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Master Thesis

La dialyse péritonéale dans les départements et pays d'outre-mer en comparaison à la métropole : patients, modalités de prise en charge et survie

Abstract : In French overseas departments and territories, peritoneal dialysis (PD) is also used for patients with end-stage renal disease, and is sometimes the only available renal replacement therapy. In our cohort study, we compared 9 128 incident patients starting PD between 2002 and 2010, divided into three groups: patients treated in la Reunion (n=169), in French Polynesia and New-Caledonia (n=294), and in mainland France (n=8665). French overseas patients were younger (median age : 59 year old in French overseas territories, 67 in la Reunion and 72 in mainland France), and more often diabetic; underlying nephropathy was due to diabetes mellitus in about 45% of them compared to 20% in mainland France. In French overseas territories, 30% of the patients were under hemodialysis (HD) during the last 3 months before PD initiation, compared to 18% in la Reunion and 14% in mainland France. 82.84% of la Reunion patients were undergoing assisted PD (compared to 47.95% in French overseas territories and 54.67% in mainland France). The median PD duration was shorter in French overseas territories and not different in la Reunion (36.33 and 66.95 compared to 55.49 months mainland France). In the multivariate analysis, peritonitis and HD before PD initiation were associated with a higher risk for transfer to HD. Age and nurse-assistance were associated with PD continuation. Survival free of peritonitis was shorter in French overseas territories and not different in la Reunion (16.26 and 45.37 months compared to 33.05 in mainland France). After adjustment, French overseas territories, male sex, diabetes mellitus, continuous ambulatory peritoneal dialysis and the absence of nurse-assistance were associated with a higher risk for peritonitis. Conditions of PD initiation and nurse-assistance, which are not optimal in French overseas territories, seem to be crucial parameters for continuation of PD, and so is peritonitis. Patients' education should improve PD results in these regions.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00968184
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Submitted on : Monday, March 31, 2014 - 3:28:11 PM
Last modification on : Wednesday, August 23, 2017 - 4:40:20 PM
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Mélanie Marroc. La dialyse péritonéale dans les départements et pays d'outre-mer en comparaison à la métropole : patients, modalités de prise en charge et survie. Médecine humaine et pathologie. 2013. ⟨dumas-00968184⟩

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