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Inégalités sociales de santé dans la maladie rénale chronique chez les jeunes

Abstract : Chronic Kidney Disease (CKD) is a structural damage to the kidneys that leads to a progressive and abnormal reduction of kidney function. These functions of blood purification, regulation and secretion of hormones are vital and their degradation can be fatal. This disease inevitably worsens through five stages of CKD and is irreversible. Once stage 5 or end-stage kidney disease (ESKD) is reached, it is necessary to implement a kidney replacement therapy: dialysis or transplantation of a kidney graft. While CKD at different stages could affect 5 to 10% of the French adult population, and include nearly 90,000 patients treated for ESKD in 2018, the disease is rare in the pediatric population, with approximately 930 children treated for ESKD in 2018. However, its consequences can be major since it impacts the physical and psychosocial development of children (growth delay, undernutrition, cognitive problems, social adjustment, etc.). Thus, the objectives of caregivers, healthcare professionals and researchers are to slow the progression of the disease towards ESKD, and once reached, to optimize kidney replacement therapy to ensure the best possible care and a better quality of life for patients. In this context, the study of social inequalities in health may be relevant to help develop targeted interventions to each population. However, in children, the link between social factors such as income, level of education, or family context and CKD has been little investigated. To our knowledge, no study has been carried out in Europe on the impact of social deprivation on the care pathway, modalities and outcomes of kidney care at different stages of the pediatric CKD. However, in Europe, and in France in particular, the healthcare system in place, as well as the social assistance offered, is not the same as in the USA or in countries with limited resources, where associations have been identified. It is therefore important to evaluate whether the results observed in these countries are reproducible and applicable in France in order to adapt kidney care of children and adolescents. The objective of this thesis is therefore to study social inequalities in the pediatric CKD population and more specifically to evaluate the association between deprivation and the outcomes of the ESKD in children and adolescents. To meet this objective, we used data from patients aged less than 20 years who initiated kidney replacement therapy between 2002 and 2015, from the national registry REIN that collects information from all patients treated by dialysis or kidney transplantation. In the absence of individual factors, social deprivation was estimated using an ecological indicator applied to the children's home address, the European Deprivation Index, a continuous score that can be categorized into five quintiles: quintile 1 corresponding to the least deprived geographical areas and quintile 5 to the most deprived areas of the country. We thus studied the association between EDI and 1) the incidence of pediatric treated ESKD in France, 2) practice patterns and clinical conditions at dialysis initiation, and 3) graft and patient survival in young kidney transplant recipients. The main results of this thesis are that in patients from the most deprived areas, the incidence of treated ESKD was higher, kidney replacement therapy was initiated later, was more frequently started in emergency and by hemodialysis, and that kidney transplant failure was more likely. Our data suggests that studying different outcomes of ESKD is important to subsequently propose targeted management for this population.
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Submitted on : Thursday, April 8, 2021 - 5:33:09 PM
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Bénédicte Driollet. Inégalités sociales de santé dans la maladie rénale chronique chez les jeunes. Médecine humaine et pathologie. Université de Bordeaux, 2020. Français. ⟨NNT : 2020BORD0166⟩. ⟨tel-03193375⟩

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