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Perit Dial Int 28(5): 509-517
2008
© 2008 International Society for Peritoneal Dialysis
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Clinical

VARIABILITY IN CASE MIX AND PERITONEAL DIALYSIS SELECTION IN FIFTY-NINE FRENCH DISTRICTS

Cécile Couchoud1, Emilie Savoye2, Luc Frimat3, Jean-Philippe Ryckelynck4, Ylana Chalem2 and Christian Verger5 the Working Group "Peritoneal Dialysis" of the French REIN Registry

The French REIN Registry,1 National Coordinating Centre, and Medical and Scientific Department,2 Biomedicine Agency, Saint-Denis La Plaine; Nephrology Department,3 Nancy University Hospital, Vandoeuvre les Nancy; Nephrology Unit,4 Clemenceau Hospital, Caen; and The French-Speaking Peritoneal Dialysis Registry,5 René Dubos Hospital, Cergy Pontoise, France

Correspondence to: C. Couchoud, The French REIN Registry, National Coordinating Center, Biomedicine Agency, 1 Avenue du Stade de France, 93212 Saint Denis la Plaine Cedex, France. cecile.couchoud{at}biomedecine.fr

In France, the use of peritoneal dialysis (PD) as the first-choice treatment varies greatly between districts, as it is already known to do between countries. Baseline clinical factors associated with choice of first modality were analyzed in 10 815 new end-stage renal disease patients in 59 districts. To describe practices at the district level, we used an agglomerative hierarchical classification, with proximity defined by a likelihood-ratio test that compared multivariate logistic regressions of the following factors: age, gender, diabetes, congestive heart failure, severe behavioral disorders, mobility, and employment. To propose a typology, each cluster of districts was described by a multivariate logistic regression. While populations starting PD in France, as elsewhere, are more likely to be young or employed, they are also more likely to be elderly or have congestive heart failure or severe behavioral disorders. Overall, 14% of patients start with PD, but this rate varies significantly across districts, from 0% to 45%. A specific combination of factors was associated with the first-choice modality in each group of districts. This study highlights the lack of consensual medical criteria for this choice and the likelihood that nonmedical factors may explain the observed differences. The high variability suggests that PD can be used in almost all clinical conditions. Accordingly, patient preference should play a more important role in the decision-making process.

KEY WORDS: Epidemiology; first-choice treatment; variability; district; comorbidities; age; agglomerative hierarchical classification.

Received 22 November 2007; accepted 20 February 2008.






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