[CKD care in French nephrology practices]

Area of Science:

• Nephrology
• Healthcare Management
• Public Health

Background:

• Assessing the impact of bundled payment systems on chronic kidney disease (CKD) patient care requires understanding pre-implementation management.
• The CKD-REIN cohort study provides a baseline for evaluating real-world CKD patient care patterns.

Purpose of the Study:

• To describe nephrology care patterns in patients with moderate to severe CKD.
• To assess compliance with health authority guidelines for CKD management.
• To identify gaps in care prior to bundled payment implementation.

Main Methods:

• Analysis of 3-year nephrology care data for 2835 patients (2013-2019) in the CKD-REIN cohort.
• Evaluation of patient demographics, including CKD stage, age, and gender.
• Assessment of adherence to recommended nephrology visit frequency, dietitian consultations, and treatment option information.

Main Results:

• Mean age of patients was 67 years, with 65% males; 43% had CKD stages 4-5.
• Nephrology visits increased with CKD stage, but recommended minimums were met by only 84% (3B), 63% (4), and 33% (5).
• Low rates of dietitian visits (34-40%) and treatment information (33-54%) were observed in advanced CKD stages. Longer wait times and shorter appointment durations were noted at university hospitals.

Conclusions:

• A significant disparity exists between recommended and actual care received by CKD patients.
• Human resource and organizational limitations contribute to these care gaps in nephrology settings.
• Anticipated improvements in CKD management are expected with the implementation of bundled payment systems.