Setting reasonable objectives for improving preemptive kidney transplantation rates in children
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ORIGINAL ARTICLE
Setting reasonable objectives for improving preemptive kidney transplantation rates in children Cyrielle Parmentier 1,2 & Mathilde Lassalle 2 & Etienne Berard 3 & Justine Bacchetta 4 & Jean-Daniel Delbet 1 & Jerome Harambat 5 & Cécile Couchoud 2 & Julien Hogan 6 & on behalf of the REIN Registry Received: 20 January 2020 / Revised: 7 May 2020 / Accepted: 5 June 2020 # IPNA 2020
Abstract Background This study aims to develop a method to estimate the potential of preemptive kidney transplantation (PKT) by identifying patients who were transplanted after a dialysis period (non-preemptive kidney transplantation (NPKT)) despite being medically suitable for PKT. Methods All children (< 18 years old) starting kidney replacement therapy (KRT) in France, between 2010 and 2016 and transplanted before December 31, 2017, were included. A propensity score (PS) of receiving PKT was estimated by multivariate logistic regression based on recipient medical characteristics. Healthcare use during the 24 months prior to KRT initiation was extracted from the French National Health Insurance database, and a pre-KRT follow-up of more than 18 months was considered sufficient to allow preemptive transplantation. Results Among 643 patients who started KRT, 149 (23.2%) were preemptively transplanted. Using PS stratification, among 391 NPKT patients, we identified 145 patients (37%) suitable for PKT, according to clinical characteristics. Mean age was 12.3 years, 67% were males, and 56% had urological abnormalities. Among those 145 patients, we identified 79 NPKT patients who started on dialysis despite early referral to a nephrologist (more than 18 months prior to KRT initiation). Conclusions This method estimates a potential of 228 (149 + 79) PKT (35%) among pediatric patients in France. A similar method could be used in adults or in other countries. Estimation of the rate of patients with CKD stage 5 medically suitable for PKT will be of interest for health policy makers when setting up objectives for improvement in preemptive kidney transplant access. Keywords Children . Clinical epidemiology . CKD 5 . Preemptive kidney transplantation . Propensity score
Introduction
* Cyrielle Parmentier [email protected] 1
Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012 Paris, France
2
REIN Registry, Agence de la Biomedecine, La Plaine Saint-Denis, France
3
Pediatric Nephrology Unit, CHU de Nice-Hôpital, Nice, France
4
Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Lyon, France
5
Pediatric Nephrology Unit, CHU de Bordeaux, Bordeaux, France
6
Pediatric Nephrology Unit, Robert-Debré Hospital, APHP, Paris, France
Kidney transplantation is nowadays recognized as the modality of choice for kidney replacement therapy (KRT) in children and has been associated with a better survival and an improved quality of life [1–3]. Preemptive kidney transplantation (PKT), defined as transplantation prior to the initiation of dialysis, is the optimal treatment for patients with stage 5 chronic kidney dise
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