Chronic renal failure (CRF) is a kidney disease that progresses silently: gradually, the filtration function deteriorates and can progress to a terminal stage (CRF) which requires the establishment of a treatment to replace the kidneys. Either by dialysis or by kidney transplantation.
Faced with the increase in the cost of treating this disease, the HAS and the Biomedicine Agency have studied the possibilities of changing the care path for patients. They have just published their report, which confirms that the development of kidney transplantation, regardless of the patient’s age, is the most effective strategy.
To develop transplantation the HAS recommended in 2012 several avenues :
– develop renal transplantation from deceased donors by improving the donor census;
widen the circle of potential donors;
– develop transplantation from living donors.
But as the number of transplants remains limited due to the low number of grafts, the HAS also recommends setting up alternative dialysis strategies, in particular dialysis at home.
“Without calling into question the patients’ freedom of choice, the objective was to assess the consequences of changes in patient care trajectories” writes the HAS. A cost study made it possible to analyze the differences according to the treatment methods. For example, it shows that the average monthly cost of treating a patient with stable care is € 7,253 / month for hemodialysis in a center and € 4,377 / month for autodialysis.
Alternative strategies evaluated by the HAS which appear to be as effective and less costly are as follows:
– in patients aged 45 to 69: treatment based on the development of unassisted peritoneal dialysis (at the start of treatment) followed by hemodialysis in autodialysis.
– in patients over 70 years of age, treatment based on the development of assisted peritoneal dialysis (at the start of treatment), followed by hemodialysis in a dialysis unit.
On the other hand, in young patients (less than 45 years old), the impact of the development of dialysis strategies is limited insofar as they live most of the time with a functioning graft.
These innovative treatment models should be regularly updated by the Biomedicine Agency. But they may also be the subject of more in-depth studies carried out at the regional level.
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