L’essentiel pour une gestion sans stress des patients porteurs d’une polykystose hépato-rénale en dialyse péritonéale. : Cas clinique et revue.

Summary Autosomal dominant polycystic hepatorenal disease is a common chronic kidney disease. Among the proposed replacement therapies, peritoneal dialysis (PD) concerns less than 7% of polycystic patients. The underutilization of PD is due to the fear of potential technical failure due to its potential impact on the large intraperitoneal organs.To illustrate the feasibility of the use of PD with polycystic patients despite the risk of organomegaly, we report the case of a 70-year-old patient with polycystic hepatorenal disease who has been treated with peritoneal dialysis after a long history of renal transplantation and hemodialysis. The evolution of the patient on PD was satisfactory in terms of adequacy and fluid balance. We then review the literature on the specifics of the management of polycystic patients on peritoneal dialysis.The survival of patients with polycystic disease is identical in PD and hemodialysis. There is no excess risk of technical failure or peritonitis in polycystic patients being treated with PD. However, there are slightly more symptomatic hernias in polycystic patients treated with PD, though this is without impact on technical survival. The measurement of intraperitoneal pressure (IPP) is an aid to prescribing PD, allowing the volume of dialysate to be adapted for exchanges. If kidney reduction is necessary, renal artery embolization seems to be the preferred technique. It is associated with a better likelihood of technical survival, a reduction of temporary or permanent transfers to hemodialysis and a reduction of hospitalization time.In conclusion, peritoneal dialysis is a viable option for patients with polycystic hepatorenal disease despite organomegaly. Early referral to PD could preserve patients’ vascular capital. Healthcare professionals should be educated about survival, technical failure, peritonitis, symptomatic hernias, and the use of PIP to optimize the management of polycystic patients on PD.Résumé La polykystose hépatorénale autosomique dominante (PKR) est une maladie rénale chronique fréquente. La dialyse péritonéale (DP) concerne moins de 7% de ces patients. La sous-utilisation de la DP est due à la crainte d’un échec technique en raison de volumineux organes intra-péritonéaux.Pour illustrer la faisabilité de la DP chez les patients PKR malgré les organomégalies. nous rapportons le cas d’une patiente de 70 ans atteinte de polykystose hépatorénale, traitée par DP après une longue histoire de transplantation rénale et d’hémodialyse. L’évolution de la patiente en DP a été satisfaisante en termes d’adéquation et d’équilibre hydrosodé. Nous faisons ensuite une revue de la littérature sur les spécificités de la prise en charge des patients PKR en DP. La survie des patients atteints de polykystose est identique en DP et en hémodialyse. Il n’y a pas de surrisque d’échec technique ni de péritonites chez les patients polykystiques en DP. Cependant, il y a un peu plus de hernies symptomatiques chez les patients polykystiques, sans impact sur la survie technique. La mesure de la pression intra-péritonéale (PIP) est une aide à la prescription, permettant d’adapter le volume de dialysat pour les échanges. En cas de nécessité de réduction néphronique, l’embolisation artérielle rénale semble être la technique à privilégier. Elle est associée à une meilleure survie technique, à une réduction des transferts temporaires ou permanents en hémodialyse et à une réduction du temps d’hospitalisation.En conclusion, la dialyse péritonéale est une option viable pour les patients atteints de polykystose hépatorénale malgré les organomégalies. Une orientation précoce en DP pourrait préserver le capital vasculaire des patients. Les professionnels de santé doivent être informés sur la survie, l’échec technique, les péritonites, les hernies symptomatiques et l’utilisation de la presssion intrapéritonéale (PIP) pour optimiser la prise en charge des patients polykystiques en DP

Tendances évolutives des sorties de technique en dialyse péritonéale de 2002 a 2017 en France. Données du RDPLF.

English AbstractIn France, 6 to 7 % of patients with end stage renal failure are treated by peritoneal dialysis (1). Despite the annual augmentation of treated patients, it’s still under public health goal. Peritoneal dialysis technique failure is one restraint of technique growth in France. The RDPLF collect data about technique survival and infections since 1986. Technique failure width is on restraint of PD growth. We used available data to describe trends in the different causes of technique failure to identify areas with feasible improvement to increase technical survival. Methods: This retrospective study includes public data from RDPLF over the 2002-2017 period.Results: More than 30% of treated patients experience technique failure each year and transfer to hemodialysis count for 33%. Main causes of HD transfer are inadequate dialysis, peritonitis, catheter dysfunction and fluid inadequacy. The study of technique failure causes trends shows a decreased mortality form 51% in 2002 to 38% in 2017 (p<0.05), an increase of transplantation access from 15% to 22% (p<0.05). Transfer to hemodialysis is stable 33% to 36% in the same period. The analysis au hemodialysis transfer shows a decrease of peritonitis from 22% in 2002 and 26% in 2004 to 13.6% in 2017 (p<0.05). It shows a light increase of catheter dysfunction from between 7-8% during 2002-2005 period, to 8.6-11.8% during 2013-2016 period (p>0.05). Conclusion: Technique failure causes evolved over the past fifteen years in France, there is an improvement in mortality and access to transplant, a decrease in peritonitis. Despite technique improvement and new PD solutions (Icodextrine based, biocompatible), there is still 10% of PD patients transferred each year to hemodialysis without favorable trends.RésuméEn France, 6 à 7% des patients présentant une maladie rénale chronique terminale au stade de la suppléance sont traités par dialyse péritonéale (1). Depuis 1986, le Registre de Dialyse Péritonéale de Langue Française (RDPLF) recueille les données des patients en dialyse péritonéale. Malgré une augmentation annuelle du nombre de patients incidents, la prévalence reste en dessous des objectifs de santé publique. L’ampleur des mouvements de sorties de la technique peuvent expliquer la faible prévalence de la dialyse péritonéale. Nous avons repris les données disponibles dans le but de décrire les tendances des différentes causes de sorties de technique et d’identifier des points à améliorer pour augmenter la survie technique. Méthodes : Il s’agit d’une étude rétrospective reprenant les données publiques du RDPLF concernant les sorties de techniques sur l’ensemble de la période 2002 à 2017. Le site du RDPLF publie ces données annuellement ; de plus il est mis à disposition un outil statistique qui permet des analyses statistiques descriptives simples grâce à la mise à disposition d’un export anonymisée de la base de données. Résultats : Plus de 30% des patients quittent la DP chaque année et le transfert en hémodialyse compte pour environ 1/3 des sorties techniques. Les tendances évolutives de sortie de technique montrent une diminution de la part de la mortalité de 51% à 38% (2002 à 2017, p<0.05). Sur la même période, la part des transferts en HD est stable de 33% - 36% (p>0.05) et celle de la transplantation est en augmentation de 15% à 22% (p<0.05). Concernant le transfert en HD, les principales causes sont la « sous-dialyse », les péritonites, la dysfonction de cathéter, et l’ultrafiltration insuffisante. L’évolution de ces causes montre une diminution des péritonites de 22% - 26% en 2002-2004 vs 13.6% en 2017 (p<0.05). Une tendance à l’augmentation des dysfonctions de cathéter de 7 - 8% en 2002-2005 vs 8.6 - 11,8% en 2013-2016 (p>0.05). Conclusion : Sur la période 2002-2016, les causes de sortie technique ont évoluées avec une diminution des décès et une augmentation de la transplantation. Néanmoins malgré les améliorations de la technique et l’apparition de nouvelles solutions de DP, la proportion des patients transférés vers l’HD chaque année, n’a pas été modifiée. English AbstractIn France, 6 to 7 % of patients with end stage renal failure are treated by peritoneal dialysis (1). Despite the annual augmentation of treated patients, it’s still under public health goal. Peritoneal dialysis technique failure is one restraint of technique growth in France. The RDPLF collect data about technique survival and infections since 1986. Technique failure width is on restraint of PD growth. We used available data to describe trends in the different causes of technique failure to identify areas with feasible improvement to increase technical survival. Methods: This retrospective study includes public data from RDPLF over the 2002-2017 period.Results: More than 30% of treated patients experience technique failure each year and transfer to hemodialysis count for 33%. Main causes of HD transfer are inadequate dialysis, peritonitis, catheter dysfunction and fluid inadequacy. The study of technique failure causes trends shows a decreased mortality form 51% in 2002 to 38% in 2017 (p<0.05), an increase of transplantation access from 15% to 22% (p<0.05). Transfer to hemodialysis is stable 33% to 36% in the same period. The analysis au hemodialysis transfer shows a decrease of peritonitis from 22% in 2002 and 26% in 2004 to 13.6% in 2017 (p<0.05). It shows a light increase of catheter dysfunction from between 7-8% during 2002-2005 period, to 8.6-11.8% during 2013-2016 period (p>0.05). Conclusion: Technique failure causes evolved over the past fifteen years in France, there is an improvement in mortality and access to transplant, a decrease in peritonitis. Despite technique improvement and new PD solutions (Icodextrine based, biocompatible), there is still 10% of PD patients transferred each year to hemodialysis without favorable trends. Cet article est mis à disposition selon les termes de la Licence Creative Commons Attribution - Pas d’Utilisation Commerciale 4.0 International

Les produits de glycation avancée et leur récepteur RAGE dans le remodlage cardiovasculaire des patients en dialyse péritonéale (étude pilote)

REIMS-BU Santé (514542104) / SudocSudocFranceF

LES VASCULARITES SYSTEMIQUES AVEC ATTEINTE RENALE CHEZ LES SUJETS DE PLUS DE 70 ANS (ETUDE RETROSPECTIVE)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Comparison of four equations for estimation of glomerular filtration rate in predicting cardiovascular events and subclinical vascular disease in patients with type-2 diabetes

International audienceAims: Chronic kidney disease (CKD), defined by a low glomerular filtration rate (GFR), is a predictor of cardiovascular disease in patients with type-2 diabetes (T2D). We aimed to compare four GFR equations in predicting future cardiovascular events in T2D and the presence of subclinical vascular disease. Methods: Four equations were used to estimate GFR in asymptomatic T2D patients consulting our centre for cardiovascular assessment. Follow-up was performed to collect cardiovascular events. Cox proportional hazard ratio (HR) was used to build and compare prediction models, and the incremental value of the addition of GFR with any of the 4 formulas was evaluated. The ability to triage patients with and without CVD events according to GFR were assessed by comparing the receiver operator characteristics (ROC) curves with the 4 models. Results: Among 829 asymptomatic T2D patients, the CKD prevalence was 20.2% for Modification of Diet in Renal Disease (MDRD), 17.3% for Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), 20.7% for Lund-Malmö Revised (LMR) and 21.4% for Full Age Spectrum (FAS). All the estimated GFRs were well correlated from one formula to another, with stronger agreement to define CKD (GFR <60 mL/min/1.73 m2) between MDRD and CKD-EPI, and between LMR and FAS. The 5-year incidence of cardiovascular events was 8% (n = 63). After adjustment on covariables, CKD was significantly associated with cardiovascular events when defined by MDRD (HR = 2.04; 1.15-3.60) and CKD-EPI (HR = 1.90; 1.05-3.41) but missed statistical significance when using LMR (HR = 1.74; 0.97-3.14) or FAS (HR = 1.71; 0.94-3.14). Only the prediction models including MDRD and CKD-EPI provided a significant incremental information to the predictive model without GFR, but the area under the ROC curves were similar with the 4 models: 0.60 [0.54-0.68] for MDRD, 0.61 [0.49-0.65] for CKD-EPI and 0.62 [0.55-0.69] for LMR and FAS, without any significant difference among formulas. Conclusion: In asymptomatic T2D patients, MDRD and CKD-EPI may be preferable when more specificity is desired (stronger association between GFR and CVD events), while LMR and FAS appear more sensitive by including a higher number of patients with GFR <60 mL/min/1.73 m2

Assessment of the interest of an open-access French-language journal specializing in home dialysis

The Bulletin de la dialyse à Domicile (Home Dialysis Bulletin) is a quaterly open access journal, created in June 2018. It adheres to international standards of ethics and good practices in medical publishing; it is indexed in the directory of open access journals (doaj.org). The aim of this work was, by means of an anonymous online survey, to assess its appreciation among French-speaking nephrologists and healthcare teams. The analysis of the responses to the survey highlighted a high degree of appreciation by readers, the importance of using their native language which abrogates language barriers to their easy access to medical or nursing information, the need for practical articles but also recommendations, the sharing of clinical cases. Readers believe that the Bulletin de la Dialyse à Domicile provides them with a source of information to which they have little or no access elsewhere. It responds to a clearly expressed need for all those who take care of patients treated by home dialysis, but remains closely linked to English speakers because its the bi-lingual online publication which give the opportunity to accept foreign&nbsp; submissions and share experience between countries.Le Bulletin de la dialyse à domicile est une revue en accès libre à parution trimestrielle, créée en juin 2018. Elle adhère aux normes internationales d'éthique et bonnes pratiques de l'édition médicale ; elle est indexée dans la plupart des bibliothèques universitaires, indexée dans l'index international des revues en libre accès "doaj.org". Le but de ce travail était, au moyen d'un sondage anonyme en ligne, d'évaluer son appréciation auprès des néphrologues et équipes soignantes francophones. L'analyse des réponses a mis en évidence un haut degré d'appréciation par les lecteurs, l'importance d'utiliser la langue maternelle pour abroger les barrières linguistiques d'accès à l'information médicale ou infirmière, le besoin d'articles pratiques mais aussi de recommandations, le partage de cas cliniques. Les lecteurs estiment que la revue Bulletin de la Dialyse à Domicile met à leur disposition une source d'informations auxquelles ils n'ont pas ou peu accès ailleurs. Elle répond à un besoin, clairement exprimé, pour toutes celles et ceux qui prennent en charge des patients traités par dialyse à domicile mais demeure étroitement lié aux anglophones du fait de la mise en ligne bi linguale.&nbsp

High Mortality and Graft Loss after Infective Endocarditis in Kidney Transplant Recipients: A Case-Controlled Study from Two Centers

International audienceKidney transplant recipients (KTRs) tend to develop infections with characteristic epidemiology, presentation, and outcome. While infective endocarditis (IE) is among such complications in KTRs, the literature is scarce. We describe the presentation, epidemiology, and factors associated with IE in KTRs. We performed a retrospective case/control study which included patients from two centers. First episodes of definite or possible IE (Duke criteria) in adult KTRs from January 2010 to December 2018 were included, as well as two controls per case, and followed until 31 December 2019. Clinical, biological, and microbiological data and the outcome were collected. Survival was studied using the Kaplan–Meier method. Finally, we searched for factors associated with the onset of IE in KTRs by the comparison of cases and controls. Seventeen cases and 34 controls were included. IE was diagnosed after a mean delay of 78 months after KT, mostly on native valves of the left heart only. Pathogens of digestive origin were most frequently involved (six Enterococcus spp, three Streptococcus gallolyticus, and one Escherichia coli), followed by Staphylococci (three cases of S. aureus and S. epidermidis each). Among the risk factors evaluated, age, vascular nephropathy, and elevated calcineurin inhibitor through levels were significantly associated with the occurrence of IE in our study. Patient and death-censored graft survival were greatly diminished five years after IE, compared to controls being 50.3% vs. 80.6% (p < 0.003) and 29.7% vs. 87.5% (p < 0.002), respectively. IE in KTRs is a disease that carries significant risks both for the survival of the patient and the transplant

Outcome of autosomal dominant polycystic kidney disease patients on peritoneal dialysis: a national retrospective study based on two French registries (the French Language Peritoneal Dialysis Registry and the French Renal Epidemiology and Information Network).

International audienceBackground: Pathological features of autosomal dominant polycystic kidney disease (ADPKD) include enlarged kidney volume, higher frequency of digestive diverticulitis and abdominal wall hernias. Therefore, many nephrologists have concerns about the use of peritoneal dialysis (PD) in ADPKD patients. We aimed to analyse survival and technique failure in ADPKD patients treated with PD.Methods: We conducted two retrospective studies on patients starting dialysis between 2000 and 2010. We used two French registries: the French Renal Epidemiology and Information Network (REIN) and the French language Peritoneal Dialysis Registry (RDPLF). Using the REIN registry, we compared the clinical features and outcomes of ADPKD patients on PD (n = 638) with those of ADPKD patients on haemodialysis (HD) (n = 4653); with the RDPLF registry, those same parameters were determined for ADPKD patients on PD (n = 797) and compared with those of non-ADPKD patients on PD (n = 12 059).Results: A total of 5291 ADPKD patients and 12 059 non-ADPKD patients were included. Analysis of the REIN registry found that ADPKD patients treated with PD represented 10.91% of the ADPKD population. During the study period, PD was used for 11.2% of the non-ADPKD population. Compared with ADPKD patients on HD, ADPKD patients on PD had higher serum albumin levels (38.8 ± 5.3 versus 36.8 ± 5.7 g/dL, P < 0.0001) and were less frequently diabetic (5.31 versus 7.71%, P < 0.03). The use of PD in ADPKD patients was positively associated with the occurrence of a kidney transplantation but not with death [hazard ratio 1.15 (95% confidence interval 0.84–1.58)]. Analysis of the RDPLF registry found that compared with non-ADPKD patients on PD, ADPKD patients on PD were younger and had fewer comorbidities and better survival. ADPKD status was not associated with an increased risk of technique failure or an increased risk of peritonitis.Conclusions: According to our results, PD is proposed to a selected population of ADPKD patients, PD does not have a negative impact on ADPKD patients’ overall survival and PD technique failure is not influenced by ADPKD status. Therefore PD is a reasonable option for ADPKD patients

Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys

International audienceBackground: Apheresis is the gold standard for idiopathic nephrotic syndrome (INS) relapse after transplantation, but it remains unknown whether such treatment is useful for adults with refractory INS on native kidneys.Methods: This retrospective study included patients older than 16 years with biopsy-proven refractory (persistent nephrotic syndrome on corticosteroids plus at least 1 immunosuppressive drug) INS treated by apheresis and followed for at least 3 months.Results: Between September 1997 and January 2020, 21 patients (focal segmental glomerulosclerosis: 12, minimal change nephrotic syndrome: 9, men: 67%, median age: 34 years) were identified. At last follow-up (12 months), 7 of 21 patients were in complete or partial remission. Remission was associated with older age (51 vs. 30 years, P = 0.05), lower proteinuria (3.9 vs. 7.3 g/d, P = 0.03), and lower estimated glomerular filtration rate (eGFR) (28.0 vs. 48.5 ml/min per 1.73 m2, P = 0.05) at apheresis. The need for dialysis before apheresis (odds ratio [OR] 22.0 [1.00-524], P = 0.026), age ≥50 years (OR: 22.6 [1.00-524], P = 0.006), a marked (>4.5 g/d) decrease in proteinuria (OR: 9.17 [1.15-73.2], P = 0.041), and a short (<12 months) time between diagnosis and apheresis (OR: 10.8 [1-117], P = 0.043) were significantly associated with remission. Three of 7 patients in remission who were initially on dialysis became dialysis-free; by contrast, none of the 14 patients without remission was initially on dialysis, but 5 of 14 had become dialysis-dependent (P = 0.01).Conclusion: Apheresis may result in remission in adult patients with refractory INS, particularly in those at risk of renal failure, with limited sensitivity to medical treatments, if apheresis is initiated within a year of diagnosis

Living kidney donor evaluation for all candidates with normal estimated GFR for age

International audienceMultiple days assessments are frequent for the evaluation of candidates to living kidney donation, combined with an early GFR estimation (eGFR). Living kidney donation is questionable when eGFR is 55 years) in a population of 1825 French living kidney donors with a median follow-up of 5.9 years. In donors younger than 45, postdonation eGFR, absolute- and relative-eGFR variation were not different between the three groups. For older donors, postdonation eGFR was higher in S90 than in S80 or Sage but other comparators were identical. Postdonation eGFR slope was comparable between all groups. Our results are in favour of in-depth screening for all candidates to donation with a normal eGFR for age