Module infirmier du Registre de Dialyse Péritonéale de Langue Française. Rapport 2022-2023.

Résumé

La base de données du registre de dialyse péritonéale de langue française (RDPLF) est constituée de plusieurs modules spécialisés et interconnectés. Depuis 1980, les centres du RDPLF ont enregistré les principaux aspects de la formation infirmière, pour plus de 16.000 patients, dans un module infirmier destiné aux équipes soignantes. Nous rapportons une analyse descriptive des informations incluses dans le module infirmier du RDPLF sur les deux années 2022 et 2023, afin d’éviter le biais qui aurait pu être présent pendant la période de pandémie de SRAS Cov2 qui a précédé. Afin d’avoir une population homogène, nous n’avons inclus que des patients de France métropolitaine. L’âge moyen des patients était de 69,5±16 ans. Il était plus élevé en dialyse péritonéale continue ambulatoire (69,7 ans) qu’en dialyse péritonéale automatisée (DPA) (57,8 ans). Les patients autonomes représentaient 60% de la population étudiée. La majorité des patients savaient adapter leurs fluides à leur état clinique. Une modification des informations enregistrées dans le module sera nécessaire pour l’adapter aux outils de formation modernes.

Introduction

The French-Language Peritoneal Dialysis Registry (RDPLF) is divided into two parts: one specialized in monitoring patients treated by peritoneal dialysis, the other in monitoring patients treated by home hemodialysis. The peritoneal dialysis data are divided into various interconnected files, called modules. The main module is 98% complete for all patients treated in mainland France, while the other modules are optional, with varying degrees of completeness. The precise description of this database organization has been described previously[1].

One of the optional modules created in 1980 was a nursing module specializing in patients’ characteristics at the end of their training to be treated on PD at home. Of a total of 47 300 patients from Belgium, France, and Switzerland included in the database since 1980, 16 900 have had a nursing module recorded.

We report below on the main raw results of the nursing module observed in the recent years of 2022 and 2023. The aim here is not to carry out a statistical analysis on a specific subject but to provide an overview of the recent data available in order to stimulate future work by nursing teams wishing to do so. Each result is therefore presented in the form of graphs or tables that can be freely used, provided that the source is quoted, with simply a legend or a short explanatory comment.

Methods

Nurses at centers participating in the RDPLF nursing module enter a 52-question questionnaire at the time of home initiation only; there is no subsequent updating of this questionnaire. The following results therefore reflect the training and management of patients at the start of peritoneal dialysis treatment.

Selection of centers and patients: Patients aged 18 and over in mainland France who began treatment with peritoneal dialysis, namely continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD), between January 1, 2022, and December 21, 2023.

As practices may vary from one country to another or from one French-speaking territory to another, for the sake of homogeneity, only patients in mainland France were studied.

Results

Number of patients and gender

During the study period, 2554 patients started PD treatment at 156 centers in mainland France. Nine hundred and forty patients in 66 centers were registered in the nursing module. Thus, 42% of nursing teams completed the module, and the number of patients included represented 37% of incident patients.

Sex ratio: 32% of incident patients were female and 67% male.

Age and autonomy

The patients’ average age was 69.5±16 years. It was higher in CAPD (69.7 years) than in APD (57.8 years). The age pyramid is summarized inFigure 1and the level of autonomy inTable I.

Figure 1.Age pyramid for incident PD patients (2022-2023)

Table I.Patients’ level of autonomy

Autonomy	Numbers	Percentage
Autonomous	1460	60.4%
Assisted by a registered nurse	844	34.9%
Assisted by family	103	4.3%
Assisted (unspecified)	10	0.4%

Professional or domestic activity

One question asks for a subjective description of activity during the 3 months preceding the start of dialysis. Activity is defined as either professional activity or its equivalent at home. A housewife, for example, taking care of all household activities is counted as a full-time activity.

- 26% felt they had the equivalent of a full-time job

- 7% felt they had the equivalent of a part-time job

- 67% felt they had almost no activity

Training dates and catheter implantation

Ninety-six percent of patients started training after catheter insertion, and 4% before. When patient training was started after catheter insertion, the average time between catheter insertion and the start of training was 9.1 days, although there are wide variations (Figure 2).

Figure 2.Waiting time between catheter implantation and start of training, when training is started after catheter implantation.

Training duration

The average training time was 10 days. Some patients, however, required more than 39 days of training before starting home treatment (Figure 3).

Figure 3.Durations of patient training times before being allowed to be treated at home

People trained in peritoneal dialysis

Training was given exclusively to the patient in 48% of cases; in 17% of cases, training was given to both a family member and the patient; in 2 % of cases, only to a family member; and in 33 %, exclusively to a nurse (Figure 4).

Figure 4.Person trained to treat the patient at home

Pre-training disabilities

Patients in our care may have single or multiple disabilities, which affect their ability to become independent and explain the frequent need for third-party assistance. The relatively high average age probably explains the frequency of disabilities. Deficient visual acuity despite correction existed in 11% of cases (Table II).

Table II.Presence of a disability at the time of training

Handicap	Numbers	Percentage
Visual	106	11.0%
Manuel	48	5.0%
Auditory	43	4.4%
Moderate intellectual	42	4.3%
Auditory and visual	29	3.0%
Severe cognitive impairment	3	0.3%

Regardless of language, 1.7% of patients had never learned to read or write.

Free choice of peritoneal dialysis

The majority of patients (90 %) had complete freedom of choice of the dialysis technique, without the team seeking to influence their decision. In a small number of cases, the method was imposed, sometimes without information about other techniques. The reasons for this are not known in the database.Figure 5summarizes the choice process.

Figure 5.Choice of dialysis technique for PD patients

Patient

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