Survival advantage of hemodialysis relative to peritoneal dialysis in patients with end-stage renal disease and congestive heart failure

Peritoneal dialysis (PD) has been proposed as a therapeutic option for patients with end-stage renal disease and associated congestive heart failure (CHF). Here, we compare mortality risks in these patients by dialysis modality by including all patients who started planned chronic dialysis with associated congestive heart failure and were prospectively enrolled in the French REIN Registry. Survival was compared between 933 PD and 3468 hemodialysis (HD) patients using a Kaplan–Meier model, Cox regression, and propensity score analysis. The patients were followed from their first dialysis session and stratified by modality at day 90 or last modality if death occurred prior. There was a significant difference in the median survival time of 20.4 months in the PD group and 36.7 months in the HD group (hazard ratio, 1.55). After correction for confounders, the adjusted hazard ratio for death in PD compared to the HD patients remained significant at 1.48. Subgroup analyses showed that the results were not changed with regard to the New York Heart Association stage, age strata, or estimated glomerular filtration rate strata at first renal replacement therapy. The use of propensity score did not change results (adjusted hazard ratio, 1.55). Thus, mortality risk was higher with PD than with HD among incident patients with end-stage renal disease and congestive heart failure. These results may help guide clinical decisions and also highlight the need for randomized clinical trials

Conditions de début de dialyse (description et impact sur la survie des patients incidents en dialyse au CHLS (1995 - 2006))

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Impact du diabète de type 2 sur la survie et sur les causes de décès d'une cohorte de 539 patients incidents en dialyse

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease.

International audienceThis simple clinical score effectively predicts short-term prognosis among elderly patients starting dialysis. It should help to illuminate clinical decision making, but cannot be used to withhold dialysis. It ought to only be used by nephrologists to facilitate the discussion with the patients and their families

Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study.

Determinants of nonfunctional arteriovenous (AV) access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter. We estimated crude and adjusted odds ratio (OR) with 95% confidence intervals (CI) of nonfunctional versus functional AV access associated with case-mix, facility characteristics, and timing of AV access creation. Analyses were stratified by dialysis start condition (planned or as an emergency) and comorbidity profile. Overall, 18% patients had nonfunctional AV access at hemodialysis initiation. In the group with planned dialysis start, female gender (OR 1.43, 95% CI 1.32-1.56), diabetes (OR 1.28, 95% CI 1.15-1.44), and a higher number of cardiovascular comorbidities (OR 1.27, 95% CI 1.09-1.49, and 1.31, 1.05-1.64, for 3 and >3 cardiovascular comorbidities versus none, respectively) were independent predictors of nonfunctional AV access. A higher percentage of AV access creation at the region level was associated with a lower rate of nonfunctional AV access (OR 0.98, 95% CI 0.98-0.99 per 1% increase). The odds of nonfunctional AV access decreased as time from creation to hemodialysis initiation increased up to 3 months in nondiabetic patients with fewer than 2 cardiovascular comorbidities and 6 months in patients with diabetes or 2 or more such comorbidities. In conclusion, both patient characteristics and clinical practices may play a role in successful AV access use at hemodialysis initiation. Adjusting the timing of AV access creation to patients' comorbidity profiles may improve functional AV access rates

Assessing the efficiency of passive samplers for groundwater sampling

Chlorinated solvents are among the most common soil and groundwater contaminants due to their widespread use as cleaning solvents or degreasing agents. Due to their physico-chemical properties, chlorinated solvents produce large-scale plumes of pollution in the groundwater. In the densely populated north western Europe, these pollution plumes often are situated under residential and urban development areas and, therefore, not easily accessible. Vapors can migrate through building slabs and affect the quality of indoor air. That is why the CityChlor project was created. It aims at improving the quality and minimizing pollution of soil and groundwater by developing an integrated approach to tackle the threats caused by contamination with chlorinated solvents in urban areas. One of the goals of the project is to define the most reliable, fast, and cost-effective techniques to detect, characterize, and delineate chlorinated solvent pollution in groundwater. In this context, passive sampling is an innovative way of sampling contaminants in groundwater in Europe, and it seems very promising. Therefore, tests are required at each country level to make regulations concerning these samplers, which will encourage consultants to use them. That is why the aim of this work was to assess the performance of 3 passive samplers to sample chlorinated solvents in groundwater and to compare the results to those obtained with the traditional groundwater sampling method, that is to say well purging prior to groundwater sampling with a pump. The pilot site chosen to conduct these experiments is an in-service facility located in France, 60 km east from Paris, in an urban area. In this factory, door locks and metal fittings have been produced since 1926 and chlorinated solvents are used to remove grease marks from metal fittings. On site, soils are composed of one layer of silty embankments (2 to 3 m) and then a sandy horizon. The water table is at around 2 m below the ground surface and it goes to 10 m deep. In order to test passive sampling, 5 dedicated water wells were installed on site. In this way, the design of the wells was totally known and passive samplers were tested in controlled conditions. One of them was screened from 2 to 8 m deep and the other ones were screened respectively from 2 to 3.5 m; 3.5 to 5 m; 5 to 6.5 m and 6.5 to 8 m. Three passive samplers were therefore tested: PDB (Polyethylene Diffusion Bags), Ceramic Dosimeters and Gore Sorber Modules. Multilevel sampling was done in the well screened from 2 to 8 m and one sampler was installed in the middle of each screened interval of the other wells. This was done for the 3 samplers tested. PDB were very easy to install and the cost of these samplers was lower than the one corresponding to the conventional method with the pump. In addition, these samplers exhibited a good reproducibility. Ceramic dosimeters were very easy to use as well, but results were not reproducible for some compounds. Some tests are still in progress to confirm this trend. For Gore Sorber Modules, the first sampling campaigns gave consistent results comparing to the pump. In general, passive samplers seemed to be very efficient to sample HVOC in groundwater and to be a good alternative to the standard method with purge and sampling with a pump

Reasons for action, morality and

Kaplan-Meier survival curves according to vascular access group at hemodialysis initiation. Abbreviation: AV, arteriovenous. (TIF 2362 kb

The renal epidemiology and information network (REIN): a new registry for end-stage renal disease in France.

International audienceThe French Renal Epidemiology and Information Network (REIN) registry began in 2002 to provide a tool for public health decision support, evaluation and research related to renal replacement therapies (RRT) for end-stage renal disease (ESRD). It relies on a network of nephrologists, epidemiologists, patients and public health representatives, coordinated regionally and nationally. Continuous registration covers all dialysis and transplanted patients. In 2003, 2070 patients started RRT, 7854 were on dialysis and 7294 lived with a functioning graft in seven regions (with a population of 16.5 million people). The overall crude annual incidence rate of RRT for ESRD was 123 per million population (p.m.p.) with significant differences in age-adjusted rates across regions, from 84 [95% confidence interval (CI): 74-94] to 155 [138-172] p.m.p. The principal causes of ESRD were hypertension (21%) and diabetic (20%) nephropathies. Initial treatment for ESRD was peritoneal dialysis for 15% of patients and a pre-emptive graft for 3%. The one-year survival rate was 81% [79-83] in the cohort of 2002-2003 incident patients. As of December 31, 2003, the overall crude prevalence was 898 [884-913] p.m.p, with 5% of patients receiving peritoneal dialysis, 47% on haemodialysis and 48% with a functioning graft. The experience in these seven regions over these two years clearly shows the feasibility of the REIN registry, which is progressively expanding to cover the entire country