First successful pregnancy on peritoneal dialysis in Reunion island

We report the first successful pregnancy on peritoneal dialysis (PD), in 2023, in the overseas territories and departments (DOM-TOM) of France, in LA REUNION island, in a 34-year-old woman, a nurse by profession. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) since February 2022. The original nephropathy was Alport syndrome. Pregnancy began twenty months after the start of dialysis. The patient wished to continue her pregnancy in CAPD in order to carry out exchanges during the day in her office, so as to be more available to her family in the evening. The first trimester of pregnancy was uneventful. During this period, the patient was informed of the risks of pregnancy, and together we defined our objectives with the means available. Adjuvant drug prescriptions (calcium, aspirin, iron, folic acid, vitamin D, etc.) were adapted during the second trimester, as was the PD protocol, in line with defined objectives. The third trimester required largely hospital-based management. Infusion volumes were progressively reduced, while the frequency of infusions was increased, thereby increasing the total daily volume of dialysis.  Residual renal function remained stable throughout the pregnancy, and plasma urea levels were kept below 20 mmol/L. She was delivered by Caesarean section under spinal anaesthesia at 33 weeks and 4 days of amenorrhea, with the birth of a 1,800g boy with Apgar coefficients of 5 at 1min, 8 at 3min and 9 at 5min. The baby's development and growth were very satisfactory. Respect for the patient's choices, her autonomy and her participation in the treatment were decisive factors in the success of the procedure

Première grossesse avec succès en dialyse péritonéale à La Réunion

We report the first successful pregnancy on peritoneal dialysis (PD), in 2023, in the overseas territories and departments (DOM-TOM) of France, in LA REUNION island, in a 34-year-old woman, a nurse by profession. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) since February 2022. The original nephropathy was Alport syndrome. Pregnancy began twenty months after the start of dialysis. The patient wished to continue her pregnancy in CAPD in order to carry out exchanges during the day in her office, so as to be more available to her family in the evening. The first trimester of pregnancy was uneventful. During this period, the patient was informed of the risks of pregnancy, and together we defined our objectives with the means available. Adjuvant drug prescriptions (calcium, aspirin, iron, folic acid, vitamin D, etc.) were adapted during the second trimester, as was the PD protocol, in line with defined objectives. The third trimester required largely hospital-based management. Infusion volumes were progressively reduced, while the frequency of infusions was increased, thereby increasing the total daily volume of dialysis.  Residual renal function remained stable throughout the pregnancy, and plasma urea levels were kept below 20 mmol/L. She was delivered by Caesarean section under spinal anaesthesia at 33 weeks and 4 days of amenorrhea, with the birth of a 1,800g boy with Apgar coefficients of 5 at 1min, 8 at 3min and 9 at 5min. The baby's development and growth were very satisfactory. Respect for the patient's choices, her autonomy and her participation in the treatment were decisive factors in the success of the procedure.Nous rapportons la première grossesse menée avec succès en dialyse péritonéale (DP), en 2023, dans les territoires et départements outre-mer (DOM-TOM) de France, à la REUNION, chez une femme de 34 ans, infirmière de profession. Elle été traitée par dialyse péritonéale continue ambulatoire (DPCA) depuis février 2022. La néphropathie d’origine était un syndrome d’Alport. La grossesse a débuté vingt mois après le début de la dialyse. La patiente a souhaité poursuivre sa grossesse en DPCA afin d’effectuer les échanges durant la journée à son cabinet pour être plus disponible en famille le soir. Le premier trimestre de la grossesse a été sans évènement particulier. Durant cette période la patiente a été informée des risques de la grossesse et nous avons défini ensemble nos objectifs avec les moyens disponibles. Les prescriptions médicamenteuses adjuvantes (calcium, aspirine, fer, acide folique, vitamine D..) ont été adaptées au cours du deuxième trimestre ainsi que le protocole de DP en suivant certains objectifs définis. Le troisième trimestre a nécessité une prise en charge en grande partie hospitalière Les volumes d’infusion ont été progressivement diminués conjointement à une augmentation de leur fréquence qui a permis d’augmenter le volume quotidien total de dialyse.  Elle   a conservé une fonction rénale résiduelle stable pendant tout la durée de la grossesse et le taux d’urée plasmatique a pu être maintenu inférieur à 20 mmol/L L’accouchement a été réalisé par césarienne sous rachianesthésie à 33 semaines et 4 jours d’aménorrhée avec naissance d’un garçon de 1800g dont le coefficient d’Apgar était de 5 à 1min, de 8 à 3min et de 9 à 5min. Le développement du bébé, et sa croissance ont été très satisfaisants. Le respects des choix de la patiente, son autonomie et sa participation au traitement ont été des facteurs déterminants de réussite

Adaptability of vetiver grass as a material for an alternative wastewater treatment

Most untreated wastewater comes from rural areas due to inadequate funding of the government for the rural sectors leading to them to individual treatment schemes such as constructed wetlands. The study investigated the potential of Vetiver grass in reducing the amount of contaminants present in the wastewater. The experiment followed the plants to exist in a hydroponic condition where said parameters were monitored. A set-up was designed and adopted to examine particularly the plant in terms of age and quantity. By comparing to other existing cells, best conditions for the given age were determined. Percentage difference was used to compare incremental performance of the plant in terms of BOD. For fecal, maximum tolerable days of retention was a means for the allowable retention time to be selected. The study recognized that the 4th day of retention was the best retention time since this is where the maximum BOD reduction per sampling rate and the least fecal coliform growth occurred. Evidence supports that greater reduction transpired at the older plant but these values were still considered insignificant with respect to the control (wastewater without Vetiver grass). Statistical approaches were performed to give quantitative evidence on whether or not the plant at this age is a good alternative. A relationship between the number of grass and the percentage difference of BOD reduced was established by means of correlation method but this relationship was very weak which meant that it is not that reliable. With a weak relationship and an insignificant change of high concentration wastewater, the Vetiver grass for this particular age bracket was concluded to be a poor alternative. Hence, the study recommends that a larger age bracket to be tested so that the effectiveness of the plant could be determined

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed