[Dialysis-computer program. IV. Summary report. Epidemiology of complications]

Area of Science:

• Nephrology
• Public Health
• Epidemiology

Context:

• The Diaphane-program, established by the French Society of Nephrology, has tracked approximately 1500 patients across 30 dialysis centers since 1972.
• This report analyzes data from 1572 adult patients undergoing maintenance hemodialysis between 1972 and 1976 in 24 French dialysis centers.

Purpose:

• To profile the evolution of patients undergoing maintenance hemodialysis in France.
• To analyze trends in dialysis techniques, treatment strategies, and patient complications.
• To identify demographic, clinical, and socioeconomic factors influencing dialysis outcomes.

Summary:

• Patient age at dialysis initiation increased from 40.1 to 48.2 years between 1972 and 1976.
• Male predominance is noted, linked to higher rates of chronic glomerulonephritis and renal vascular diseases.
• Despite earlier treatment initiation (lower mean plasma creatinine), significant proportions of patients presented with high creatinine, hypertension, and retinopathy.
• Delayed dialysis initiation correlated with increased early cardiopulmonary complications and first-year mortality.
• Socioeconomic disparities were observed, with higher-income patients receiving earlier diagnosis and treatment.
• Dialysis frequency increased, while weekly duration decreased, with a shift towards daytime sessions and increased use of disposable dialyzers.
• Hypotension and cramps were common complications, with risk factors including female sex, older age, orthostatic hypotension, and significant weight loss during dialysis.

Impact:

• Highlights the need for earlier detection and intervention for chronic kidney disease to mitigate complications and mortality.
• Reveals socioeconomic disparities in healthcare access and treatment initiation for dialysis patients.
• Provides crucial data for refining dialysis protocols, patient selection, and complication management strategies in France.