Nephrology in France

Abstract

Nephrology is a relatively young medical discipline that emerged in France in the 1960s when first attempts of renal replacement therapy (dialysis and transplantation) of end-stage renal disease were experimented clinically by pioneering doctors. Nephrology has become a mature and broad discipline that encompasses clinical nephrology, clinical research, dialysis, transplantation, and adjacent specialties.

Nephrology specialization relies on a national classifying competition opening internship for 5 years and eventually post-internship training of 2 years split in semester mostly in university hospitals. Workforce currently consists in 1657 nephrologists exerting almost exclusively in healthcare facilities, 59% in the public sector and the rest distributed in private (for profit and non-profit sector). Nephrology has become a quite attractive discipline for trainees and interns ranked among the five medical specialties over the last few years.

The French healthcare system is extremely regulated. Treatment of kidney diseases relies on a mixed system provided by public (university and non-university hospitals) and private health institutions (hospitals or private clinics for profit and/or non-profit) developing a dense regional network. Kidney disease and chronic renal failure are part of long-lasting diseases (ALD30) totally covered by the universal national social security insurance. Patients on renal replacement therapy are 87,273 (55% dialysis, 45% transplant). From “September 2002,” dialysis practice has been regulated by decrees defining technical platforms and quotas of minimum caregivers to ensure safety and care quality to patients. Dialysis units are categorized according to patient risk and medical support: (1). in-center hemodialysis; (2). medicalized dialysis units; (3). self-care dialysis; (4). home hemodialysis; and (5). peritoneal dialysis at home. Renal transplant should be proposed to all end-stage renal disease patients and assessed by referent transplant centers. Acute kidney injury management is shared among various departments and/or specialties depending on the stage and severity of AKI. ICUs are caring patients with severe stage 3 AKI requiring dialysis and with two additional organs failed.

Future plan for optimizing kidney care is currently evaluated by health authorities in collaboration with healthcare professionals consisting in strengthening training of junior nephrologists, improving the efficiency of care through better management of the patient trajectory, increasing self-care and home therapy, increasing the number of kidney transplants, and investing in new technologies (ITC and IA) as well as revising healthcare model to focus more on performances than numbers.