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Theses

Home dialysis for the treatment of end stage chronic kidney disease

Abstract : Peritoneal dialysis (PD) utilization has been declining over the past decades in Europe. Several reasons could explain this PD under-utilization, such as a low PD uptake and the persistence of an elevated rate of PD cessation. Strategic incentives to increase home dialysis, such as assisted PD programs, have been developed, however their impact remains under-described. In this work, we combined data of patients on PD from France and the UK, using statistical models including time-varying covariate, fractional polynomials and Cox regression with robust variance, to address some of the gaps in the current knowledge in PD under-utilization. With the present thesis, we have reported how the introduction of an assisted PD service positively influenced the uptake of PD and counterbalanced the decline in PD rates over time. In France, assisted PD currently relies on nurse assistance; which can be successfully promoted with economic incentives. Both PD cessation (due to either death or transfer to HD) and death linearly declined over time, and transfer to HD declined from 2011 mainly because of a significant decline in infection-related transfers. Finally, we have shown that time spent on HD before transfer to PD impacts patient survival but does not impact retransfer to HD. In lights of the results of this work, we believe that economic incentives promoting the reimbursement of assisted PD added with a shift in mentality and an increased commitment to PD could successfully increase PD rates and enable patients to have a free choice regarding their treatment modality.
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https://tel.archives-ouvertes.fr/tel-03555500
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Submitted on : Thursday, February 3, 2022 - 4:17:10 PM
Last modification on : Monday, February 28, 2022 - 11:27:36 AM
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  • HAL Id : tel-03555500, version 1

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Annabel Boyer. Home dialysis for the treatment of end stage chronic kidney disease. Human health and pathology. Normandie Université, 2021. English. ⟨NNT : 2021NORMC425⟩. ⟨tel-03555500⟩

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