Patients migrants dialysés en Alsace : caractéristiques cliniques et pronostiques/thèse présentée pour le diplôme de docteur en médecine, diplôme d'État, mention néphrologie

Médecine (néphrologie)Nous avons réalisé une étude épidémiologique rétrospective en Alsace portant sur les patients migrants en dialyse sur 10 ans. L’histoire migratoire de tous les patients pris en charge en dialyse chronique entre janvier 2008 et décembre 2017 en Alsace a été recherchée. Les données cliniques et de suivi ont été extraites du registre REIN. Les 89 patients migrants identifiés représentent 2,7% des patients mis en dialyse sur la période, avec une proportion plus élevée à Strasbourg (7%). La majorité des migrants dialysés étaient originaires du Caucase, des Balkans et d’Afrique subsaharienne. Les patients migrants étaient plus jeunes de 25 ans en moyenne à la mise en dialyse. Ils présentaient nettement moins de diabète et de comorbidités cardio-vasculaires. L’accès à la greffe des migrants (versus non-migrants) est retardé, après ajustement pour l’âge et les comorbidités. Le délai prolongé d’attente d’une greffe rénale pourrait altérer le pronostic des dialysés migrants à long terme.Thèses et écrits académique

High Incidence of Acute Kidney Injury in Patients Treated with High-Dose Amoxicillin and Cloxacillin Combination Therapy

High-dose amoxicillin and cloxacillin combination therapy is recommended for the empiric treatment of selected patients with infective endocarditis despite a low level of evidence. The main objective of this study was to evaluate the renal tolerance of high-dose intravenous amoxicillin and cloxacillin combination. We studied 27 patients treated with amoxicillin and cloxacillin (≥100 mg/kg daily) for at least 48 h. The primary endpoint was the occurrence of acute kidney injury (AKI). The median patient age was 68 ± 8 years, and 16 (59%) were male. The indication for this combination therapy was suspected or confirmed endocarditis with no bacterial identification in 22 (81%) patients. The primary endpoint occurred in 16 (59%) patients after initiating this combination therapy within an average of 4.4 ± 3.6 days. Among them, seven (26%) patients developed severe AKI, including four (15%) patients who required hemodialysis. Other risk factors for AKI were identified in all patients, including injection of iodinated contrast media in 21 (78%), acute heart failure in 18 (67%), cardiac surgery in 11 (41%), and aminoglycoside use in 9 (33%) patients. This study reports an incidence of 59% of AKI after initiating amoxicillin and cloxacillin combination therapy in a population at high renal risk

French nationwide survey of undocumented ESRD migrant patient access to scheduled hemodialysis and kidney transplantation

International audienc

Strong antibody response after a first dose of a SARS-CoV-2 mRNA-based vaccine in kidney transplant recipients with a previous history of COVID-19

No abstract availabl

Breakthrough COVID-19 cases despite prophylaxis with 150 mg of tixagevimab and 150 mg of cilgavimab in kidney transplant recipients

The cilgavimab-tixagevimab combination retains a partial in vitro neutralizing activity against the current SARS-CoV-2 variants of concern (omicron BA.1, BA.1.1, and BA.2). Here, we examined whether preexposure prophylaxis with cilgavimab-tixagevimab can effectively protect kidney transplant recipients (KTRs) against the omicron variant. Of the 416 KTRs who received intramuscular prophylactic injections of 150 mg tixagevimab and 150 mg cilgavimab, 39 (9.4%) developed COVID-19. With the exception of one case, all patients were symptomatic. Hospitalization and admission to an intensive care unit were required for 14 (35.9%) and three patients (7.7%), respectively. Two KTRs died of COVID-19-related acute respiratory distress syndrome. SARS-CoV-2 sequencing was carried out in 15 cases (BA.1, n = 5; BA.1.1, n = 9; BA.2, n = 1). Viral neutralizing activity of the serum against the BA.1 variant was negative in the 12 tested patients, suggesting that this prophylactic strategy does not provide sufficient protection against this variant of concern. In summary, preexposure prophylaxis with cilgavimab-tixagevimab at the dose of 150 mg of each antibody does not adequately protect KTRs against omicron. Further clarification of the optimal dosing can assist in our understanding of how best to harness its protective potential