Anti-glomerular basement membrane disease, ulcerative colitis, and primary sclerosing cholangitis: link or co-incidence?

International audienceUlcerative colitis, primary sclerosing cholangitis, and anti-glomerular basement membrane disease (anti-GBM) are three rare immune diseases with incompletely under-stood pathogenic mechanisms. We describe here the case of a 29-year-old man with ulcer-ative colitis and primary sclerosing cholang -itis who, eight years later, developed anti-GBM disease with destruction of all glomeruli leading to end-stage kidney disease. Association of these three immune diseases in the same patient has never been described. Because HLA-mediated susceptibility cannot be incriminated completely in our case, we hypothesize that environmental factors or previous immunosuppressive treatment used might be the link

Characteristics and treatment course of patients older than 75 years, reaching end-stage renal failure in France. The PSPA study.

International audienceBACKGROUND: The age of patients with end-stage renal disease is increasing in Europe and United States. In France, patients older than 75 years represent 40% of the patients who start renal replacement therapy (dialysis or renal transplantation). In these elderly patients with many comorbidities, the benefit of dialysis remains controversial. To provide clear information to patients about diagnosis, prognosis, and all treatment options, more data are needed on their clinical characteristics, therapeutic projects, and outcome. METHODS: Researchers present here the ongoing Parcours de Soins des PersonnesAgées (PSPA) multicenter prospective study, which includes 581 patients with a mean age of 82±5 years and an estimated glomerular filtration rate (by sMDRD) of 14±4ml/min/1.73m(2) without dialysis. RESULTS: Despite a high prevalence of associated comorbidities, most of the patients are autonomous, living at home. Less than 10% are followed jointly by a nephrologist and a geriatrician. At inclusion, postponed dialysis decision due to stable estimated glomerular filtration rate was reported in 43%, 17% of the patients are under evaluation, the decision to start dialysis was chosen in 24% of the patients, nondialysis decision was decided in 16%. CONCLUSIONS: Geriatricians' expertise may help nephrologists to identify patients at high risk of early death for who nondialysis care may be discussed. They also may be more able to evaluate and anticipate the impact of such restricting treatments. A multidisciplinary approach of these old and frail patients' needs to be reinforced

LE MELPHALAN A DOSE INTERMEDIAIRE (ALTERNATIVE THERAPEUTIQUE AU TRAITEMENT DU MYELOME AVEC INSUFFISANCE RENALE)

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

1er Séminaire international de néphro-épidémiologie – Paris, 22 et 23 mai 2012 [The First International Seminars on renal Epidemiology held In Paris,France, in May 2012]

National audienceCe symposium de deux jours a pour vocation de devenir une rencontre biennale qui réunit ensemble néphrologues et épidémiologistes impliqués dans la nephroépidémiologie dans le monde entier. Le sujet de ce premier séminaire était de montrer en quoi l’épidémiologie peut aider les néphrologues dans leurs décisions. Autour de sept sessions de communications orales, plusieurs questions ont été abordées. À chaque fois, les aspects méthodologiques et les résultats d’études ont été présentés

Daily hemodialysis practices in Australia/New Zealand and in France a comparative cohort study

International audienceBackground - As patients on daily hemodialysis (DHD) have heterogeneous profiles, DHD benefit in terms of survival is still debated. The aim of this study was to compare DHD practices in France and in Australia and New Zealand.Methods - This study was based on data from the French Renal Epidemiology and Information Network (REIN) and the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). All incident patients from both registries who underwent DHD (i.e., 5-6 sessions/week, including short daily hemodialysis and long nocturnal hemodialysis) at least once during their trajectories were included, and their characteristics and care trajectories were compared. For survival analyses, one French patient was matched to one Australian or New Zealand patient, based on age, sex and year of dialysis start. Survival was assessed using the Cox proportional hazards model, and access to renal transplantation was evaluated using the Fine & Gray model to take into account death as competing risk.Results - Between 2003 and 2012, 523 patients from the AZNDATA and 753 from the REIN registry started DHD. ANZDATA patients were younger (54.8 vs 64.0 years, p < 0.001) and had comorbidities more frequently than French patients. In both registries, one third of patients were on early DHD (i.e., DHD started less than one year after dialysis initiation). Long nocturnal hemodialysis was more frequent in the ANZDATA than in the REIN cohort (20.8 and 3%, respectively). Comparison of the matched subgroups showed comparable survival rates between French and Australian/New Zealand patients (HRadjusted = 1.08; 95%CI: 0.78-1.50). Access to renal transplantation also was similar between matched groups (SHRadjusted = 1.30, 95%CI: 0.86-1.97).Conclusions - Our study shows that, despite differences in terms of patients' characteristics and DHD regimens, the mortality risk and access to renal transplantation are similar in France and Australia and New Zealand

Systemic sclerosis and end-stage renal disease: study of patient characteristics, follow-up and outcomes in France

International audienceBackground - Scleroderma renal crisis (SRC), the most frequent renal complication of Systemic Sclerosis (SSc), can lead to end-stage renal disease (ESRD), most frequently, but not exclusively, because of scleroderma renal crisis (SRC). Methods - The main objectives of our study using data extracted from the French renal epidemiology and information network (REIN) registry, were to describe the characteristics and outcomes in an incident French cohort of SSc patients requiring renal replacement therapy (RRT) compared with a matched RRT patient sample. Results - Between 2002 and 2014, 120 incident SSc patients started RRT in France. SSc was significantly associated with higher mortality (HR 1.95; 95% CI 1.41-2.71; p = 0.001) in comparison with matched controls. Among SSc patients in dialysis, besides age, the only risk factor independently associated with mortality was the inability to walk without help (HR 2.34, CI 95% 1.37-4.02, p = 0.002). Dialysis withdrawal was reported for 22 (18.3%) of the SSc patients compared to 15 (6.3%) for the controls. Patients with SSc have less access to transplantation waiting list (HR 0.21; CI 95% 0.11-0.41, p < 0.001) and to kidney transplantation (KTR) (HR 0.22; 95% CI 0.12-0.43; p < 0.001). During the follow-up, 6 of the 27 patients (22.2%) registered on KTR waiting list died compared to 69 of the 93 (74.2%) patients who were not on the waiting list. Conclusions - The prognosis for SSc patients requiring RRT is still poor, with a significantly higher mortality and lower registration on kidney transplant waiting-list compared to matched controls

Contribution of medico-administrative data to the development of a comorbidity score to predict mortality in End-Stage Renal Disease patients

International audienceComorbidity scores to predict mortality are very useful to facilitate decision-making for personalized patient management. This study aim was to assess the contribution of medico-administrative data in addition to French Renal Epidemiology and Information Network (REIN) data to the development of a risk score to predict the 1-year all-cause mortality in patients with End Stage Renal Disease (ESRD), and to compare it with previous scores. Data from a derivation sample (n = 6336 patients who started dialysis in 2015 in France) obtained by linking the REIN and the French National Health Insurance Information System databases were analyzed with multivariate Cox models to select risk factors to establish the score. A randomly chosen validation sample (n = 2716 patients who started dialysis in 2015) was used to validate the score and to compare it with the comorbidity indexes developed by Wright and Charlson. The ability to predict one-year mortality of the score constructed using REIN data linked to the medico-administrative database was not higher than that of the score constructed using only REIN data (i.e., Rennes score). The Rennes score included five comorbidities, albumin, and age. This score (AUC = 0.794, 95%CI: 0.768-0.821) outperformed both the Wright (AUC = 0.631, 95%CI: 0.621-0.639; p < 0.001) and Charlson (AUC = 0.703, 95%CI: 0.689-0.716; p < 0.001) indexes. Data from the REIN registry alone, collected at dialysis start, are sufficient to develop a risk score that can predict the one-year mortality in patients with ESRD. This simple score might help identifying high risk patients and proposing the most adapted care

The clinical characteristics of HIV-infected patients receiving dialysis in France between 1997 and 2002

The clinical characteristics of HIV-infected patients receiving dialysis in France between 1997 and 2002.BackgroundIn 1997, 0.38% of dialysis patients in France were infected by human immunodeficiency virus (HIV). No prevalence data were available in France since the widespread introduction of highly active antiretroviral therapy.MethodsThis was a cross-sectional epidemiologic survey. A questionnaire was sent to all French dialysis centers in July 2002. The centers that did not respond were sent 3 additional mailing reminders. Finally, the nonresponding centers were called early in 2004.ResultsOf the 27,577 patients on hemodialysis and 587 patients on peritoneal dialysis, 190 patients (0.67%) were infected by HIV. HIV-associated nephropathy was the cause of renal failure in 39.8% patients. Mean age was 44.6 ± 10.9 years, the mean duration of dialysis was 4.9 ± 5.9 years, the mean known duration of HIV infection was 8.9 ± 5.6 years. Eighty-two percent of patients received antiretroviral therapy (ART). Fifty-eight percent of ART-treated patients had an undetectable HIV plasma viral load with a median CD4+ T-cell count 303/mm3.ConclusionThe prevalence of HIV infection among French dialysis patients was 0.67% in late 2002, a 79% increase since 1997. Possible reasons for this large increase include increased access to dialysis, better general status of HIV dialysis patients, and increasing proportion of patients originating from Africa and the Caribbean. The current efficacy of ART makes renal transplantation a realistic option for these young patients