Question 13678 — health

Summary

Mr. Hadrien Clouet draws the attention of the Minister of Health, Families, Autonomy and People with Disabilities to the urgency of a national plan for screening and care for kidney diseases. World Kidney Day, March 12, is a moment of public attention to this issue. Clinicians, medical biologists, nephrologists, the High Authority of Health, general practitioners, patient associations jointly accomplish extraordinary work of mass awareness, in particular by taking to the streets - such as on Place Saint-Georges in Toulouse. They make their action carried out throughout the year to detect emerging conditions visible. Such an approach constitutes the right of people to understand their body in order to better manage it. Because the kidney is an organ essential to the daily functioning of the body, of which it regulates the volume of water, the concentration of different substances and from which it evacuates waste. However, chronic kidney disease is on the rise. At the current rate, they will represent the fifth cause of death worldwide in 2040. In France, no less than 6 million people live with chronic kidney disease. As it is a silent pathology, many patients are unaware of it. They discovered either during unbearable pain or discomfort, or through clinical signs such as pallor, hypertension, fatigue. In such cases, the disease has reached the advanced stage: excess body water is accumulated, waste remains in the body, ionic balances collapse. In such a situation, patients switch to invasive and heavy treatments, dialysis (11,000 per year, but with a survival rate lower than the average for cancers) to transplant (4,000 per year for 21,000 patients on the waiting list). This bottleneck kills: of the 1,000 patients who died of kidney failure in 2022, 70% were waiting for a kidney transplant. This is a major health scandal. However, the prevention, screening and information system remains incomplete. However, only early detection provides treatment slowing the progression of the disease. For the patient, quality of life is maintained and many deaths are avoided. For caregivers, therapeutic options remain varied. For social security, more resources are available. But what does the State do? It holds primary responsibility for the functioning of the kidneys in the community. Thus, many schoolchildren, especially schoolgirls, deprive themselves of using the toilets schools. The study Urinating problems and access to toilets among school children published in the public health journal, carried out in the Toulouse academy, estimates inappropriate use of toilets at 30%. Blocked toilets, lack of toilet paper, non-locking doors, connection between girls' and boys' toilets: the reasons are multiple but ignore circular no. 2016-008 of January 28, 2016 and flout the European Convention on the Rights of the Child. Such a situation accentuates kidney problems due to lack of drinking and urinating. More generally, how many public places still do not offer free access to toilets, pushing the population to regularly give up drinking water? Also the MP asks the Minister of Health what action program she will undertake with her counterpart from the Ministry of Education national. He reminds him of the existence of a proposed law from France Insoumise “aimed at guaranteeing equal and free access to toilets for all”, tabled by his colleague François Piquemal. In addition, the MP asks how the effectiveness of screening will be strengthened. What fine targeting of patients at risk: elderly, diabetics, prone to cardiovascular diseases, hypertension or obesity? How to coordinate with treating doctors will be strengthened? How will the harmonization of biological reports be organized among laboratories? Furthermore, regarding the quality of prevention, when will the recommendations of the High Authority for Health be applied in a standard manner, for example the updating of the nomenclature of biological procedures, the inclusion of screening in prevention assessments, the removal of obstacles administrative requirements for complete screening or the facilitation of the personalized addition of certain tests (for example the albuminuria/creatininuria ratio, an indicator of renal damage) in populations at risk? As for the capacity to transplant patients in danger, the MP wonders how samples and transplants will be made a hospital priority, at a time when fee-for-service pricing and the neoliberal turn of the public hospital lead to favoring “more profitable” activities? What public investment is planned to support clinical trials of cell therapy, such as the one carried out at the Nantes University Hospital, allowing transplant patients to do without immunosuppressants? When will the transplant plan monitoring committees be open to hospital management, anesthetists and intensivists? How information to families will be improved in order to reduce the rate of opposition of families to organ donation, which deprives many patients of a chance of survival? Finally, what assessment does the Minister of Health draw from the existing systems, the effect of which is visibly not very tangible? How many individuals have benefited from a conclusive renal screening as part of “My prevention check-up”? How many practitioners have used the professional training modules “management of high blood pressure associated with chronic kidney disease” among nephrologists? So many missing elements which call into question the coherence of public action in this area. He asks her for her position on this subject.

Machine translation from French. The official text remains authoritative.

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