Résultats préliminaires et étude médico-économique d’un programme d’hémodialyse quotidienne à domicile dans un centre d’hémodialyse privé

Abstract: Between 2015 and 2017 there was a 40% increase in daily hemodialysis, according to the REIN database. This increase concerns 1% of patients and the private sector remains under-represented. Our retrospective study aims to describe the clinical features, the organizational and medico-economic specificities of this technique in a private hemodialysis center. Methods: We included 12 dialyzed patients trained on Nx Stage® machine from February 2020 to April 2021. Data were retrospectively obtained through review of our electronic medical records (EUCLID®). Results: Of the 12 patients trained, 11 dialyzed from home, with an average follow-up of 9 months (1-14). The average age was 45 with a sex ratio of 4/8 (M/W), and a median Charlson score of 3 (2-4). The average residual urinary output was 700 mL/24h, and 50% of patients were anuric. 100% of patients had an arteriovenous fistula and were cannulated using the buttonhole technique. 9 patients are on a transplant list. One patient needed anticoagulants. The mean training time was 35 days (28-35). 83% of patients were dialyzed 6 days a week with an average duration of 210 minutes (130-150) per session. The average volume of dialysate was 24.85 liters. One patient developed an allergy to the PUREMA® membrane. Pre-dialytic hemoglobin, serum creatinine, urea, phosphoremia and B2-microglobuline are stable at 9 months with improvement in metabolic acidosis. Conclusion: DHHD allowed a better socio-professional integration. One patient received a transplant and 3 patients resumed professional activity.Introduction : En France, entre 2015 et 2017 on note une progression de 40% de l’hémodialyse quotidienne (HDQ), selon le registre REIN. Celle-ci concerne moins de 1% de la population dialysée et le secteur privé restant sous-représenté. Matériels et méthodes : Notre étude rétrospective a pour objectifs de décrire les résultats cliniques, les spécificités organisationnelles et medico-économiques de cette technique dans un centre d’hémodialyse privé.Résultats :Entre le 01/02/2020 et 30/04/2021, 12 patients ont été formés. La moyenne d’âge est de 45 ans (28-71) avec une sex-ratio 4/8 (H/F) et un score de Charlson médian à 3. 58% des patients étaient en auto-dialyse. La résiduelle moyenne est de 700 ml/24h, 50% des patients sont anuriques. 100% étaient dialysés sur fistule artérioveineuse. La technique de la boutonnière est utilisée chez 100% des patients. Le temps médian de formation était de 35 jours (28-35). 83% des patients étaient dialysés 6 jours/semaine avec une durée moyenne de 210 minutes (130-150) par séance, avec un volume moyen de dialysat de 24.58 litres. 10 patients n’avaient pas d’anticoagulant. Une patiente a développé une allergie à la membrane PUREMA® motivant son switch vers une autre membrane. L’hémoglobinémie, la créatininémie, l’urémie, la phosphorémie et la bêta-2microglobulinémie pré-dialytiques sont stables à 9 mois, avec une amélioration significative de l’acidose métabolique. La survie de la technique est de 83% à 12 mois. La principale cause de sortie de technique étant la transplantation rénale. 3 patients ont repris une activité professionnelle. Conclusion :Nos résultats préliminaires suggèrent que l’HDQ offre une bonne qualité de dialyse et une meilleure insertion socio-professionnelle. &nbsp

Arteriovenous fistulas thrombosis in hemodialysis patients with COVID-19

International audienceBackground: The current Coronavirus disease 2019 (COVID-19) outbreak is associated with significant mortality, especially in patients suffering from end stage renal disease (ESRD) and hemodialysis patients. Several previous studies reported an over-risk of arterial and venous thrombosis, in particular pulmonary embolism and venous thrombosis of catheter in COVID19 patients in intensive care unit. However, arteriovenous fistula (AVF) thrombosis has rarely been reported yet in these patients. AVF thrombosis is a serious complication that impacts significantly patients outcome. Here, we aim to describe characteristics and prognosis of a cohort of COVID-19 hemodialysis (HD) patients presenting with AVF thrombosis. Methods: In the Ile de France region (Paris area) during the March 11th–April 30th 2020 period, fistula thrombosis cases were collected among COVID-19 hemodialysis patients in seven dialysis units and in interventional vascular departments. These patients’ characteristics were analyzed through a review of the patient’s medical records. Results: Seventeen patients were included in our study (median age 69 years). Ten patients (59%) were men. Ten patients (59%) were diabetic and 88% had a high blood pressure. The mortality rate in these patients was 47%. All thrombosis treated with a declotting procedures (64%) were successfully cleared, but with early relapse in 36%. Conclusion: Our study highlights AVF thrombosis as a severe complication in COVID-19 hemodialysis patients that contributed to the severity and accelerated death

COVID-19 in Patients on Maintenance Dialysis in the Paris Region

International audienceIntroduction: Coronavirus disease 2019 (COVID-19) represents a serious threat to patients on maintenance dialysis. The clinical setting, mortality rate, and prognostic factors in these patients have not been well established. Methods: We included all dialyzed patients with COVID-19 referred to our dialysis center between March 11 and April 11, 2020. Data were obtained through the review of the medical records and were censored at the time of data cutoff, on May 11, 2020. Results: Forty-four patients on maintenance dialysis with COVID-19 were referred to our dialysis unit during the COVID-19 epidemic. Median age was 61 years (interquartile range [IQR]: 51.5–72.5); 65.9% were men. Comorbidities included hypertension (97.7%), diabetes mellitus (50%), and chronic cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (79.5%), shortness of breath (29.5%), cough (43.2%), and diarrhea (13.6%). Three profiles of severity were distinguished based on the World Health Organization (WHO) progression scale. Forty-one (93.2%) were hospitalized and only 3 were maintained on outpatient hemodialysis. Thirty-three (75%) patients required oxygen therapy, including 15 (45.5%) who were referred to the intensive care unit. Overall, 27.3% of patients died, and 58.5% were discharged from hospital, including only 2 (13.3%) of those admitted to the intensive care unit. By multivariate analysis, cough, thrombopenia 175 mg/l were significantly associated with death. Conclusion: A major outbreak of COVID-19 occurred in the Paris region, and spread among dialyzed patients. Our study underscores the severity of COVID-19 in these patients and identified prognostic markers

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