Social Deprivation Is Associated With Lower Access to Pre-emptive Kidney Transplantation and More Urgent-Start Dialysis in the Pediatric Population

Introduction Socioeconomic status (SES) is recognized as an important determinant of kidney health. We aimed to evaluate the association of social deprivation with different indicators at kidney replacement therapy (KRT) initiation in the French pediatric metropolitan population. Methods All patients with end-stage kidney disease (ESKD) who started KRT before 20 years old in France between 2002 and 2015 were included. We investigated different indicators at KRT initiation, which are as follows: KRT modality (dialysis vs. pre-emptive transplantation), late referral to a nephrologist, and dialysis modality (hemodialysis [HD] vs. peritoneal dialysis [PD], urgent vs. planned start of dialysis, use of catheter vs. use of fistula for HD vascular access). An ecological index (European Deprivation Index [EDI]) was used as a proxy for social deprivation. Results A total of 1115 patients were included (males 59%, median age at dialysis 14.4 years, glomerular/vascular diseases 36.8%). The most deprived group represented 38.7% of the patients, suggesting pediatric patients with ESKD come from a more socially deprived background. The most deprived group was more likely to initiate KRT with dialysis versus kidney transplantation. Among patients on HD, the odds of starting treatment in emergency with a catheter was >2-fold higher for the most deprived compared with the least deprived children (adjusted odds ratio [aOR] 2.35, 95% CI 1.16–4.78). Conclusion Children from the most deprived area have lower access to pre-emptive transplantation, have lower access to PD, tend to be late referred to a nephrologist, and have more urgent initiation of HD with a catheter

Croissance et nutrition de l’enfant en dialyse péritonéale

Stunting and malnutrition are common in children with chronic kidney disease and increase with the degree of impairment to be maximal in children at the dialysis stage, leading to a risk of excess mortality. Despite many advances in the field of pediatric dialysis, small size in adulthood remains very common in this population. The origin of malnutrition and stunting is complex and multifactorial. In infants on peritoneal dialysis, insufficient nutritional intake is recognized as a major barrier to adequate growth. The diagnostic approach to undernutrition and stunting in peritoneal dialysis requires the use of several elements: an interrogation, a clinical examination, and various complementary examinations. Due to the multifactorial aspect of the nutritional and statural status of the child, several therapeutic axes are to be taken into account, namely a nutritional treatment adapted to the needs of the child, a treatment by growth hormone, and an optimization of dialysis to allow optimal metabolic control.Le retard de croissance et la dénutrition sont fréquents chez l’enfant atteint de maladie rénale chronique et s’accentuent avec le degré de l’atteinte pour être maximaux chez l’enfant au stade de dialyse, conduisant à un risque de surmortalité. Malgré de nombreux progrès réalisés dans le domaine de la dialyse pédiatrique, la petite taille à l’âge adulte reste très commune dans cette population. L’origine de la dénutrition et du retard de croissance est complexe et multifactorielle. Chez le nourrisson en dialyse péritonéale, les apports nutritionnels insuffisants sont reconnus comme un frein majeur à la croissance adéquate. L’approche diagnostique de la dénutrition et du retard de croissance de l’enfant en dialyse péritonéale nécessite de s’appuyer sur plusieurs éléments : un interrogatoire, un examen clinique, et des examens complémentaires divers. En raison de l’aspect multifactoriel du statut nutritionnel et statural de l’enfant, plusieurs axes thérapeutiques sont à prendre en compte, à savoir un traitement nutritionnel adapté aux besoins de l’enfant, un traitement par hormone de croissance, et une optimisation de la dialyse pour permettre un contrôle métabolique optimal

Influenza vaccination among children with idiopathic nephrotic syndrome: an investigation of practices

Abstract Background Annual influenza vaccination is recommended for all children with idiopathic nephrotic syndrome (INS) in France. Consequently, the Social Security automatically sends prescriptions to all patients suffering from a chronic disease. The aim of this study was to evaluate the follow-up to these recommendations. Methods We conducted a monocentric retrospective investigation of practices. We included all children with steroid-sensitive INS in remission who attended our clinics from January 1st 2015 to January 1st 2017, resided in France and had a valid phone number. Data were collected from May 2017 to June 2017 through a phone interview and review of clinical charts. Results 75 patients met the inclusion criteria. The parents of 57 children could be reached by phone and agreed to participate to the survey. 35/57 (61.4%) declared having received a prescription during the 2016–2017 campaign. Only 14 children (24.6%) were vaccinated. 17/43 (39.5%) parents of unvaccinated children had concerns about the safety of the vaccine, 16/43 (37.2%) were not aware of the recommendations, 5/43 (11.6%) had been recommended by their physician not to vaccinate their child, 3/43 (7%) forgot to have them vaccinated and 2/43 (4.6%) reported no reason. 13/43 (30%) unvaccinated children presented a relapse during the flu season - 2/13 during an influenza-like illness - whereas 1/14 (7%) immunized children presented a relapse during the six months of post-vaccination follow-up. Relapse rates were not increased in vaccinated children compared to unvaccinated children (p = 0.15), nor in the 6 months following vaccination compared to the 6 months prior (1/14 vs 5/14, p = 0.20). Conclusions 1) < 2/3 patients were properly prescribed the recommended yearly influenza vaccination at our center 2) only 1/4 were vaccinated and most of their parents were misinformed. Physicians must be aware of this and should make every effort to better inform their patients on the risks of flu illness and the benefits and safety of the vaccination

ARTERIAL HYPERTENSION IS PREVALENT IN PEDIATRIC HEMODIALYSIS AND RELATED TO DIALYSATE SODIUM CONCENTRATION AND WEEKLY DIALYSIS TIME -DATA FROM THE INTERNATIONAL PEDIATRIC HEMODIALYSIS NETWORK (IPHN)

WOS: 00044399840002

Haemodiafiltration does not lower protein-bound uraemic toxin levels compared with haemodialysis in a paediatric population

Background Haemodiafiltration (HDF) is accepted to effectively lower plasma levels of middle molecules in the long term, while data are conflicting with respect to the additive effect of convection on lowering protein-bound uraemic toxins (PBUTs). Here we compared pre-dialysis β2-microglobulin (β2M) and PBUT levels and the percentage of protein binding (%PB) in children on post-dilution HDF versus conventional high- (hf) or low-flux (lf) haemodialysis (HD) over 12 months of treatment. Methods In a prospective multicentre, non-randomized parallel-arm intervention study, pre-dialysis levels of six PBUTs and β2M were measured in children (5–20 years) on post-HDF (n = 37), hf-HD (n = 42) and lf-HD (n = 18) at baseline and after 12 months. Analysis of variance was used to compare levels and %PB in post-HDF versus conventional hf-HD and lf-HD cross-sectionally at 12 months and longitudinal from baseline to 12 months. Results For none of the PBUTs, no difference was found in either total and free plasma levels or %PB between post-HDF versus the hf-HD and lf-HD groups. Children treated with post-HDF had lower pre-dialysis β2M levels [median 23.2 (21.5; 26.6) mg/dL] after 12 months versus children on hf-HD [P<0.01; 35.2 (29.3; 41.2) mg/dL] and children on lf-HD [P<0.001; 47.2 (34.3; 53.0) mg/dL]. While β2M levels remained steady in the hf-HD and lf-HD group, a decrease in β2M was demonstrated for children on post-HDF (P<0.01). Conclusions While post-HDF successfully decreased β2M, no additive effect on PBUT over 12 months of treatment was found. PBUT removal is complex and hampered by several factors. In children, these factors might be different from adults and should be explored in future research