Kidney diseases: how to better support patients?

How can we improve care for the 5 million French people affected by chronic kidney disease (CKD)? This public health issue is at the heart of the reflection carried out by T-Rein, an independent working group which has brought together, since January 2023, scientific experts, health professionals and association representatives with the support of Reinomed, a federation of specialized establishments in non-profit.

Its president, Professor Maurice Laville, nephrologist and former head of department at the Hospices de Lyon, must present recommendations to the public authorities on the issue on Wednesday, November 13. “These can be summed up in one request: to adopt, without delay, a national kidney disease plan which will allow, like the cancer plan, to make CKD a priority subject and to build, between public authorities and committed actors, coherent care pathways”he emphasizes for The Cross.

Screen high-risk populations

In fact, the findings established by the T-Rein group show that there remain many gaps in patient care. The first concerns prevention from the early stage of the disease. “CKD results in a reduction in the ability of the kidneys to filter blood and is characterized by five stages of severity up to terminal failure. Hence the interest in identifying and treating patients as early as possible”specifies Professor Laville.

However, currently, there is no organized screening for populations identified at risk – obesity, diabetes, hypertension, cardiovascular diseases, family history. Another downside: health insurance only finances “prevention” packages at stages 4 or 5 of the disease, which is often too late to prevent the patient from going to dialysis, a medical device which currently concerns nearly 50,000 patients.

However, this so-called replacement treatment – ​​since it is a machine which ensures kidney function – is particularly heavy and restrictive for the patient. “The most common modality is that of hemodialysis carried out in a specialized center for three sessions of four hours per week, plus installation and travel time. A constraint which does not really facilitate family, social and professional life”testifies Aziz Aberkane, 57 years old, member of the France Rein association and “patient partner” who can draw on his forty years of experience with the disease.

Take into account the quality of life of patients

There are many systems that promote the autonomy and social inclusion of patients, such as hemodialysis in local units or at home. “But these practices are still not widespread due to insufficient funding and regulatory constraints”specifies Professor Laville.

What remains above all is finding the necessary money when the treatment of kidney failure already costs the community more than 4 billion euros per year, one of the highest costs per patient for health insurance.

“The T-Rein group is well aware that the public resource is not infinitely expandablerecognizes Anne-Valérie Boulet, vice-president of Reinomed. This is why we recommend, as part of the reform announced for 2026, to rethink a financing model which is not content, as currently, to manage the illness act by act but which will tomorrow make it possible to support the sick person throughout of his life journey. »