Abstract
Emergency first dialysis start considerably increases the risk of morbidity and mortality. Our objective was to identify the geographic variations of emergency first dialysis risk in patients with end-stage renal disease in the Bretagne region, France. The spatial scan statistic approach was used to determine the clusters of municipalities with significantly higher or lower risk of emergency first dialysis. Patient data extracted from the REIN registry (sociodemographic, clinical, and biological characteristics) and indicators constructed at the municipality level, were compared between clusters. This analysis identified a cluster of municipalities in western Bretagne with a significantly higher risk (RR = 1.80, p = 0.044) and one cluster in the eastern part of the region with a significantly lower risk (RR = 0.59, p < 0.01) of emergency first dialysis. The degree of urbanization (the proportion of rural municipalities: 76% versus 66%, p < 0.001) and socio-demographic characteristics (the unemployment rate: 11% versus 8%, p < 0.001, the percentage of managers in the labor force was lower: 9% versus 13% p < 0.001) of the municipalities located in the higher-risk cluster compared with the lower-risk cluster. Our analysis indicates that the patients’ clinical status cannot explain the geographic variations of emergency first dialysis incidence in Bretagne. Conversely, where patients live seems to play an important role.
Highlights
In 2011, the incidence rates of end stage renal disease (ESRD) varied considerably betweenEuropean countries, from 85 people per million in Finland to 226 ppm in Portugal [1,2]
A second clusterfirst of municipalities showed a significantly lower risk of emergency first dialysis compared with all the other municipalities (RR = 0.59; p < 0.01)
We identified one cluster of municipalities with higher risk of emergency first dialysis located in western Bretagne, and one cluster with lower risk in eastern Bretagne
Summary
In 2011, the incidence rates of end stage renal disease (ESRD) varied considerably betweenEuropean countries, from 85 people per million (ppm) in Finland to 226 ppm in Portugal [1,2]. In 2011, the incidence rates of end stage renal disease (ESRD) varied considerably between. In mainland France, the rate increased from 144 to 159 ppm between 2005 and 2014 [4]. In 2016 in France, 32% of incident hemodialyzed patients with ESRD started dialysis in emergency. This has major negative effects on both outcomes and costs [5,6]. A previous study in France analyzed the characteristics of patients with ESRD who started dialysis in emergency conditions, and found that their one-year survival and placement on the kidney transplant waiting list rates were lower than those of patients who received planned first
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