0122: Peritoneal dialysis and heart failure: designing of the heart module in the French speaking peritoneal dialysis registry (RDPLF)

Heart failure (HF) is a frequent and severe comorbidity in dialysis patients (pts); conversely, 30% of pts in the large Acute Decompensated Heart Failure National Registry had moderate to severe chronic kidney disease and 5% were receiving dialysis therapy. Refractory HF is a not uncommon indication for peritoneal ultrafiltration although its benefits have been unconsistently reported through mainly retrospective or monocentric studies. The main objectives of the “heart module” are to prospectively collect data related to cardiac status in PD pts and to allow longitudinal follow-up of cardiac- and dialysisrelated parameters in HF ptsMethodsThe RDPLF constitutes the largest recruiting observational cohort of French speaking PD pts, with coverage estimated at 98,3% of PD in France in 2013. All centers complete a set of core modules covering sociodemographics and basic clinical information, peritonitis episodes, and outcomes. Optional specialized modules are available. The heart module consists of baseline followed by quarterly collection of information related to cardiac disease, hospitalization rate, and dialysis-related parameters.Results14 centers volunteered to participate since the heart module was launched in February 2013, now totalizing 75 pts. PD was initiated because of HF in 73%. Mean eGFR was 22±14ml/mn/1.73m2 with GFR>15ml/mn/ 1.73m2 in 69%. Half of the pts had echocardiographic Left Ventricular Ejection Fraction (LVEF)<30% and 71% pts had NYHA III-IV status. Mean rate of hospitalization the previous year was 30.8 days/pts/yr. Follow-up data were obtained in 38 pts at 3 months. Hospitalization rate decreased from 8.4 days/ 100 days to 4.7 days/100 days. LVEF increased by more than 10% in 13/ 23 pts. Mortality rate was 15.6% among the 32 pts with 1-year follow-up.ConclusionsExpanding this cohort will give the unique opportunity to define features of HF requiring PD and clarify which pts take most benefit from the strategy. The rapid decrease of hospitalization rate is confirmatory of previous studies

Fasting Urinary Osmolality, CKD Progression, and Mortality: A Prospective Observational Study

International audienc

Fasting Urinary Osmolality, CKD Progression, and Mortality: A Prospective Observational Study

International audienc

Longitudinal Bone Loss Occurs at the Radius in CKD

Introduction: Chronic kidney disease (CKD) exposes to an increased incidence of fragility fractures. International guidelines recommend performing bone mineral density (BMD) if the results will impact treatment decisions. It remains unknown where bone loss occurs and what would preclude the longitudinal loss in patients with CKD. Here, we aimed to investigate factors influencing BMD and to analyze the longitudinal BMD changes. Methods: In the NephroTest cohort, we measured BMD at the femoral neck, total hip, lumbar spine, and proximal radius, together with circulating biomarkers and standardized measured glomerular filtration rate (mGFR) by 51Cr-EDTA in a subset of patients with CKD stage 1 to 5 followed during 4.3 ± 2.0 years. A linear mixed model explored the longitudinal bone loss and the relationship of associated factors with BMD changes. A total of 858 patients (mean age 58.9 ± 15.2 years) had at least 1 and 477 had at least 2 BMD measures. Results: At baseline, cross-sectional analysis showed a significantly lower BMD at femoral neck and total hip and a significant higher serum parathyroid hormone (PTH) along with CKD stages. Baseline age, gender, tobacco, low body mass index (BMI), and high PTH levels were significantly associated with low BMD. Longitudinal analysis during the mean 4.3 years revealed a significant bone loss at the radius only. BMD changes at the femoral neck were associated with BMI, but not CKD stages or basal PTH levels. Conclusions: CKD is associated with low BMD and high PTH in the cross-sectional analysis. Longitudinal bone loss occurred at the proximal radius after 4.3 years

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