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A MULTIDISCIPLINARY APPROACH TO DETECT AND PREVENT WORSENING OF CHRONIC KIDNEY FAILURE IN REUNION ISLAND (FRANCE).
THE PRESCRIR STUDY PRELIMINARY RESULTS
J. Guiserix1, S.Veillon1, P. Finielz1, M. Ramdane1, A. Amaouche1, T. Dervaux1, B. Bonal2, F. Favier2
1 Pole de Nephrologie, CHR, Hôpital de Saint Pierre BP 350, 97448 Ile de la Reunion, France.
2 Centre d'Investigation Clinique, Ile de la Reunion, France
Reunion Island has a four-fold end-stage renal failure prevalence, compared to France as a whole, with a standardized rate of 2,082 in December 2007.
During 2005, a chronic kidney failure (CKF) patients cohort was made up in southern Reunion Island territory to evaluate patient status at discovery of CKF by general practitioners, efficiency of collaboration on renal function evolution, annually and during 2 years with the same protocol.
Selection population was based on a Cockcroft Gault (CG) <80ml/mn estimation in general practice, as recommended in year 2000, confirmed some weeks later in the hospital laboratory. Non parametric statistical tests were used, each patient being his own control for evolution.
Cohort composed of 313 females and 168 males, aged 67,9 (±11) and 68(±8,8) (NS), 208 (43,2%) were diabetic.
Renal diseases classified by nephrologists were : hypertension: 234 (48,6%); undetermined: 159 (33%); diabetes mellitus: 43 (8,9%); interstitial nephropathy: 24 (4,9%); glomerular disease: 11 (2,2%); Other: 10 (2%).
77 patients did not achieved study : 4 were lost, 23 died, 5 began dialysis, 6 moved out of territory, 39 (8,1%) gave up.
Estimated CG clearance was initially: 47,2±14,7ml/mn; at the end of study: 48,7±16ml/mn (p=0,81).
Arterial pressure levels dropped in the same time from 147,6/77,6mmHg to 142,4/73mmHg (systolic: p=0,003; diastolic: p<0,0001). Systolic target level <130mm Hg was obtained in 112/481 (23,3%), 2 years later in 104/403 (25,8%); Diastolic <80mmHg goal was reached initially in 284/481 (59,04%) patients; at the end of study in 294/403 (72,95%).
However, HbA1c levels in diabetics patients worsened during the study from 7,48%±1,25 to 7,54±1,21% (p=0,041).
During the austral 2005-2006 summer outbreak, 218 patients were infected by Chikungunya virus without significant impact on their renal function, compared to the 180 non-infected (20 having undetermined serologic status).
At the start of study, 134 patients (28,5%) had anti-Hbs antibodies, 56 anti-Hbc (11,9%), 336 have no anti-Hbs; 2 years later : 202 were anti-Hbs positive (50,3%), 199 remaining negative.
Conclusion :
Vascular nephropathies appears now as the leading cause of chronic kidney failure in Reunion Island, diabetes mellitus being recognized as a major regional public health priority since 1998, and subsequent interventions to prevent diabetic renal complications.
Renal function can be stabilized in a short term, may be due to a good collaboration between general practitioners and nephrologists with a significant arterial pressure reduction in a cohort of patients mainly with renal vascular disease.
It seems useful to continue and develop this active collaboration to further improve goals as vaccination coverage, and blood pressure target to maintain this results on a long term.
Acknowledgments : To the 150 Reunion Island Southern Territory general practitioners who actively participate in study Grants were obtained from French Health Ministery (Programme Hospitalier de Recherche Clinique), and from Conseil Regional de la Reunion; logistic was provided by Saint Pierre General Public Hospital
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