title: Spatial Analysis of Case-Mix and Dialysis Modality Associations.
abstract: ♦
  
  
  
  Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities. ♦
  
  
  
  The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients. ♦
  
  
  
  The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities. ♦
  
  
  
  The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients' clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients' clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients' quality of life, satisfaction, survival, and global efficiency.
authors.affiliation: REIN registry, Agence de la biomédecine, France Children's Medical Centre "Mrcheveli," Tbilissi, Georgia.
authors.forename: Tamar
authors.initials: T
authors.lastname: Phirtskhalaishvili
authors.affiliation: REIN registry, Agence de la biomédecine, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Bayer
authors.affiliation: Nephrology Unit, Dieppe Hospital, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Edet
authors.affiliation: Department of Economic Evaluation and Public Health, Haute Autorité de Santé, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bongiovanni
authors.affiliation: REIN registry, Agence de la biomédecine, France Nephrology Unit, Robert Debré, University Hospital, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Hogan
authors.affiliation: REIN registry, Agence de la biomédecine, France cecile.couchoud@biomedecine.fr.
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups; D005260:Female; D005602:France; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012648:Self Care; D062206:Spatial Analysis; D055815:Young Adult
keywords: Hemodialysis; agglomerative hierarchical cluster analysis; case mix; health-care planning; peritoneal dialysis