The epidemiology of end-stage kidney failure in France: reason for hope?

Background: Many European countries have experienced a decrease in the incidence of kidney replacement therapy (KRT), from as far back as 2008 for some. However, in France, the incidence increased by +0.8% annually from 2005 to 2014. This study aimed to examine the recent trend in incidence of KRT in France and variations in different subgroups to understand the possible mechanisms involved. Methods: To estimate the trend in KRT incidence for the French population, we used data from the Renal Epidemiology Information Network (REIN) registry, which has been available and comprehensive since 2012 for all of France. We estimated time trends from 2012 to 2023 by using a Joinpoint regression model that provides the annual percentage change and its confidence interval. We also analyzed the data by patient subgroups (age, comorbidities, etc.) or treatment conditions (emergency initiation, preemptive kidney transplantation, etc.). Results: From 2012 to 2017, the number of new patients starting KRT increased annually by +2.7% in France, but the standardized incidence was stable. Since 2017, the number of new patients has been stable and the age- and sex-standardized incidence rate has decreased annually by 2.2%, likely due to the aging of the population. The reversal of the trend was particularly noticeable among older people and people with diabetes. Early mortality in people aged ≥75 years decreased significantly, which suggests that the most comorbid patients are now referred for conservative treatment. Even before the flat-rate payment system was introduced in 2019, more comprehensive and multidisciplinary care may have been developed for patients with stage 4-5 disease. Conclusion: In France, since 2017, the age- and sex-standardized KRT incidence rate decreased probably due to the combination of factors relating to changes in practices, the arrival of new treatments and changes in the general population.