels were significantly higher in responders than in non-responders (26.5 kg/m2 vs. 23.2 kg/m2, p = 0.0392; and 41.9 g/l vs. 39.0 g/l, p = 0.0042, respectively). For the study population as a whole at the end of the study, a history of COVID-19, at least two vaccine doses, and being on the French national waiting list for kidney transplantation were the only factors independently associated with the anti-S1 IgG titre. CONCLUSIONS Dialysis patients vaccinated with two doses of BNT162b2 might not be sufficiently protected against SARS-CoV-2 and so should receive a third (booster) dose. TRIAL REGISTRATION The present retrospective study of clinical practice was not interventional and so was not registered.
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Affiliation(s)
- Jean-François Verdier
- Centre de Néphrologie d’Antibes/Centre d’Hémodialyse de la Riviera, 103 ter avenue de Nice, F-06600 Antibes, France
| | - Sonia Boyer
- Centre de Néphrologie d’Antibes/Centre d’Hémodialyse de la Riviera, 103 ter avenue de Nice, F-06600 Antibes, France
| | - Florence Chalmin
- Centre de Néphrologie d’Antibes/Centre d’Hémodialyse de la Riviera, 103 ter avenue de Nice, F-06600 Antibes, France
| | - Ahmed Jeribi
- Centre de Néphrologie d’Antibes/Centre d’Hémodialyse de la Riviera, 103 ter avenue de Nice, F-06600 Antibes, France
| | - Caroline Egasse
- Centre de Néphrologie d’Antibes/Centre d’Hémodialyse de la Riviera, 103 ter avenue de Nice, F-06600 Antibes, France
| | | | - Philippe Auvray
- Centre de Néphrologie d’Antibes/Centre d’Hémodialyse de la Riviera, 103 ter avenue de Nice, F-06600 Antibes, France
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Sypek MP, Clayton PA, Lim W, Hughes P, Kanellis J, Wright J, Chapman J, McDonald SP. Access to waitlisting for deceased donor kidney transplantation in Australia. Nephrology (Carlton) 2019; 24:758-766. [DOI: 10.1111/nep.13484] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Matthew P Sypek
- ANZDATA Registry Adelaide South Australia Australia
- Department of Medicine, Dentistry and Health SciencesUniversity of Melbourne Melbourne Victoria Australia
- Department of NephrologyRoyal Melbourne Hospital Melbourne Victoria Australia
| | - Philip A Clayton
- ANZDATA Registry Adelaide South Australia Australia
- Central and Northern Renal and Transplantation ServicesCentral Adelaide Local Health Network Adelaide South Australia Australia
- Adelaide Medical SchoolUniversity of Adelaide Adelaide South Australia Australia
| | - Wai Lim
- Renal DepartmentSir Charles Gairdner Hospital Perth Western Australia Australia
- School of Medicine and PharmacologyUniversity of Western Australia Perth Western Australia Australia
| | - Peter Hughes
- Department of Medicine, Dentistry and Health SciencesUniversity of Melbourne Melbourne Victoria Australia
- Department of NephrologyRoyal Melbourne Hospital Melbourne Victoria Australia
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Department of MedicineMonash University Melbourne Victoria Australia
| | - Jenni Wright
- National Organ Matching Service, Australian Red Cross Blood Service Sydney New South Wales Australia
| | - Jeremy Chapman
- National Organ Matching Service, Australian Red Cross Blood Service Sydney New South Wales Australia
- Department of Renal MedicineWestmead Hospital Sydney New South Wales Australia
| | - Stephen P McDonald
- ANZDATA Registry Adelaide South Australia Australia
- Central and Northern Renal and Transplantation ServicesCentral Adelaide Local Health Network Adelaide South Australia Australia
- Adelaide Medical SchoolUniversity of Adelaide Adelaide South Australia Australia
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Pladys A, Morival C, Couchoud C, Jacquelinet C, Laurain E, Merle S, Vigneau C, Bayat S. Outcome‐dependent geographic and individual variations in the access to renal transplantation in incident dialysed patients: a French nationwide cohort study. Transpl Int 2018; 32:369-386. [DOI: 10.1111/tri.13376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/16/2018] [Accepted: 11/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Adélaïde Pladys
- EA 7449 REPERES EHESP Rennes, Sorbonne Paris Cité Rennes France
| | - Camille Morival
- EHESP High School of Public Health Rennes Sorbonne Paris Cité Rennes France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN) Biomedicine Agency La Plaine Saint‐Denis France
| | - Christian Jacquelinet
- Renal Epidemiology and Information Network (REIN) Biomedicine Agency La Plaine Saint‐Denis France
- INSERM U1018 Villejuif France
| | | | - Sylvie Merle
- Martinique Regional Observatory on Health of Martinique Le Lamentin France
| | - Cécile Vigneau
- INSERM U1085‐IRSET University of Rennes 1 Rennes France
- Department of Nephrology CHU Pontchaillou Rennes France
| | - Sahar Bayat
- EA 7449 REPERES EHESP Rennes, Sorbonne Paris Cité Rennes France
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7
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Le Meur N, Vigneau C, Lefort M, Lebbah S, Jais JP, Daugas E, Bayat S. Categorical state sequence analysis and regression tree to identify determinants of care trajectory in chronic disease: Example of end-stage renal disease. Stat Methods Med Res 2018; 28:1731-1740. [PMID: 29742976 DOI: 10.1177/0962280218774811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with chronic diseases, like patients with end-stage renal disease (ESRD), have long history of care driven by multiple determinants (medical, social, economic, etc.). Although in most epidemiological studies, analyses of health care determinants are computed on single health care events using classical multivariate statistical regression methods. Only few studies have integrated the concept of treatment trajectories as a whole and studied their determinants. METHODS All 18- to 80-year-old incident ESRD patients who started dialysis in Ile-de-France or Bretagne between 2006 and 2009 and could be followed for a period of 48 months after initiation of a renal replacement therapy were included (n = 5568). Their care trajectories were defined as categorical state sequences. Associations between patients' characteristics and care trajectories were assessed using a regression tree model together with a discrepancy analysis. RESULTS On average, each patient experienced 1.56 different renal replacement therapies (min = 1; max = 5) during the 48 months of follow-up. About 55% of patients never changed treatment and only 1% tried three or more renal replacement therapy modalities. Twelve homogeneous care trajectory groups were identified. Covariates explained 12% of the discrepancy between groups, particularly age, regions and initiation of hemodialysis with a catheter. CONCLUSIONS Regression tree analysis of categorical state sequence highlighted geographical disparities in the care trajectory of French patients with ESRD that cannot be observed when focusing on a single outcome, such as survival. This method is an original tool to visualize and characterize care trajectories, notably in the context of chronic condition like ESRD.
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Affiliation(s)
- Nolwenn Le Meur
- 1 Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449, Rennes, France
| | - Cécile Vigneau
- 2 CHU Pontchaillou, Service de Néphrologie, Rennes, France.,3 IRSET, INSERM UMR 1085, Rennes, France
| | - Mathilde Lefort
- 1 Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449, Rennes, France
| | - Saïd Lebbah
- 4 CHU Necker Enfants Malades, Biostatistics unit, INSERM UMR S 872, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Philippe Jais
- 4 CHU Necker Enfants Malades, Biostatistics unit, INSERM UMR S 872, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Eric Daugas
- 5 Hôpital Bichat, Service de Néphrologie, DHU FIRE, INSERM U1149, Université Paris Diderot, Paris, France
| | - Sahar Bayat
- 1 Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449, Rennes, France
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