[Supply of care and prevention]

THE SITUATION: The needs for care of terminal renal failure (TRF) has changed over the past 10 years, particularly with more elderly patients presenting with more comorbid states. The supply of care, the quota of which is fixed by the demand, is no longer adapted and reorganization is primordial. The delayed referral to a nephrologist is an increased source of morbidity and mortality. It is also the cause of increased costs of around 0.2 billion francs per year. In our paper we present 2 major axes of development, defined during the last National Health Conference. ORGANIZATION OF A NETWORK ON NEPHROLOGIC EPIDEMIOLOGY AND INFORMATION (RESEAU EPIDEMIOLOGIE ET INFORMATION EN NEPHROLOGIE -REIN): This network will pilot the development of the first axe, which is the supply of care adapted to requirements. The characteristics of this multidisciplinary program are presented together with the multi-source information system. The provisional annual budget for dialysis alone would correspond to the contribution of 1.00 FF per session for the Health Scheme and to 0.6 FF for the State. SECOND AXE OF DEVELOPMENT: Transplant planning is aimed to increase the collection of organs and thus the yearly number of transplants, clearly insufficient today. The principle elements of the program are presented. The yearly return on investment of such a program would be of half a billion Francs after five years. PREVENTION OF TRF: The notion of renal risk, risk factors for the progression of chronic renal failure and risk factors for a nephropathy must be introduced. There are two major axes to the prevention of TRF: slowing the progression of chronic renal failure and preventing the occurrence of subjacent nephropathies. These tasks come within the framework of the "Chronic Renal Failure Plan" presented by the Ministry of Health last September.