Indole 3-acetic acid, indoxyl sulfate and paracresyl-sulfate do not influence anemia parameters in hemodialysis patients

International audienceBackground: The main reason for anemia in renal failure patients is the insufficient erythropoietin production by the kidneys. Beside erythropoietin deficiency, in vitro studies have incriminated uremic toxins in the pathophysiology of anemia but clinical data are sparse. In order to assess if indole 3-acetic acid (IAA), indoxyl sulfate (IS), and paracresyl sulfate (PCS)-three protein bound uremic toxins-are clinically implicated in end-stage renal disease anemia we studied the correlation between IAA, IS and PCS plasmatic concentrations with hemoglobin and Erythropoietin Stimulating Agents (ESA) use in hemodialysis patients. Methods: Between June and July 2014, we conducted an observational cross sectional study in two hemodialysis center. Three statistical approaches were conducted. First, we compared patients treated with ESA and those not treated. Second, we performed linear regression models between IAA, IS, and PCS plasma concentrations and hemoglobin, the ESA dose over hemoglobin ratio (ESA/Hemoglobin) or the ESA resistance index (ERI). Third, we used a polytomous logistic regression model to compare groups of patients with no/low/high ESA dose and low/high hemoglobin statuses

Quality of life analysis in a cohort of Kidney Transplant Recipients 'KTR)

Quand elle est possible, la greffe de rein est le meilleur traitement de l’insuffisance rénale chronique terminale. La qualité de vie des patients joue un rôle essentiel dans la réussite de la transplantation. Dans ce contexte, notre objectif était d’analyser la qualité de vie dans une cohorte de patients transplantés rénaux en France. Dans un premier temps, nous avons analysé la qualité de vie des patients au moment de leur inclusion dans l’étude dans le but de déterminer les facteurs associés à la qualité de vie. Nous avons retrouvé des caractéristiques socio-démographiques et cliniques connues dans la littérature et de nouvelles variables psycho-sociales ont été identifiées. Ce travail nous a ensuite amené à analyser le profil des patients qui utilisent l’Internet et les réseaux sociaux : près de 80% de patients utilisent Internet et la plupart d’entre eux ont besoin de soutien informatif. Nous avons pu montrer, dans un deuxième temps, une faible concordance de l’évolution de l’état de santé du patient du point de vue du patient et du médecin. Enfin, pour interpréter les scores de qualité de vie dans cette cohorte, nous avons calculé la différence minimale cliniquement significative par la méthode des courbes ROC, en utilisant le changement d’état de santé du point de vue du patient comme critère de changement (anchor). Cette analyse a montré que l’évolution de la qualité de vie de ces patients n’est pas liée au changement d’état de santé des patients. Cette thèse fournit une analyse approfondie sur la qualité de vie des patients transplantés rénaux francophones.Kidney transplant is the best treatment for chronic end-stage renal failure. The quality of life of the patient plays a vital role in the success of the transplantation. In this context, our objective was to analyze the quality of life in a cohort of kidney transplanted patients in France. As a first step, we analyzed the quality of life of patients at the time of their inclusion in the study in order to determine the factors associated with the quality of life. Socio-demographic and clinical characteristics known in literature were found and new psycho-social variables were identified. This work then led us to analyze the profile of patients using the Internet and social networks: nearly 80% of the patients use Internet and the majority need an informative support. We were able to show, in a second time, a weak concordance of the evolution of the state of health of the patient from the patient and the doctor point of view. Finally, to interpret the quality of life scores in this cohort, we calculated the minimal clinically significant difference, by the ROC curve method and using the change in health status from the patient's point of view as a criteria for change. This analysis showed that the quality of life of these patients is not related to the patient's state of health, and no clinical changes could be detected for the quality of life scores of the two questionnaires. This thesis provides an in-depth analysis of the quality of life of French kidney transplanted patients

“Without Them, I Would Never Have Been Able to Carry on” Levers for the Sustained Employment of Patients with Chronic Inflammatory Arthritis: A French Qualitative Study

International audienceBackground. Chronic inflammatory arthritis (IA) is known to be involved in declining work outcomes and increased risk of experiencing unemployment. The aim of this study is to qualitatively identify the levers for the employment of patients with IA and AI-like conditions. Methods. To accomplish this task, a multi-centered, exploratory qualitative design involving one-on-one semi-directed interviews and a focus group was performed among 18 IA French patients to deepen our understanding of what enables patients to maintain employment despite the limiting, chronic, and expanding nature of their symptoms. Results. Analysis revealed five clusters of levers for the employment of chronic IA patients: The first cluster of levers was based on a set of verbatim records mentioning an overall improvement in the management of the disease. The second cluster of levers was based on a set of verbatim records mentioning the perceived added value of one’s occupation at a personal, familial, or societal scale. The third cluster of levers was based on a set of verbatim records mentioning the perceived interpersonal supportiveness of the professional sphere. The fourth cluster of levers was based on a set of verbatim records mentioning the micro-, meso-, and macro-characteristics of the working environment. The fifth cluster of levers was based on a set of verbatim records mentioning intrapersonal attributes. Conclusions. This study deepens and updates the current knowledge on what empowers patients dealing with chronic AI. These results provide valuable insights for stakeholders involved in designing or deploying employment initiatives for patients with AI

Internet and social network users’ profiles in Renal Transplant Recipients in France

Abstract Background The use of the Internet for searching and sharing health information and for health care interactions may have a great potential for Renal Transplant Recipients (RTR). This study aims to determine the characteristics associated with Internet and social network use in a representative sample of RTR at the time of their inclusion in the study. Methods Data of this cross-sectional design is retrieved from a longitudinal study conducted in five French kidney transplant centers in 2011, and included Renal Transplant Recipients aged 18 years with a functioning graft for at least 1 year. Measures include demographic characteristics (age, gender, level of education, employment status, living arrangement, having children, invalidity and monthly incomes in the household), psycho-social characteristics measured by the perceived social support questionnaire, and medical characteristics (previous dialysis treatment, duration since transplantation, graft rejection episodes, chronic graft dysfunction, health status and comorbidities: neoplasia for the current transplant, hypertension, diabetes mellitus, smoking status, BMI > 30 kg/m2 and Charlson Comorbidity Index (CCI)). Polytomous linear regression analysis was performed to describe the Internet and social network users’ profiles, using lack of Internet access as the comparison category. Results Among the 1416 RTR participating in the study, 20.1% had no Internet access in the household, 29.4% connected to social networks and 50.5% were not connected to social networks. Patients who connected the most to the Internet and social networks were younger, male, without children, employed, with high monthly incomes in the household, without hypertension and having felt a need for an informative or an esteem support. Conclusion In our study, the majority of RTR were actively using Internet and social networks. Renal transplant units should develop flexible and Web-based sources related to transplant information, which will allow a rapid adaptation to changes in prevalent practice, improve the health of the patients and reflect their preferences

Omphalolith: An underdiagnosed entity

Abstract Omphalolith is a rare and underdiagnosed entity due to the accumulation of sebum and keratin in the umbilicus. It usually occurs in the elderly with deep and narrow umbilicus. Early recognition of omphalolith is important to prevent complications, unnecessary investigations, and anxiety. We report herein two new cases of omphalolith

Selective reporting of antibiotic susceptibility testing results: a promising antibiotic stewardship tool

International audienc

Factors associated with Health-Related Quality of Life in Kidney Transplant Recipients in France

Abstract Background Health-Related Quality of Life (HRQoL) assessment after kidney transplantation has become an important tool in evaluating outcomes. This study aims to identify the associated factors with HRQoL among a representative sample size of Kidney Transplant Recipients (KTR) at the time of their inclusion in the study. Methods Data of this cross-sectional design is retrieved from a longitudinal study conducted in five French kidney transplant centers in 2011, and included KTR aged 18 years with a functioning graft for at least 1 year. Measures include demographic, psycho-social and clinical characteristics. To evaluate HRQoL, the Short Form-36 Health Survey (SF-36) and a HRQoL instrument for KTR (ReTransQol) were administered. Multivariate linear regression models were performed. Results A total of 1424 patients were included, with 61.4% males, and a mean age of 55.7 years (±13.1). Demographic and clinical characteristics were associated with low HRQoL scores for both questionnaires. New variables were found in our study: perceived poor social support and being treated by antidepressants were associated with low scores of Quality of Life (QoL), while internet access was associated with high QoL scores. Conclusion The originality of our study’s findings was that psycho-social variables, particularly KTR treated by antidepressants and having felt unmet needs for any social support, have a negative effect on their QoL. It may be useful to organize a psychological support specifically adapted for patients after kidney transplantation