RDPLF 2022 annual report: Profile of home hemodialysis patients in Belgium and France (synthetic raw results)

Abstract

We present primary descriptive data in the form of tables and graphs for patients treated with home hemodialysis in France and French-speaking Belgium in 2022. These data were recorded in the database of the French-speaking Register of Peritoneal Dialysis and Home Hemodialysis (RDPLF).

The average age of the patients is similar in both countries: 52.7 years in France and 54.7 years in Belgium. The percentage of patients with diabetes is 25.6% in Belgium and 18.5% in France.

The majority of patients undergo daily hemodialysis 5 to 7 times per week.

Of the patients, 11% have received peritoneal dialysis in the past. Of these, 23.5% transitioned to home hemodialysis less than 3 months after stopping peritoneal dialysis, while 23.6% transitioned after 2 years of center-based or self-administered hemodialysis.

Practices differ between Belgium and France. In Belgium, a central catheter is used in 57.5% of cases, compared to 8.5% in France. For arteriovenous fistula puncture, the buttonhole technique is used in 91% of cases in Belgium and 47.8% of cases in France.

In Belgium, 70% of patients dialyze independently, while in France, 71% of patients dialyze in the presence of a family member.

The main cause of treatment discontinuation is transplantation (44% of technical dropout).

INTRODUCTION

The aim of this document is to summarize in graphic form the main descriptive elements obtained from the database of the Register of Peritoneal Dialysis and Home Hemodialysis (RDPLF) in French-speaking Belgium (Dutch-speaking Belgium does not participate in the Home Hemodialysis Register) and France (metropolitan France and overseas departments and territories) in 2022. No discussion is planned in this report, which is intended above all to provide basic documentation for dialysis teams to illustrate their work or presentations. An identical presentation was adopted for peritoneal dialysis in our last issue[1]. The original slides can be obtained from the RDPLF secretariat.

These tables and graphs may be freely copied, provided that the present document is cited with its DOI. The originals can also be obtained as PowerPoint files from the RDPLF secretariat.

EXHAUSTIVENESS

Taking as a reference the Réseau Epidemiologie Information en Néphrologie (REIN)[2], which is exhaustive for France, the number of patients treated by home hemodialysis (HDD) and registered in the RDPLF represents around 45% of the total number of French patients treated by home hemodialysis. In comparison, 98% of peritoneal dialysis (PD) patients are included in the RDPLF. In Belgium, only French-speaking centers (Wallonia) participate in the HDD register of the RDPLF: taking the GNFB report[3]as a reference, the completeness of the RDPLF for Wallonia is 91%.

DESCRIPTION OF THE POPULATION

Number of prevalent patients in 2022 (treated at least 1 day): 573 patients (181 in Belgium and 392 in France); their profile is summarized inTable I.andTable II..

Table I. Profile of patients treated with home hemodialysis in 2022 followed in the RDPLF

Table I.Profile of patients treated with home hemodialysis in 2022 followed in the RDPLF

	Men	Women	Median age (Min-Max)	Diabetes
Belgium	68.5%	31.5%	54.7 ans (14.5-91.3)	25.6%
France	67.3%	32.7%	52.7 ans (17.7-84.2)	18.5%

Pre-home he

Table II.Nephropathies monitored in the RDPLF in 2022 in patients treated with home hemodialysis

Table II.Nephropathies monitored in the RDPLF in 2022 in patients treated with home hemodialysis

Nephropathy	Belgium	France	Nephropathy	Belgium	France
Vascular	12.5%	10.1%	System desease	4.0%	2.1%
Congenital	4.0%	1.1%	Malformative	8.5%	8.0%
Diabetes	14.8%	10.1%	Drug-induced	2.3%	1.9%
Glomerular	11.9%	27.1%	Cystic fibrosis	14.2%	12.5%
Uncertain	6.8%	9.8%	Alport-Syndrome	1.7%	1.3%
Cardiac failure	2.8%	0.3%	Tumoral	1.1%	4.0%
Interstitial	6.2%	5.1%	Others	9.1%	6.6%

hemodialysis treatment

Table III.summarizes the treatment modality prior to home hemodialysis, but this does not preclude a different one prior home hemodialysis treatment. In the case of hemodialysis or transplantation, patients may have been previously treated with PD. This table should therefore be compared with the following (Table IV).

Table III. Treatment before home hemodialysis: this is the treatment immediately preceding

Table III.Treatment before home hemodialysis: this is the treatment immediately preceding

Pre-home hemodialysis treatment	Belgium	France
Peritoneal dialysis	7.8%	4.6%
In center or self hemodialysis	62.7%	71.2
Not dialysed	16.6%	11.3
Transplantation	13.9%	12.9

Table IV.. Causes d’arrêt de DP des patients ultérieurement hémodialysés à domicile

Table IV.Causes d’arrêt de DP des patients ultérieurement hémodialysés à domicile

Causes of PD stops	Number	Percentages
Diuresis recovery	1	1.7%
Transplantation	12	20.3%
Peritonitis	5	8.4%
PD catheter problems	4	6.7
Insufficient dialysis/UF	21	35.6%
Malnutrition	1	1.7%
Psychological intolerance	6	10.2%
Others not related to PD	8	13.6%
Diaphragmatic breach	1	1.7%

History of peritoneal dialysis before home hemodialysis

Sixty-four patients (11.7%) of the 573 patients treated by home hemodialysis in 2022 had previously been treated by peritoneal dialysis (PD). This percentage is higher than that shown in Table II, as it includes patients who have had other treatment in the meantime (in-center hemodialysis or transplantation): the way the data are entered into the system means that it is not possible to know the exact path taken by patients who have changed treatment modality several times between PD and HDD.

The duration of in-center hemodialysis and/or limited care self-dialysis treatment after cessation of peritoneal dialysis and before home hemodialysis treatment varies widelyFigure 1:

Figure 1.Distribution of patients’ duration of in-center hemodialysis before home hemodialysis, for patients who were transferred from peritoneal dialysis to in-center hemodialysis before being treated with home hemodialysis

HOME HEMODIALYSIS PRACTICES

Figure 2.Number of hemodialysis sessions per week.

MONITORING OF DIALYSIS SESSIONS

- In Belgium, the patient monitors the session alone in 70% of cases.

- In France, 71% of sessions are monitored by the family.

VASCULAR ACCESS

Table V.Duration per session by number of home hemodialysis sessions per week (Belgium and France have been grouped together as there is no significant difference).

Table V.Duration per session by number of home hemodialysis sessions per week (Belgium and France have been grouped together as there is no significant difference). 

Number of session per week	Duration of each session	Total/ weekly
3	240	12 h
4	180	12 h
5	150	12,5 h
6 ou 7	120	12 to 14 h

Table VI.. Vascular access used in home hemodialysis patients

Table VI.Vascular access used in home hemodialysis patients

Vascular access	Belgium	France
Double lumen central catheter	57.8%	8.5%
Arteriovenous fistula	42.2%	91.5%

Table VII.Table VII.Types of arterio-venous fistula.

Table VII.Types of arterio-venous fistula.

Type of fistula	Belgium	France
Classical	8.8%	52.2%
Buttonhole	91.2%	47.8%

IN-CENTER HEMODIAYSIS RESPITE

The cumulative duration of treatment in 2022 in the cohort monitored was 154361 days; the

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