Influence of Socio-Economic Inequalities on Access to Renal Transplantation and Survival of Patients with End-Stage Renal Disease

International audienceBACKGROUND: Public and scientific concerns about the social gradient of end-stage renal disease and access to renal replacement therapies are increasing. This study investigated the influence of social inequalities on the (i) access to renal transplant waiting list, (ii) access to renal transplantation and (iii) patients' survival.METHODS: All incident adult patients with end-stage renal disease who lived in Bretagne, a French region, and started dialysis during the 2004-2009 period were geocoded in census-blocks. To each census-block was assigned a level of neighborhood deprivation and a degree of urbanization. Cox proportional hazards models were used to identify factors associated with each study outcome.RESULTS: Patients living in neighborhoods with low level of deprivation had more chance to be placed on the waiting list and less risk of death (HR = 1.40 95%CI: [1.1-1.7]; HR = 0.82 95%CI: [0.7-0.98]), but this association did not remain after adjustment for the patients' clinical features. The likelihood of receiving renal transplantation after being waitlisted was not associated with neighborhood deprivation in univariate and multivariate analyses.CONCLUSIONS: In a mixed rural and urban French region, patients living in deprived or advantaged neighborhoods had the same chance to be placed on the waiting list and to undergo renal transplantation. They also showed the same mortality risk, when their clinical features were taken into accoun

Type 1 and type 2 diabetes and cancer mortality in the 2002-2009 cohort of 39 811 French dialyzed patients

International audienceEnd-stage renal disease is a chronic and progressive pathology associated with several comorbidities, particularly diabetes. Indeed, diabetes is the first cause of end-stage renal disease and, in France, 42% of incident patients had diabetes in 2012. In the general population, diabetes is associated with increased cancer risk. The aim of this study was to examine the association between risk of cancer death and diabetes in a large French cohort of patients with end-stage renal disease. Data on all patients with end-stage renal disease who initiated dialysis in France between 2002 and 2009 were extracted from the Renal Epidemiology Information Network registry. The risk of dying by cancer was studied using the Fine and Gray model to take into account the competing risk of death by other causes. We analyzed 39 811 patients with end-stage renal disease. Their mean age was 67.7±15 years, 39.4% had diabetes and 55.3% at least one cardiovascular disease. Compared with the non-diabetic group, patients with diabetes were older and had more cardiovascular and respiratory comorbidities when they started dialysis. Conversely, fewer diabetic patients had also a tumor at the beginning of the renal replacement therapy. Cancer was indicated as the cause of death for 6.7% of diabetic and 13.4% of non-diabetic patients. The Fine and Gray multivariate analyses indicated that diabetes (HR=0.72 95% CI: [0.68-0.95], p\textless0.001) and also female gender, peritoneal dialysis, cardio-vascular disease and kidney transplantation were associated with decreased risk of death by cancer. In this French cohort of patients with end-stage renal disease, diabetes was not associated with a significant increased risk of dying from cancer. Studies on the incidence of cancer in patients with ESRD are now needed to evaluate the potential association between diabetes and specific malignancies in this population

Long-term clinical and angiographic outcome of the Woven EndoBridge (WEB) for endovascular treatment of intracranial aneurysms

The Woven EndoBridge (WEB) is a well-established device for endovascular treatment of wide-necked bifurcation aneurysms. The objective was to evaluate the long-term angiographic outcome of the WEB and to identify factors that influence aneurysm occlusion. Patient, aneurysm and procedural characteristics of 213 consecutive patients treated with the WEB at three German tertiary care centers between 2011 and 2020 were retrospectively reviewed. Aneurysm occlusion was determined immediately after the procedure, at mid-term ( 12 months) follow-up. Among 182 included aneurysms (mean diameter: 7.0 +/- 2.4, mean neck width: 4.3 +/- 1.6 mm), 29.7% were ruptured. The novel WEB 17 was used in 41.8%, and 11.0% were treated in combination with coiling and/or stenting. Complete and adequate occlusions were observed in 101/155 (65.2%) and 133/155 (85.8%) at mid-term, respectively, and in 59/94 (62.8%) and 87/94 (92.6%) at long-term follow-up (median: 19 months), respectively. Among 92 patients available for both mid- and long-term follow-up, occlusion was stable in 72.8%, improved in 16.3% and worsened in 10.9%. There were no major recurrences leading to aneurysm remnants between mid- and long-term follow-up. Retreatment was performed in 10/155 (6.5%) during mid-term and in 1/94 (1.0%) during long-term follow-up. The WEB provides durable aneurysm occlusion at the long-term. Nevertheless, follow-up imaging is necessary to identify late recurrences that may occur in around 10%

Intrasaccular Flow Disruption with the Woven EndoBridge for Narrow-Necked Aneurysms: A Safety and Feasibility Study

OBJECTIVE: The Woven EndoBridge (WEB) received U.S. Food and Drug Administration approval for endovascular treatment of wide-necked bifurcation aneurysms. We evaluated the feasibility, safety, and efficacy of the WEB for treatment of narrow-necked aneurysms. METHODS: This multicenter study included 17 narrow necked aneurysms, defined by a neck width 2. Aneurysm characteristics, treatment strategies, technical success, complications, and angiographic outcomes were retrospectively assessed. RESULTS: Aneurysm locations included the internal carotid artery (7 cases), anterior communicating artery (4 cases), middle cerebral artery (4 cases), and basilar artery (2 cases). The median aneurysm size was 7.4 mm with a median neck width of 2.3 mm. The technical success rate was 100%. There were no neurological complications. Angiographic control revealed complete and adequate occlusion in 13 of 15 (86.7%) and 14 of 15 (93.3%) cases, respectively, after 6 months and in 6 of 7 (85.6%) and 7 of 7 (100%) cases, respectively, after a median of 13 months. Two aneurysms were retreated with flow diverters. CONCLUSIONS: WEB embolization of narrow-necked aneurysms was technically feasible and safe and might be considered as an alternative treatment option to conventional coiling in selected cases. - RESULTS: Aneurysm locations included the internal carotid artery (7 cases), anterior communicating artery (4 cases), middle cerebral artery (4 cases), and basilar artery (2 cases). The median aneurysm size was 7.4 mm with a median neck width of 2.3 mm. The technical success rate was 100%. There were no neurological complications. Angiographic control revealed complete and adequate occlusion in 13 of 15 (86.7%) and 14 of 15 (93.3%) cases, respectively, after 6 months and in 6 of 7 (85.6%) and 7 of 7 (100%) cases, respectively, after a median of 13 months. Two aneurysms were retreated with flow diverters

Characteristics of patients with ESRD at dialysis initiation.

<p>*After adjusting for sex and age</p><p>^†Cardio-vascular diseases included: myocardial infarction, arrhythmias, coronary insufficiency, heart failure, lower limbs arteritis, cerebrovascular accident.</p><p>^‡Solid tumors and hematological malignancies</p><p>^sBMI: Body Mass Index</p><p>Characteristics of patients with ESRD at dialysis initiation.</p

Factors associated with death by cancer in the Fine and Gray analysis.

<p>*HR: Hazard Ratio; CI: Confidence Interval</p><p>^¶RRT: Renal Replacement Therapy</p><p>^#PD: Peritoneal Dialysis; HD: Hemodialysis</p><p>^‡Solid tumors and hematological malignancies</p><p>^†Cardio-vascular diseases included: myocardial infarction, arrhythmias, coronary insufficiency, heart failure, lower limbs arteritis, cerebrovascular accident</p><p>^sBMI: Body Mass Index</p><p>Factors associated with death by cancer in the Fine and Gray analysis.</p

Factors associated with death by cancer in the Fine and Gray analysis.

<p>*HR: Hazard Ratio; CI: Confidence Interval</p><p>Factors associated with death by cancer in the Fine and Gray analysis.</p

Association between patients’ characteristics and access to renal transplantation after placement on the waiting list (univariate and multivariate Cox analyses).

<p>Association between patients’ characteristics and access to renal transplantation after placement on the waiting list (univariate and multivariate Cox analyses).</p