Ten-years trends in renal replacement therapy for end-stage renal disease in mainland France: Lessons from the French Renal Epidemiology and Information Network (REIN) registry.
BACKGROUND
The incidence rate of renal replacement therapy (RRT) for end-stage renal disease (ESRD) is decreasing in several countries, but not in France. We studied the RRT trends in mainland France from 2005 to 2014 to understand the reasons for this discrepancy and determine the effects of ESRD management changes.


METHODS
Data were extracted from the French Renal Epidemiology and Information Network registry. Time trends of RRT incidence and prevalence rates, patients' clinical and treatment characteristics were analysed using the Joinpoint regression program and annual percentage changes. Survival within the first year of RRT was analysed using Kaplan-Meier estimates for 4 periods of time.


RESULTS
The overall age- and gender-adjusted RRT incidence rate increased from 144 to 159 individuals per million inhabitants (pmi) (+0.8% per year; 95% CI: 0.5-1.2) and the prevalence from 903 to 1141 pmi (+2.4% per year; 95% CI: 2.2-2.7). This increase concerned exclusively ESRD associated with type 2 diabetes (+4.0%; 3.4-4.6) and mostly elderly men. Despite patient aging and increasing comorbidity burden and a persistent 30% rate of emergency dialysis start, the one-year survival rate slightly improved from 82.1% (81.4-82.8) to 83.8% (83.3-84.4). Pre-emptive wait listing for renal transplantation and the percentage of wait-listed patients within one year after dialysis start strongly increased (from 5.6% to 15.5% and from 29% to 39%, respectively).


CONCLUSIONS
Kidney transplantation and survival significantly improved despite the heavier patient burden. However, the rise in type 2 diabetes-related ESRD and the stable high rate of emergency dialysis start remain major issues.
Service de néphrologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, 2, avenue Léon-Bernard, 35000 Rennes, France. Electronic address: cecile.vigneau@chu-rennes.fr.
Cécile
C
Vigneau
AURA, 185-191, rue Raymond-Loserand, 75014 Paris, France.
Anne
A
Kolko
CESP, Inserm U1018, université Paris-Sud, UVSQ, université Paris-Saclay, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
Bénédicte
B
Stengel
REIN registry, agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Plaine-Saint-Denis, France.
Christian
C
Jacquelinet
UPRES EA2415, Clinical Research Institute, Montpellier University and Biostatistics, Epidemiology and Public Health department, Nîmes University Hospital, 641, avenue du Doyen-Gaston-Giraud, 34093 Nîmes, France.
Paul
P
Landais
Service de néphrologie, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France.
Philippe
P
Rieu
EHESP, Sorbonne Paris Cité, EA MOS France, 15, avenue Léon-Bernard, 35000 Rennes, France.
Sahar
S
Bayat
REIN registry, agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Plaine-Saint-Denis, France.
Cécile
C
Couchoud
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data / Q000639:trends*; D017678:Sex Distribution; D014850:Waiting Lists; D055815:Young Adult
ESRD; Epidemiology; Incidence; Prevalence; Transplantation