Sexe ratio : women : 36,4 % Men : 63,6 %

44.8% of patients treated with peritoneal dialysis in metropolitan France in 2021 had diabetes. The distribution of patients according to diabetic status and treatment of their diabetes is summarized in Table II.

Among diabetic patients on insulin, 98.7% were on subcutaneous insulin and 1.34% on intraperitoneal insulin.

In 2021, 43.7% of patients required assistance to perform their peritoneal dialysis; this assistance is mostly provided by private nurses at home, paid by national health insurance (Table III).

CAPD patients are older than those on APD, more often diabetic and 50% require nurse assistance, contrary to APD where the majority (nearly 82%) are autonomous (Table IV).

On December 31, 2021, 2724 patients were treated by PD in metropolitan France, 1714 (63%) in CAPD and 1010 (37%) in APD.

In CAPD, the age was 70.6 years±13.6, the sex ratio was 38% female and 61.7% male. In APD the age was 60 years±16.2 and the sex ratio was 33.6% women and 66.4% men.

Figure 2 shows the distribution of the PD technique used according to age.

The latest ISPD guidelines recommend that peritonitis recidives should not be counted in the calculation of the peritonitis rate; nevertheless, clinical recurrences are indeed additional stresses for patients and their peritoneal membrane, so we report the results with and without counting recurrences. All calculations were computed using the method recommended by ISPD [5].

- Rate of peritoneal infection (including recidives): 1 episode every 37.8 months or 0.32 episodes per year

- Rate of peritoneal infection (excluding recidives): 1 episode every 40 months or 0.30 episodes per year

TheTable V summarizes the distribution of organisms cultured in 2021. Multiple germ peritonitis is not detailed but is the subject of an accepted work in the journal Nephrology Dialysis and Transplantation (in press) [6].

The percentage of aseptic peritonitis was 15.1%, in line with international recommendations. However, it should be remembered that the rate of culture-negative peritonitis may vary considerably between centers, as we have previously shown [7].

Since the beginning of 2020, the trend observed is an increase in the number of transfers from peritoneal dalysis to hemodialysis in centers, associated with a decrease in transplantation ( Figure 5. and Table VII ; Table VIII)

2018: 372

2019: 381

2020: 325

2021: 310

Only clinically symptomatic and proven COVID-19 infections were counted. Cases of COVID-19 infections diagnosed with a positive PCR test without clinical signs were not counted.

645 episodes of symptomatic COVID-19 were reported. 95 times, the cause was not recorded; in the remaining 553, COVID-19 patients were asked to indicate what they considered most likely to have caused the contamination. The suspected causes are summarized in the table below. In 34% of the cases, the patient did not know the probable source, but contamination by a family member and during a hospital stay for consultation or hospitalization came in first and second place (Table IX).

These raw results show that, in metropolitan France, there has been no increase in the prescription of PD since the beginning of the SARS-Cov2 epidemic, contrary to what has been reported or observed in other countries. In addition, there appears to be an increase in the number of transfers from PD to in-center hemodialysis with a high and increasing proportion of transfers for inadequat dialysis. There was also a slight decrease in the number of new registrations on the transplant waiting list.