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Luc Frimat

Publications and source records attributed to Luc Frimat.

9 recordsLinked to original sources
PubMed2006

Medical and non-medical determinants of access to renal transplant waiting list in a French community-based network of care.

BACKGROUND: Evaluation of adult candidates for kidney transplantation diverges from one centre to another. Concurrently, ethnic background, female gender, late referral to a nephrologist, distance from transplantation department and private ownership of a dialysis facility have been associated with poor access to kidney transplantation. We assessed determinants of access to a waiting list in a French community-based network of care. METHODS: From July 1997 to June 2003, 1725 adults living in Lorraine, who started renal replacement therapy in one of the 13 facilities of the network, were included. We compared, first, the patients registered on the waiting list with those not registered and, second, the patients registered before starting dialysis with those registered after. RESULTS: Using logistic regression, registration on the waiting list was exclusively associated with age and medical factors, except for one variable: medical follow-up in the department performing transplantation [odds ratio (OR): 1.67 (95%CI: 1.05-2.67)]. Registration before starting dialysis was not associated with medical factors but with age [OR of patients younger than 45 years vs those older than 65 years: 3.85 (95%CI: 1.05-24.92)] and medical follow-up in the department performing transplantation [OR: 3.56 (95%CI: 1.98-6.67)]. CONCLUSIONS: In a French community-based network, patients followed by the nephrology department performing transplantation are more likely to be registered on the transplant waiting list early in the course of chronic kidney disease. Age over 55 per se is a considerable barrier to access to kidney transplantation. Medical guidelines should allow a standardization of criteria for registration.

Adolescent↗
PubMed2006

[Chronic kidney disease: do generalists and nephrologists differ in their care?].

INTRODUCTION: Chronic kidney disease (CKD) is a major public health problem. We report an evaluation of the CKD perception from a French family physician's (FP) point of view. METHODS: A questionnaire was sent to a representative and independently selected sample of 497 FP, i.e. 20% of the FP working in the administrative region Lorraine. There were 214 completed surveys, i.e. response rate: 43%. RESULTS: Age of FP was: < 40 years of age: 13%, 40-50: 40%, > 50: 47%. The geographic working place was urban: 41%, rural: 22%, urban and rural: 37%. Ninety-nine per cent of FP has a nephrologist, devoted to CKD referral. Twenty-one per cent of FP has a comprehensive picture of CKD and 75% thinks that CKD diagnostic is difficult Thirty per cent of FP were aware of CKD guidelines. For FP, risk-factors for CKD were: hypertension: 93%, diabetes: 99%, age over 65: 64%, urinary infection: 34%, hematuria/proteinuria: 78%, anaemia: 43%, therapeutics associated with risk of renal injury: 79%, all of these circumstances: 20%. The referral decision to a nephrologist was done at a mean creatinine clearance of 41+/-12 ml/min. Age over 80, dementia, and cancer were considered to be a contra-indication of renal replacement therapy, for respectively 30%, 69%, and 63% of FP. CME was associated with better awareness of guidelines, and use of clearance rather than serum creatinin. CONCLUSION: From FP point of view, overall awareness of CKD guidelines is low. In the context of the current nephrology services, greater sharing of CKD care with FP is needed.

Adult↗
PubMed2003

Kidney warming during transplantation.

The objective of the present study was to describe kidney temperature variations during transplantation and to identify the factors responsible for kidney warming. Kidney temperature was recorded steadily during transplantation. Kidney weight, body mass index (BMI), second warm ischemia time (t), and kidney temperature at the time of being placed in the recipient were analyzed so that we could evaluate their influence on kidney temperature and on kidney warming during transplantation. Kidney temperature at the time of removal from the container was 1.6 degrees C and 6. 3 degrees C when the kidney was placed in the recipient. Kidney temperature in the recipient depended on kidney temperature after serum washing (P<0.0001), but was independent of kidney preparation time (P=0.94). Then, kidney temperature (T) increased according to the logarithmic curve given in the following equation: T=7.2 ln(t)-0.6. Kidney temperature at the end of anastomosis was 26.7 degrees C. Kidney warming speed was 0.48 degrees/min and was dependent on the length of time of vascular anastomosis (P<0.0001). Kidney weight decreased the kidney warming speed (P=0.02). In conclusion, kidney warming increases slowly during ex vivo preparation. Kidney temperature stays below the damaging ischemic temperature of 18 degrees C. Because of its major impact on kidney warming, it is desirable that vascular anastomosis time be reduced, and, consequently, ex vivo kidney preparation needs to be meticulous.

Adolescent↗
PubMed2003

Impact of nephrology referral on early and midterm outcomes in ESRD: EPidémiologie de l'Insuffisance REnale chronique terminale en Lorraine (EPIREL): results of a 2-year, prospective, community-based study.

BACKGROUND: Most studies looking at how the outcome of end-stage renal disease (ESRD) is affected by the timing and quality of the care received before initiation of renal replacement therapy (RRT) are inconclusive. METHODS: Five hundred and two adult French patients (age, 62.8 +/- 16 years) receiving their first RRT were enrolled in a 2-year, community-based, prospective study. Subjects were assigned to 1 of 5 groups depending on the time between their first serum creatinine reading above 2 mg/dL (177 micromol/L): chronic renal failure (CRF) and nephrology referral (NR) and RRT. Multivariate logistic regression was used to analyze 90-day survival data, and data concerning long-term survival and inclusion on the waiting list for renal transplantation were analyzed using Cox proportional hazards regression. RESULTS: Overall survival rates were 88% at 90 days, 77.2% at 1 year, 65.2% at 2 years, and 54.2% at 3 years. The nephrology referral pattern was associated with age and systolic blood pressure, and independently predicted early death. Compared with group 1 (NR > 12 months), odds ratios (confidence interval 95%) were 2.7 (1.2 to 6.3) for group 2 (NR < or = 12 months or >4 months), 2.8 (1.0 to 8.0) for group 3 (NR < or = 4 months or >1 month), 4.9 (2.2 to 11.0) for group 4 (NR < or = 1 month; CRF > 1 month), and 5.2 (2.2 to 12.3) for group 5 (NR < or = 1 month; CRF < or = 1 month). Independent predictors of death in 90-day survivors were age, cardiac disease with previous episodes of heart failure, vascular disease, low diastolic blood pressure, and group 3 referral pattern. Not being entered on the waiting list for renal transplantation was predicted by age, diabetes, vascular disease, and nonelective first dialysis. CONCLUSION: Late nephrology referral is strongly associated with early death. Emergency first dialysis is an independent risk factor for not being placed on the waiting list for transplantation. Among 90-day survivors, referral pattern has little influence on mortality, which is mainly determined by cardiovascular complications at initiation of RRT.

Age Factors↗
PubMed2003

Effect of end-stage renal disease on the quality of life of older patients.

OBJECTIVES: To assess the effect of chronic renal failure (CRF) on quality of life (QOL). DESIGN: Controlled cross-sectional study. SETTING: All 13 dialysis units in the French Lorraine region and six departments of a Nancy hospital. PARTICIPANTS: One hundred sixty-nine older patients with end-stage renal disease (ESRD) who were starting first dialysis (mean age +/- standard deviation = 76.2 +/- 5.1) and 169 age- and sex-matched non-CRF controls. MEASUREMENTS: QOL was assessed using the short-form health survey 36-item (SF-36) self-administered questionnaire. Information on comorbid conditions, clinical symptoms and laboratory findings was obtained from medical records. RESULTS: Mean QOL scores ranged from 11.2 (role limitation due to physical function (RP) dimension) to 55.5 (social function) in the ESRD group, and from 22.0 (RP) to 54.3 (mental health) in the non-CRF group. Among ESRD patients, factors related to QOL scores (physical function (PF) and vitality dimensions) were the conditions under which dialysis was initiated and comorbidity. Patients whose first dialysis was unplanned had 10.4 fewer points in the PF dimension than those in whom it was planned (P =.014). CONCLUSIONS: If dialysis initiation is planned, ESRD in older patients has no more effect on QOL than others diseases. However, patients whose dialysis is unplanned have severely impaired QOL. These results represent an argument for improving the predialysis care of older renal failure patients to optimize conditions at first dialysis.

Aged↗
PubMed2000

Polymorphism of angiotensin converting enzyme, angiotensinogen, and angiotensin II type 1 receptor genes and end-stage renal failure in IgA nephropathy: IGARAS--a study of 274 Men.

The impact of renin-angiotensin system (RAS) gene polymorphism on the prognosis of IgA nephropathy (IgAN) is still debated. A longitudinal study of renal prognosis in patients with IgAN was conducted to search retrospectively for a genotype-phenotype association between RAS polymorphisms and end-stage renal failure (ESRF). A classification based on serum creatinine (S(cr)) and 24-h proteinuria (24-P) measured at the time of renal biopsy was used to estimate the risk of ESRF in IgAN: stage 1 (S(cr) </= 150 micromol/L and 24-P < 1 g), stage 2 (S(cr) > 150 micromol/L and 24-P < 1 g or S(cr) < or = 150 micromol/L and 24-P > or = 1 g), stage 3 (S(cr) > 150 micromol/L and 24-P > or = 1 g). Deletion/insertion polymorphism (D/I) of the angiotensin I converting enzyme gene, M235T polymorphism (T/M) of the angiotensinogen gene and A1166C polymorphism (C/A) of the angiotensin II type 1 receptor gene were determined in 274 Caucasian men with biopsy-proven IgAN (n = 86, 112, and 76 in stages 1, 2, and 3, respectively). Mean global follow-up was 6 +/- 5 yr after renal biopsy. For stages 1, 2, and 3, ESRF developed in 7 (8. 1%), 39 (34.8%), and 49 (64.4%) cases (P: < 0.0001), 11.7 +/- 4, 5.4 +/- 4, and 2 +/- 2 yr, respectively, after renal biopsy (P: < 0.001). The distributions of the three genotypes into the three stages were similar. Different distributions were observed when patients were grouped by stage and genotype: ID+DD: 72% in stage 1 versus 84.6% in stages 2 + 3 (P: = 0.02; kappa = 0.14); MT+TT: 66.2% in stages 1 + 2 versus 78.9% in stage 3 (P: = 0.04; kappa = 0.09); and AA+AC: 89.9% in stages 1 + 2 versus 97.4% in stage 3 (P: = 0.04; kappa = -0.1). However, with the use of the Cox proportional hazard model, none of the three genotypes was found to have predictive value for renal survival. Compared with S(cr) and 24-P, genotypes DD, TT, and AA are unlikely to serve as clinically useful predictors of ESRF in IgAN.

Adolescent↗
PubMedDate not supplied

Impact of first dialysis modality on outcome of patients contraindicated for kidney transplant.

BACKGROUND: We compared, in patients contraindicated for kidney transplant, outcomes between those patients who were only on hemodialysis (HD) and those who were given peritoneal dialysis (PD) as first renal replacement therapy (RRT). DESIGN: Prospective, population-based cohort study of incident cases of end-stage renal disease between June 1997 and June 1999. SETTING: A network of dialysis care: NEPHROLOR, that is, all the renal units in Lorraine, one of the 22 French administrative regions (population over 2.3 million people). PARTICIPANTS: 387 patients were contraindicated for kidney transplant during the first 2 years of RRT: 284 were on HD, 103 on PD. Mean age was 67.6 +/- 11.3 years for HD patients and 70.8 +/- 11.4 years for PD patients (p = 0.015). MAIN OUTCOME MEASURES: Mortality until June 2003, hospitalization over the 2 first years of RRT, and Kidney Disease and Quality of Life Short Form (KDQOL-SF) 6 and 12 months after initiation of RRT. RESULTS: HD patients were more likely to die from cardiac or cerebrovascular causes, PD from cachexia or withdrawal from dialysis. Whatever mode of RRT, the unadjusted 2-year and 5-year survival rates were similar (p = 0.98). The rate of total duration of hospital stay per month of RRT was similarin HD and PD groups: 2.7 +/- 4.5 and 2.9 +/- 4.2 days respectively (p = 0.7). PD was associated with better quality of life than HD. The dimensions Role limitation due to emotional function, Burden of kidney disease, and Role limitation due to physical function ranked first, second, and third for PD. CONCLUSION: In Lorraine, end-stage renal disease patients who were given PD as first-line RRT had no excess of death risk or hospitalizations, and better quality of life the first year of RRT.

Aged↗
PubMedDate not supplied

Nephrology referral and appropriateness of therapeutic drug care in chronic kidney disease.

BACKGROUND: Rates of morbidity and mortality remain high among patients with chronic kidney disease, but depend to some extent on modifiable factors such as the therapeutic drug care provided. METHODS: This prospective community-based study assessed the impact of early nephrology referral on the drug treatments of a consecutive series of patients. More than 98% of patients with end-stage renal disease, living in a French region, who began kidney replacement therapy (KRT) between 1997 and 1999 were enrolled. They were classified into 5 groups according to the timing of the 1st serum creatinine reading in excess of 2 mg/dL and the 1st visit to a nephrologist. The drugs prescribed and the appropriateness of therapeutic care at the initiation of KRT and 6 months later were compared between groups. RESULTS: Five hundred and two patients were included. On initiation of KRT, early referral patients were more likely than other groups to be receiving epoetin, iron salts, phosphate binders, synthetic vitamin D, and/or ACE inhibitors. The earlier the nephrology care, the more appropriate was treatment by epoetin, phosphate binders and vitamin D. Six months later, the 5 groups did not differ in the drugs prescribed or their appropriateness. CONCLUSIONS: This study provides evidence of an association between the timing of nephrology referral and the quality of therapeutic drug care at the start of KRT. Later, when all patients are under the care of a nephrologist, drug treatments are no longer related to the timing of referral.

Adult↗