#1111 The impact of the Covid-19 pandemic on mortality: a study based on the National Health Data System (SNDS)

International audienceBackground and Aims The Covid-19 pandemic had a major impact on healthcare systems, challenging the continuity of chronic disease management. Patients with Chronic Kidney Disease (CKD) were identified as particularly at risk. The aim of this study was to measure the impact of the Covid-19 pandemic on their mortality using the French National Health Data System (SNDS). Method The SNDS contains the outpatient and inpatient care of all the French population. We applied an algorithm to identify individuals with CKD based on the healthcare consumption available in the SNDS. We identified two cohorts: individuals identified with CKD in 2016 and in 2019. These two cohorts were followed for one year after the year of identification. Patients’ characteristics were extracted from the SNDS and compared between the two cohorts. The event of interest was death documented in the SNDS with death certificates. The follow-up year was divided into periods according to the chronology of the epidemic: pre-epidemic, first lockdown, post-lockdown and second lockdown. Results The 2016 and 2019 cohorts included 570,701 and 674,008 individuals respectively. The two cohorts didn't differ in terms of age and sex or comorbidities (median age = 76 years old, 51% female). At 31/12 of the year following identification, 10.90% (n = 62,234) of the 2016 cohort had died, compared with 10.94% (n = 76,756) of the 2019 cohort. Among the 60-year-old and less, mortality in the 2019 cohort was lower than the mortality in the 2016 cohort in all periods of the follow-up year. This remained true among those aged ≥60 years old during the pre-epidemic period (Week 1-Week 10). During the first week of the first lockdown, the instantaneous risk of death for the 2019 cohort reached 5.42 individuals per 1000 in the ≥75-year-old group, compared with 3.12 in the equivalent period for the 2016 cohort (+68%). Conclusion All results suggest overall lower mortality in the 2019 cohort of CKD. However, an increase in mortality was observed during strong epidemic periods in the age group of those over 75. These results will be completed with the analyses of the healthcare consumption in the two cohorts describe above

Care trajectory differences in women and men with end-stage renal disease after dialysis initiation.

Few studies investigated sex-related differences in care consumption after dialysis initiation. Therefore, the aim of this study was to compare the care trajectory in the first year after dialysis start between men and women by taking into account the context of dialysis initiation. All patients who started dialysis in France in 2015 were included. Clinical data of patients and context of dialysis initiation were extracted from the Renal Epidemiology and Information Network (REIN) registry. Data on care consumption in the first year after dialysis start came from the French national health data system (SNDS): hospital stays 24h for kidney problems and hospital stays >24h for other problems, and consultations with a general practitioner. Variables were compared between men and women with the χ2 test and Student's or Welch t-test and logistic regression models were used to identify the factors associated with care consumption after dialysis start. The analysis concerned 8,856 patients (36% of women). Men were less likely to have a hospital stays >24h for kidney problems than women (OR = 0.8, 95% CI = [0.7-0.9]) and less general practitioner consultations (OR = 0.8, 95% CI = [0.8-0.9]), in the year after dialysis initiation, after adjustment on patient's characteristics. Moreover, hospital stays for vascular access preparation or maintenance were longer in women than men (median duration: 2 days [0-2] vs. 1 day [0-2], p < 0.001). In conclusion, despite greater comorbidities in men, this study found few differences in post-dialysis care trajectory between men and women

Pre-dialysis care trajectory and post-dialysis survival and transplantation access in patients with end-stage kidney disease

Online ahead of print.International audienceBackground: The pre-dialysis care trajectory impact on post-dialysis outcomes is poorly known. This study assessed survival, access to kidney transplant waiting list and to transplantation after dialysis initiation by taking into account the patients' pre-dialysis care consumption (inpatient and outpatient) and the conditions of dialysis start: initiation context (emergency or planned) and vascular access type (catheter or fistula).Methods: Adults who started dialysis in France in 2015 were included. Clinical data came from the French REIN registry and data on the care trajectory from the French National Health Data system (SNDS). The Cox model was used to assess survival and access to kidney transplantation.Results: We included 8856 patients with a mean age of 68 years. Survival was shorter in patients with emergency or planned dialysis initiation with a catheter compared to patients with planned dialysis with a fistula. The risk of death was lower in patients who were seen by a nephrologist more than once in the 6 months before dialysis than in those who were seen only once. The rate of kidney transplant at 1 year post-dialysis was lower for patients with emergency or planned dialysis initiation with a catheter (respectively, HR = 0.5 [0.4; 0.8] and HR = 0.7 [0.5; 0.9]) compared to patients with planned dialysis start with a fistula. Patients who were seen by a nephrologist more than three times between 0 and 6 months before dialysis start were more likely to access the waiting list 1 and 3 years after dialysis start (respectively, HR = 1.3 [1.1; 1.5] and HR = 1.2 [1.1; 1.4]).Conclusions: Nephrological follow-up in the year before dialysis initiation is associated with better survival and higher probability of access to kidney transplantation. These results emphasize the importance of early patient referral to nephrologists by general practitioners

Microbial transfers across a food chain: from grassland to cheese using metagenetic high-throughput sequencing approaches

International audienceIn the context of dramatic changes in food systems (climate, farming practices), a better understanding of microbial community drivers across a food chain is essential to address food quality and global health issues. This major challenge for microbial ecology is fully relevant for farms producing raw milk cheeses, which host a great diversity of interconnected holobionts (grassland, ruminant, human) and environmental microbiomes from soil to dairy product. To address these issues, we set up an experiment to compare agro-ecological (AE) vs intensive (IN) dairy farming systems and to test their response to a forage shortage (outcome of drought). Raw milk cheeses from both systems were fed to rats with humanised microbiota. The bacterial and fungal communities in 736 samples collected across the food chain were characterised by 16S rRNA and ITS genes high-throughput sequencing. Microbial transfers were explored through the analysis of Amplicon Sequence Variants (ASVs) shared between different ecosystems in the food chain. Dissimilarities in microbiota composition assessed using Bray-Curtis distance showed clustering of bacterial and fungal profiles according to their environment of origin. The farming system explained 12-28% of the variance observed in the bacterial community profiles along the food chain from soil to rat faeces. Bedding areas were highlighted as diversity hotspots for downstream microbiomes: above 84% of the teat, air and milk ASVs could originate from bedding. Lysinibacillus stood out as one indicator of the dairy system, showing an increased relative abundance in the faeces of AE cows and cascading effects into the microbiota of cheeses.HOLOFLUX flagship project TANDEM: https://www6.inrae.fr/holoflux/Nos-Actions/Projets-emblematiques/TANDE

TANDEM : Flux microbiens au sein d’une chaîne alimentaire

International audienc

TANDEM : Flux microbiens au sein d’une chaîne alimentaire

International audienc

TANDEM : Flux microbiens au sein d’une chaîne alimentaire

International audienc

TANDEM : Flux microbiens au sein d’une chaîne alimentaire

International audienc

TANDEM : Flux microbiens au sein d’une chaîne alimentaire

International audienc