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Abstract: FR-PO833

Modelling Survival in Dialysis Patients to Improve Their Access to Life Insurance for Loan

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Author

  • Jacquelinet, Christian, Agence de la biomedecine, Saint-Denis La Plaine, France

Group or Team Name

  • on behalf the REIN Registry
Background

“AERAS convention” (Access to Loan for People with Increased Health Risk Agreement) aims in France to provide insurance companies with evidence-based data to improve their assessment of risk for patients with chronic diseases.Data from the French REIN registry were used to predict survival for ESRD patients who frequently face the highest difficulties to borrow money due to high (often precluding) life insurance premiums, especially for those under dialysis.

Methods

The study included a cohort of 27952 patients who started a replacement therapy between 2002-1-1 and 2016-12-31 at the age of 25 to 60 yo. We focus here on 10-years survival conditionally on being alive and not previously transplanted at 1, 3 or 5 years. A Cox model was used to build multivariate risk functions for each conditional time points, taking into account updated data from the closest annual follow-up. A 10-year survival threshold significantly greater than 90% with an unilateral alpha risk of 2.5% was considered as a proxy for considering a potential access to loan without major life insurance premiums.

Results

Age, albuminemia, diabetes, number of cardio-vascular comorbidities, respiratory insufficiency, dialysis modalities and placement on the waiting list were significant and independent predictors of 10-years survival, with varying HRs and ß coefficients with conditional time points (e.g. 1, 3 or 5 years from dialysis start).C-indexes were greater than 0.6 and discrimination was good, as illustrated by quartile-stratified 10-years survival conditionally on being alive and not previously transplanted at 5 years (Figure 1).
More than a quarter of patients who were 25 to 65 yo at start of dialysis and respectively alive after 1, 3 and 5 years of dialysis are predicted with 10-year survival greater than 90%.

Conclusion

ESRD registries indeed provide useful personalized tools to improve access to loan for many patients with ESRD, thus contributing to their social and professional integration of these patients, and finally to their quality of life.