ESPN 53rd Annual Meeting

ESPN 2021


 
Development of a simulation tool of the care trajectories of children and young adults with ESKD
JULIEN HOGAN 1 JEROME HARAMBAT 2 ETIENNE BERARD 3 CECILE COUCHOUD 4

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY, ROBERT DEBRé HOSPITAL, APHP, PARIS, FRANCE.
2- PEDIATRIC NEPHROLOGY UNIT, BORDEAUX UNIVERSITY HOSPITAL, BORDEAUX, FRANCE
3- PEDIATRIC NEPHROLOGY DEPARTMENT, FONDATION LENVAL, NICE, FRANCE
4- REGISTRE REIN, AGENCE DE LA BIOMéDECINE, LA PLAINE SAINT-DENIS, FRANCE
 
Introduction:

Given the improved life expectancy and the limited survival of kidney allografts, children and young adults undergo sequential periods of dialysis and transplantation over their lifetime. Most studies focus on access to transplant or allograft survival but fail to study patients’ complete KRT trajectories. This study aims at developing a tool able to simulate the impact of medical practices or healthcare interventions on these care trajectories. 

Material and methods:

Data from all ESKD patients starting KRT before 30 years old in France between 1995 and 2015 were included (N=9402). A multistate model was used to study patients’ trajectories between 15 states and transition rates were estimated using a Poisson model.

Results:

Over the 20 years following KRT initiation, patients spent on average 4.6 years on dialysis and 13.1 with a functioning transplant. The restricted mean survival was 18.5 years. The tool allowed us to assess the impact of the rate of preemptive waitlisting, the rate of living donation and the number of HLA mismatches (A/B/DR) overall and in specific age subgroups. As an example, increasing preemptive listing and transplant from living donors to 50% only resulted in a slight decrease of the time on dialysis (3.6 months over 20 years) in children (<18) while a significant reduction of 18 months would be expected among young adults. 

Conclusions:

The final aim of this tool is to guide clinicians and help health policy makers by assessing the impact of changes in clinical practices or healthcare policies. Such tools may help identifying strategies to maximize the time spent with a functioning transplant and minimize the time on dialysis.