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Master Thesis Year : 2020

Hemodialysis management strategies for migrant patients with end-stage chronic renal disease

Stratégies de prise en charge en hémodialyse des patients migrants en insuffisance rénale chronique terminale

Abstract

Introduction: In the setting of migration, extra-European patients with end-stage renal disease (ESRD) have a lower access to renal replacement therapy (RRT). Healthcare coverage access at arrival in France may influence hemodialysis strategy during the first 3 months. We aimed to study clinical healthcare costs and outcomes in this population in Marseille. Methods: We conducted a retrospective cohort study of ESRD migrant patients admitted for hemodialysis in our center over a 4-years period. Patients were recently arrived in France and willing to stay regardless of their administrative status with a local follow-up of at least 3 months. The first group with access to Protection Universelle Maladie (PUMA) was compared to patients without access to PUMA. Patients with operational health coverage were scheduled in conventional dialysis and patients without health coverage had transient “emergency-only” dialysis before their rights were effective. We assessed the ESRD-related costs for the healthcare system and the medical outcomes during the 3-months period after arrival. Multivariate analysis was performed with partial least square regression. Results: We included 25 patients aged in median 42.6 [31.7; 53.6] years old and 60% of them were males. Ten patients had access to PUMA on arrival and 15 patients did not. Baseline characteristics were similar between the two groups. Four patients (26%) in the No healthcare coverage group needed a switch from “emergency-only” to conventional strategy for medical reason. ESRD-related healthcare costs were also higher in the absence of medical coverage (20 813 [15 516; 28 609] vs 12 465 [11 957; 13 911], p < 0.001). Patients in the No healthcare coverage group spent more time in “emergency-only” dialysis (16.5 [6.5; 36.5] vs 0 [0; 7] days, p=0.002) and had more ESRD-related complications (3 [1; 9] vs 1 [0; 1], p=0.02) than patients with health coverage. Partial least square regression analysis show that the strongest independent predictor of healthcare costs was the number of ESRD-related complications (R²Xy = 0.96). Conclusion: This study is the first French cohort describing ESRD patients at their arrival in France with a medico-economic and outcome analysis. The absence of healthcare coverage and the subsequent “emergency-only” dialysis strategy are strongly associated with higher healthcare costs and more frequent ESRD-related complications in migrant patients with ESRD.
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Dates and versions

dumas-03019899 , version 1 (23-11-2020)

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  • HAL Id : dumas-03019899 , version 1

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Raphaël Godefroy. Hemodialysis management strategies for migrant patients with end-stage chronic renal disease. Life Sciences [q-bio]. 2020. ⟨dumas-03019899⟩
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