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La possibilité de rapprocher de façon indirecte les données du registre REIN et les données du Système National de Données de Santé permet d'enrichir la connaissance sur le parcours des patients atteints d'une maladie rénale sévère. S'intéresser aux hospitalisations permet d'appréhender le poids de cette maladie, à la fois pour les patients, en termes de comorbidités, complications et qualité de vie, mais également pour la société en termes de charge en soins, de besoin d'organisation de l'offre de soins et de coûts. Les patients présents en dialyse en 2019 ont été identifiés à partir des données du REIN. L'information sur les séjours hospitaliers est issue d'une extraction du Système National de Données de Santé appariées à REIN. Le taux d'hospitalisations correspond au nombre de séjours hospitaliers sur la période, rapporté au nombre de personnes à risque en dialyse sur la période. Après exclusion des séances de dialyse, 36 962 patients sur 59 137 ont eu un séjour hospitalier dans l'année 2019 : 36 738 en médecine–chirurgie–obstétrique, 2863 en soins de suite et de réadaptation, 531 en hôpital de jour et 201 en psychiatrie. Cela représente un total de 146 743 séjours, dont 140 372 en médecine–chirurgie–obstétrique. Le taux d'hospitalisations en médecine–chirurgie–obstétrique est de 259 séjours pour 100 personnes-année. Les motifs varient selon l'âge, le type d'hospitalisation (avec ou sans nuitées) et le mode de sortie (domicile, décès ou transfert/mutation). Les montants médians pour un séjour varient de 7920 € en soins de suite et de réadaptation à 719 € en médecine–chirurgie–obstétrique sans nuitée. Du fait des volumes, les séjours pour pathologie cardiovasculaire représentent un montant total élevé sur l'année. Les hospitalisations pour infection ont des coûts médians importants. Les résultats présentés dans cet article confirment la place importante de l'hospitalisation dans la trajectoire des patients dialysés. Les hospitalisations en médecine–chirurgie–obstétrique représentent 96 % des hospitalisations. Pour la première fois, cette étude montre la très faible place des hospitalisations en psychiatrie et en soins de suite et de réadaptation. The possibility of indirect linkage between data from the French REIN registry and data from the National Health Data System makes it possible to enhance knowledge of the care pathway of patients with severe kidney disease. Taking an interest in hospitalizations makes it possible to understand the burden of this disease, both for patients, in terms of comorbidities, complications and quality of life but also for society in terms of care load, need for organization of the care offer and costs. Patients on dialysis in 2019 were identified from REIN. The information on hospital stays comes from an extraction of the National Health Data System linked with REIN. The hospitalization rate corresponds to the number of hospital stays over the period, relative to the number of people at risk on dialysis over the period. After excluding dialysis sessions, 36,962 patients had a hospital stay in 2019: 36,738 in medicine, surgery, obstetrics, 2863 in rehabilitation, 531 in home hospitalizations and 201 in psychiatry facilities. This represents a total of 146,743 stays, including 140,372 in medicine, surgery, obstetrics. The hospitalization rate in medicine, surgery, obstetrics is 259 stays for 100 person-years. The reasons vary according to age, type of hospitalization (with or without overnight stays) and mode of discharge (home, death or transfer). The median amounts for a stay vary from €7920 in rehabilitation to €719 in medicine, surgery, obstetrics without overnight stay. Due to the volumes, stays for cardiovascular pathology represent a high total amount over the year. Hospitalizations for infection have significant median costs. The results presented in this article confirm the important place of hospitalization in the trajectory of dialysis patients. Hospitalizations in medicine, surgery, obstetrics represent 96% of hospitalizations. For the first time, this study shows the very low place of hospitalizations in psychiatry and rehabilitation facilities. [ABSTRACT FROM AUTHOR]

Des progrès majeurs ont été réalisés dans la prise en charge des enfants avec une maladie rénale chronique au cours des 30 dernières années. Cependant, les données épidémiologiques pédiatriques existantes proviennent essentiellement des registres de traitement de suppléance de l'insuffisance rénale terminale, et les informations disponibles aux stades plus précoces de maladie rénale chronique sont limitées. L'incidence et la prévalence de la maladie rénale chronique de stades 2 à 5 restent mal connues. De rares études en population suggèrent toutefois que la prévalence de la maladie rénale chronique tous stades confondus pourrait concerner 1 % de la population pédiatrique. Les désordres congénitaux incluant les hypodysplasies rénales et uropathies malformatives (Congenital abnormalities of the kidney and urinary tract) et les néphropahies héréditaires sont responsables de la moitié à deux tiers des cas de maladie rénale chronique de l'enfant dans les pays industrialisés, alors que les néphropathies acquises prédominent dans les pays en développement. La progression de la maladie rénale chronique est plus lente chez les enfants avec un désordre congénital que chez ceux ayant une néphropathie acquise en particulier glomérulaire, résultant en une plus faible proportion de Congenital abnormalities of the kidney and urinary tract comme cause d'insuffisance rénale terminale par rapport aux stades moins avancés de maladie rénale chronique. L'incidence du traitement de suppléance rénale dans la population pédiatrique variait selon les pays de 1 à 14 par million d'enfants du même âge en 2018 (environ 8 par million d'enfants en France) chez les patients de moins de 20 ans. La prévalence du traitement de suppléance rénale chez les moins de 20 ans en 2018 variait de 15 à 30 par million d'enfants dans certains pays d'Europe de l'Est et d'Amérique latine à 100 par million d'enfants en Finlande et aux États-Unis (56 par million d'enfants en France). La plupart des enfants atteints d'insuffisance rénale terminale démarrent un traitement de suppléance par dialyse (plus fréquemment hémodialyse que dialyse péritonéale). Dans environ 20 % des cas, le traitement initial est une greffe rénale préemptive. Dans les pays industrialisés, 60 à 80 % des patients prévalents vivent avec un greffon fonctionnel (75 % en France). Alors que la survie des enfants atteints de maladie rénale chronique s'est continuellement améliorée au cours du temps, la mortalité reste de l'ordre de 30 fois supérieure à celle de la population générale pédiatrique. Major advances have been made in the management of children with chronic kidney disease over the past 30 years. However, existing epidemiology data are primarily from kidney replacement therapy registries, and information available at earlier stages of chronic kidney disease is limited. The incidence and prevalence of chronic kidney disease stages 2 to 5 remain poorly understood. However, rare population-based studies suggest that the prevalence of all-stage chronic kidney disease may be as high as 1% of the pediatric population. Congenital disorders including congenital abnormalities of the kidney and urinary tract and hereditary nephropathies account for one-half to two-thirds of pediatric chronic kidney disease cases in middle and high-income countries, whereas acquired nephropathies seem to predominate in low-income countries. The progression of chronic kidney disease is slower in children with congenital disorders than in those with acquired nephropathy, particularly glomerular disease, resulting in a lower proportion of congenital abnormalities of the kidney and urinary tract as a cause of end-stage kidney disease compared to less advanced stages of chronic kidney disease. The incidence of kidney replacement therapy in the pediatric population ranged by country from 1 to 14 per million children of the same age in 2018 (approximately 8 per million children in France) in patients younger than 20 years. The prevalence of kidney replacement therapy in children under 20 years of age in 2018 ranged from 15-30 per million children in some Eastern European and Latin American countries to 100 per million children in Finland and the United States (56 per million children in France). Most children with end-stage kidney disease initiate kidney replacement therapy with dialysis (more frequently hemodialysis than peritoneal dialysis). In about 20% of cases, the initial kidney replacement therapy modality is a pre-emptive kidney transplantation. In high-income countries, 60-80% of prevalent children with end-stage kidney disease live with a functioning transplant (75% in France). While the survival of children with chronic kidney disease has continuously improved over time, mortality remains about 30 times higher than in the general pediatric population. [ABSTRACT FROM AUTHOR]

Le registre REIN a pour objectif, depuis 2001, de recenser les patients souffrant d'insuffisance rénale chronique terminale et bénéficiant d'un traitement de suppléance sur le territoire français. L'analyse des trajectoires vise à évaluer les flux de patients entre les différentes modalités de traitement afin de mieux connaître et prévoir leurs parcours. L'objectif de la présente étude était d'analyser les trajectoires entrantes et sortantes à 1 an des patients prévalents du registre REIN au 31 décembre 2017. L'analyse des trajectoires a été effectuée sur les patients prévalents au 31 décembre 2017 en étudiant la modalité de traitement antérieure au 31 décembre 2016 et la modalité ultérieure au 31 décembre 2018, puis en sous-groupe pour chacune des 5 modalités de traitement retenues. Les analyses ont porté sur un total de 85 472 patients. Plus de 20 % des sujets présentaient une insuffisance rénale chronique terminale découverte dans l'année. On observait une relative stabilité des flux entrants dans les modalités hémodialyse en centre ou autonome, dialyse péritonéale, et greffe, contrairement à l'hémodialyse en Unité de dialyse médicalisée. Pour les flux sortants, une proportion de décès à un an de 9 % était constatée. La dialyse péritonéale était la modalité avec la proportion la plus élevée de patients sortis à 1 an. L'analyse des trajectoires des patients montre des profils d'évolution variables, selon les modalités de traitement, et pourrait ainsi constituer un outil précieux dans l'évaluation et l'amélioration de la prise en charge et de l'offre de soins de l'insuffisance rénale chronique terminale. Since 2001, the aim of the REIN registry has been to identify patients suffering from end-stage renal disease and benefiting from replacement therapy in France. The analysis of trajectories aims to evaluate the flow of patients between the different types of treatment in order to better understand and predict patient pathways. The objective of this study was to analyse the incoming and outgoing flows at 1 year of patients prevalent in the REIN registry on 12/31/2017. Flow analysis was carried out on patients prevalent on 12/31/2017 in the REIN registry by studying the before and after treatment modalities on 12/31/2016 and 12/31/2018. This analysis was initially carried out on all patients, then in sub-groups for each of the 5 treatment modalities. The analyses covered 85,472 patients prevalent on 12/31/2017. The overall analysis showed that more than 20% of patients had been diagnosed with end-stage renal disease the year before. Regarding inflow, there was a relative stability for patients treated with self-care hemodialysis, in-center haemodialysis, peritoneal dialysis, and graft, in contrast to patients treated with hemodialysis in a medical unit. Regarding outgoing flows, proportion of deaths at one year was 9%. Peritoneal dialysis was the modality with the highest outflow proportion at one year. Analysis of patients' trajectories shows variable evolution profiles according to treatment modality and thus could be a valuable tool in the evaluation and improvement of management and care in the field of end-stage renal disease. [ABSTRACT FROM AUTHOR]

Dans le contexte d'explosion démographique de la maladie rénale chronique en France et de l'inadéquation de celle des néphrologues, le recours à la e-santé va être indispensable. Nous avons voulu faire un premier état des lieux des pratiques actuelles en France. La « télénéphrologie » regroupe toutes les pratiques de e-santé par les néphrologues, en particulier les actes de télémédecine : téléconsultation, télésurveillance et téléassistance. Nous avons également étudié leur relation aux objets connectés. Pour cela, nous avons développé un questionnaire validé par des membres du Club des Jeunes Néphrologues et de la Société Francophone de Néphrologie, Dialyse et Transplantation, qui a ensuite été diffusé à l'ensemble de la communauté néphrologique pendant les mois de juin et juillet 2017. Nous avons recueilli 175 réponses : tous les modes d'exercice de la discipline sont représentés et sont globalement comparables à la population en exercice en France. Les résultats montrent que les néphrologues sont connectés : la plupart d'entre eux sont présents sur les réseaux sociaux et une majorité utilise déjà des objets connectés, principalement pour leurs activités personnelles. Ils communiquent beaucoup entre eux et avec les patients par courrier électronique, et le dossier médical informatisé est très développé pour le suivi des patients en dialyse ou atteints de maladie rénale chronique. Ils sont majoritairement satisfaits des actes de télémédecine, mais il existe encore des freins (problèmes techniques, administratifs, modalités de financement) qu'il faudra prendre en compte pour accompagner le déploiement de ces techniques. En conclusion, les néphrologues sont déjà connectés, mais ont encore besoin d'aide pour développer l'utilisation de ces nouveaux outils au quotidien. The number of new patients with chronic kidney diseases strongly increases while the one of nephrologists does not: this is developing new challenges, in which e-health will take a special part. This field is poorly investigated: so, we developed a dedicated survey. Telenephrology is a new approach that includes all what nephrologists can do in their routine practice: especially, telehealth with teleconsulting, telesurvey, and helpline. We also studied their relationship with m-health. The questionnaire was developed and validated by members from the Club des Jeunes Néphrologues and the Société Francophone de Néphrologie, Dialyse et Transplantation: it was then broadcast to all french nephrologists, thru web media. From June to July, 2017, we collected 175 answers: they represented all kinds of practices of the profession. Results show that French nephrologists are connected: most of them are present on social network(s) and/or uses connected objects, mostly for personal reasons. They communicate a lot, between them and/or with patients, mainly via email. Computerized medical records are mostly used in the follow-up of patients on renal dialysis or with chronic kidney diseases. Most of French nephrologists are satisfied by telenephrology but there are still obstacles to its deployment: mainly, technical, administrative, and/or billing difficulties. All should be taken into account to help telenephrology developing. In conclusion, French nephrologists are yet connected but they really need more help again to face new challenges raised by e-health. [ABSTRACT FROM AUTHOR]

Hemodiafiltration (HDF) is a renal replacement therapy that is based on the principles of diffusion and convection for the elimination of uremic toxins. A significant and increasing number of end-stage renal disease (ESRD) patients are treated with HDF, even in the absence of definite and conclusive survival and anemia treatment data. However, its effects on red blood cell (RBC) physiological features have not been examined in depth. In this study, ESRD patients under regular HDF or conventional hemodialysis (cHD) treatment were examined for RBC-related parameters, including anemia, hemolysis, cell shape, redox status, removal signaling, membrane protein composition, and microvesiculation, in repeated paired measurements accomplished before and right after each dialysis session. The HDF group was characterized by better redox potential and suppressed exovesiculation of blood cells compared with the cHD group pre-dialysis. However, HDF was associated with a temporary but acute, oxidative-stress-driven increase in hemolysis, RBC removal signaling, and stomatocytosis, probably associated with the effective clearance of dialyzable natural antioxidant components, including uric acid, from the uremic plasma. The nature of these adverse short-term effects of HDF on post-dialysis plasma and RBCs strongly suggests the use of a parallel antioxidant therapy during the HDF session. [ABSTRACT FROM AUTHOR]

Intradialytic exercise (IDE) has been shown to benefit dialysis efficacy; however, the effect of IDE intensity is unknown. Dialyzer urea clearance (K urea, mL/min) was significantly greater during both IDE protocols (55% and 70% maximal heart rate, HRmax), compared with no IDE ( p < 0.05). No significant difference in K urea was found between IDE protocols (55% vs. 70% HRmax) ( p > 0.05). Results show that higher intensity IDE has no additional benefit on K urea. [ABSTRACT FROM AUTHOR]

Résumé Une information précoce sur la transplantation rénale est recommandée afin de débuter rapidement, même au stade V de l’insuffisance rénale non dialysée, le processus d’inscription sur la liste de greffe. Il s’agit d’un choix stratégique dans le parcours patient. Dès l’arrivée de tous les patients dans notre centre de dialyse, une évaluation systématique de l’accès à la liste d’attente de greffe est mise en place grâce à un chemin clinique. L’impact de cette nouvelle organisation a été évalué à 18 mois au regard de l’information sur la transplantation rénale transmise au patient, du temps nécessaire pour la complétude du bilan pré-transplantation rénale et de mise en contre-indication. Sur les 78 patients incidents, 64 ont reçu les informations concernant la transplantation rénale. À 18 mois, 50 chemins cliniques sont finalisés au moment de l’analyse, dont 25 avec un délai inférieur à 6 jours et 25 avec un délai médian de 169 jours. Une différence significative d’âge existe entre les deux groupes. Les principales causes de contre-indications médicales définitives ont été évaluées. De plus, 22 % des chemins cliniques finalisés sont en attente de levée de contre-indication temporaire. La prise en charge du patient est améliorée grâce à une motivation de toutes les équipes soignantes et un travail considérable de coordination entre le secrétariat et le service de transplantation du centre hospitalier universitaire. Early information about the kidney transplant is recommended to begin quickly the process of registration on the kidney transplantation waiting list, even for the patients not dialyzed at stage V of the renal insufficiency. It is a strategic choice for the patient care. From the arrival of all the patients in our center of dialysis, a systematic evaluation of the access to the kidney transplant waiting list is organized thanks to a clinical pathway. The impact of this new organization was estimated at 18 months with regard to the information about the kidney transplant transmitted to the patient, of the time required for the assessment of pre-kidney transplant evaluation, and of putting in contraindication. On 78 incident patients, 64 received the information concerning the kidney transplant. After 18 months, 50 clinical pathways are finalized at the time of the analysis among which 25 with a period lower than 6 days and 25 with a median of 169 days. A significant difference of age exists between both groups. The main causes of definitive medical contraindications were estimated. Twenty-two percent of the clinical pathway finalized is awaiting lifting of temporary contraindication. The management of the patient is improved, due to motivation of all the medical teams and a considerable work of coordination between the secretarial department and the department of transplantation in teaching hospital. [ABSTRACT FROM AUTHOR]

Introduction: The possibility of indirect linkage between data from the French REIN registry and data from the National Health Data System makes it possible to enhance knowledge of the care pathway of patients with severe kidney disease. Taking an interest in hospitalizations makes it possible to understand the burden of this disease, both for patients, in terms of comorbidities, complications and quality of life but also for society in terms of care load, need for organization of the care offer and costs., Methods: Patients on dialysis in 2019 were identified from REIN. The information on hospital stays comes from an extraction of the National Health Data System linked with REIN. The hospitalization rate corresponds to the number of hospital stays over the period, relative to the number of people at risk on dialysis over the period., Results: After excluding dialysis sessions, 36,962 patients had a hospital stay in 2019: 36,738 in medicine, surgery, obstetrics, 2863 in rehabilitation, 531 in home hospitalizations and 201 in psychiatry facilities. This represents a total of 146,743 stays, including 140,372 in medicine, surgery, obstetrics. The hospitalization rate in medicine, surgery, obstetrics is 259 stays for 100 person-years. The reasons vary according to age, type of hospitalization (with or without overnight stays) and mode of discharge (home, death or transfer). The median amounts for a stay vary from €7920 in rehabilitation to €719 in medicine, surgery, obstetrics without overnight stay. Due to the volumes, stays for cardiovascular pathology represent a high total amount over the year. Hospitalizations for infection have significant median costs., Discussion and Conclusion: The results presented in this article confirm the important place of hospitalization in the trajectory of dialysis patients. Hospitalizations in medicine, surgery, obstetrics represent 96% of hospitalizations. For the first time, this study shows the very low place of hospitalizations in psychiatry and rehabilitation facilities., (Copyright © 2022. Published by Elsevier Masson SAS.)

This is a questionnaire based study of 69 patients with end stage renal disease (ESRD), our purpose was to determine factors affecting their quality of life (QOL). This is a questionnaire study covering a 12 month period. The study group were patients with ESRD whose clearance of creatinin were less than 15ml/min. patients who died shortly after arrival, those with acute renal failure and those undergoing dialysis were excluded. We used the SF36 questionnaire [8] and classified the results in two groups: scores lower than 50/100=poor QOL, scores exceed or equal to 50/100=good QOL. Factors making also into two groups; for limitations: cessation of all activities and additional effort required; for pain: severe and mild; for health: good and bad; for social and physical activities: reduced and not reduced. ESRD represents 30.8% of admissions in 12 months, for a total of 69 patients. Thirty-two (46.3%) had good QOL and 37 (53.7%) poor QOL. In the latter group, the average age was of 54±4, while in the good QOL group: the average age was 47.6 ± 4 (p=0.01). Patients in the good QOL group had better health overall (OR=0.42). Poor QOL patients had more severe pain (p=0.001); however good QOL didn’t protect against mental problems (p=0.866). Limitations due to mental status were more frequent at the poor QOL (p=0.01). Social activities were more reduced in the poor QOL group (p=0.0001) and there were more co-morbidities (29.7% with more than 4). In our study good QOL is associated with younger age, fewer comorbidities, less severe physical pain and fewer physical plus social limitations. QOL could substantially be improved by acting on modifiable factors such as better treatment for the co-morbidities, more effective pain control and assistance with their social and physical limitations. [ABSTRACT FROM AUTHOR]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

En 2019, l'hémodiafiltration est la technique de dialyse utilisée chez 35 % des patients en France. Ses conditions de mise en œuvre sont de plus en plus codifiées. Les générateurs avec automatisation de la réinjection du volume de substitution permettent d'obtenir des volumes convectifs importants. Les principaux déterminants du volume convectif sont le débit de la pompe à sang et la durée de la dialyse. La dose convective cible est d'au moins 23 litres. Des membranes de grande surface doivent être utilisées. Les membranes doivent être évaluées en termes d'efficacité et de sécurité. Les concentrés d'acide citrique ou chlorhydrique doivent être préférés à ceux contenant de l'acide acétique, afin de limiter les effets secondaires et l'instabilité hémodynamique. In 2019, hemodiafiltration is the technique of dialysis used in 35% of patients in France. Its conditions of implementation are increasingly codified. Generators with automation of the reinjection of the substitution volume make it possible to obtain large convective volumes. The main determinants of convective volume are the flow rate of the blood pump and the duration of dialysis. The target convective dose is at least 23 liters. Large area membranes should be used. Membranes must be evaluated in terms of efficacy and safety. Acid concentrates with citric or hydrochloric acid should be preferred over those with acetic acid, in order to limit side effects and hemodynamic instability. [ABSTRACT FROM AUTHOR]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction. – Calciphylaxis is a rare phenomenon of medium- and small-vessel calcifications leading to cutaneous necrosis mimicking a vasculitis. Case report. – A 75 year-old-woman with a chronic renal insufficiency is admitted for extensive cutaneous necrosis of the limb. A diagnose of vasculitis is evocated, but despite a corticosteroid therapy, the condition of the patient is worsening. After cutaneous biopsy re-reading, a diagnose of calciphylaxis is established. Conclusion. – A diagnose of calciphylaxis must be suspected in case of cutaneous necrosis occuring in a patient with chronic renal failure. Treatment requires rapid normalization of phosphocalcic balance. It is a high-mortality condition. [Copyright &y& Elsevier]

Abstract: Recent advances in the knowledge of physiology, genetics, imaging, and therapeutics have lead to novel practical approaches in paediatric nephrology. Many inherited syndromes have been revisited in order to identify precise renal diseases at the molecular level. In addition, a large number of epidemiological studies and clinical trials have allowed guidelines and recommendations to be provided for chronic and end-stage renal failure, urinary tract infection, glomerular diseases, etc. [Copyright &y& Elsevier]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Objectifs – Les résultats des revascularisations des membres inférieurs chez les malades en insuffisance rénale terminale sont discutés. L’objet de notre travail a été d’évaluer rétrospectivement nos résultats pour trouver les facteurs pronostic et préciser les indications de ces revascularisations. Méthode – Nous avons fait 50 revascularisations de membres inférieurs chez 41 malades en insuffisance rénale terminale. Suivant la classification de Leriche et Fontaine les membres étaient classés au stade II six fois, aux stades III et IV (ischémie critique chronique) 44 fois. Il s’agissait de 47 pontages sous-inguinaux et de trois autres revascularisations. Le suivi moyen a été de 17,0 ± –15,7 mois. Résultats – La mortalité opératoire a été de 12 % (n = 6). Nous avons fait une amputation majeure postopératoire et huit amputations majeures secondaires. Nous avons noté 26 décès secondaires dont 12 de cause cardiaque. À deux ans les taux de sauvetage de membre et de survie ont été de 77,2 ± 7,5 % et 42,9 ± 7,7 %. La perméabilité primaire a été de 53,5 ± 10,4 % la perméabilité secondaire de 70,6 ± 10 %. La qualité de vie a été évaluée comme bonne dans 28 % des revascularisations. Les facteurs pronostic mis en évidence ont été les antécédents cardiaques pour la survie, la qualité du lit d’aval et la thrombose du pontage pour le risque d’amputation. Conclusions – Les revascularisations de membres inférieurs chez les malades en insuffisance rénale terminale sont indiquées après une évaluation rigoureuse de l’indication où seront particulièrement ... [Copyright 2005 Elsevier]

Copyright of Diabetes & Metabolism is the property of Masson Editeur and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Diabetes & Metabolism is the property of Masson Editeur and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In France, the prevalence of End-Stage Renal Disease (ESRD) is not precisely known. The sources of information are scattered and not coordinated. Consequently, care is ill adapted to meet the demand. The Multi-Source Information System is the basis of the Renal Epidemiology and Information Network (REIN). It is dedicated to improve and organise our medical and epidemiological knowledge of ESRD and to aid public health decision-making in this area. The proposed approach is based on the datawarehouses. This model allows a unified vision of scattered data into distinct databases, for a better management, be it particular (patient follow-up) or global (regional follow-up), with a finality of aid in decision-making. Several categories of problems were considered: the global conception of the information system, the organisation of the datawarehouse, which offers different viewpoints of the data, the integration of heterogeneous data coming from different sources, data exchange and definition of a specific ontology. [Copyright &y& Elsevier]

Major advances have been made in the management of children with chronic kidney disease over the past 30 years. However, existing epidemiology data are primarily from kidney replacement therapy registries, and information available at earlier stages of chronic kidney disease is limited. The incidence and prevalence of chronic kidney disease stages 2 to 5 remain poorly understood. However, rare population-based studies suggest that the prevalence of all-stage chronic kidney disease may be as high as 1% of the pediatric population. Congenital disorders including congenital abnormalities of the kidney and urinary tract and hereditary nephropathies account for one-half to two-thirds of pediatric chronic kidney disease cases in middle and high-income countries, whereas acquired nephropathies seem to predominate in low-income countries. The progression of chronic kidney disease is slower in children with congenital disorders than in those with acquired nephropathy, particularly glomerular disease, resulting in a lower proportion of congenital abnormalities of the kidney and urinary tract as a cause of end-stage kidney disease compared to less advanced stages of chronic kidney disease. The incidence of kidney replacement therapy in the pediatric population ranged by country from 1 to 14 per million children of the same age in 2018 (approximately 8 per million children in France) in patients younger than 20 years. The prevalence of kidney replacement therapy in children under 20 years of age in 2018 ranged from 15-30 per million children in some Eastern European and Latin American countries to 100 per million children in Finland and the United States (56 per million children in France). Most children with end-stage kidney disease initiate kidney replacement therapy with dialysis (more frequently hemodialysis than peritoneal dialysis). In about 20% of cases, the initial kidney replacement therapy modality is a pre-emptive kidney transplantation. In high-income countries, 60-80% of prevalent children with end-stage kidney disease live with a functioning transplant (75% in France). While the survival of children with chronic kidney disease has continuously improved over time, mortality remains about 30 times higher than in the general pediatric population., (Copyright © 2021 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Context and Objectives: Since 2001, the aim of the REIN registry has been to identify patients suffering from end-stage renal disease and benefiting from replacement therapy in France. The analysis of trajectories aims to evaluate the flow of patients between the different types of treatment in order to better understand and predict patient pathways. The objective of this study was to analyse the incoming and outgoing flows at 1 year of patients prevalent in the REIN registry on 12/31/2017., Methods: Flow analysis was carried out on patients prevalent on 12/31/2017 in the REIN registry by studying the before and after treatment modalities on 12/31/2016 and 12/31/2018. This analysis was initially carried out on all patients, then in sub-groups for each of the 5 treatment modalities., Results: The analyses covered 85,472 patients prevalent on 12/31/2017. The overall analysis showed that more than 20% of patients had been diagnosed with end-stage renal disease the year before. Regarding inflow, there was a relative stability for patients treated with self-care hemodialysis, in-center haemodialysis, peritoneal dialysis, and graft, in contrast to patients treated with hemodialysis in a medical unit. Regarding outgoing flows, proportion of deaths at one year was 9%. Peritoneal dialysis was the modality with the highest outflow proportion at one year., Conclusion: Analysis of patients' trajectories shows variable evolution profiles according to treatment modality and thus could be a valuable tool in the evaluation and improvement of management and care in the field of end-stage renal disease., (Copyright © 2021 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

The number of new patients with chronic kidney diseases strongly increases while the one of nephrologists does not: this is developing new challenges, in which e-health will take a special part. This field is poorly investigated: so, we developed a dedicated survey. Telenephrology is a new approach that includes all what nephrologists can do in their routine practice: especially, telehealth with teleconsulting, telesurvey, and helpline. We also studied their relationship with m-health. The questionnaire was developed and validated by members from the Club des Jeunes Néphrologues and the Société Francophone de Néphrologie, Dialyse et Transplantation: it was then broadcast to all french nephrologists, thru web media. From June to July, 2017, we collected 175 answers: they represented all kinds of practices of the profession. Results show that French nephrologists are connected: most of them are present on social network(s) and/or uses connected objects, mostly for personal reasons. They communicate a lot, between them and/or with patients, mainly via email. Computerized medical records are mostly used in the follow-up of patients on renal dialysis or with chronic kidney diseases. Most of French nephrologists are satisfied by telenephrology but there are still obstacles to its deployment: mainly, technical, administrative, and/or billing difficulties. All should be taken into account to help telenephrology developing. In conclusion, French nephrologists are yet connected but they really need more help again to face new challenges raised by e-health., (Copyright © 2019. Published by Elsevier Masson SAS.)

Résumé En transplantation rénale, plusieurs scores ont été récemment développés afin d’aider la prise de décision en pratique clinique. L’objectif de cette mise au point est de mettre l’accent sur ces nouveaux scores qui permettent de mieux évaluer la qualité du greffon rénal, d’affiner la politique d’attribution, de guider l’inscription sur liste des receveurs âgés, ou encore d’estimer le risque de développer une insuffisance rénale terminale pour les donneurs vivants. In renal transplant medicine, several scores have been recently developed in order to help decision-making in clinical practice. The aim of this update is to focus on these new scores that allow to better estimate the quality of the renal transplant, to refine the allocation policy, to help registration of old recipients on the waiting list, or to evaluate the risk to develop end-stage renal failure after living donation. [ABSTRACT FROM AUTHOR]

Terminal kidney failure is a serious and irreversible somatic condition. The ordeal of the disease can undermine the internal identity markers of patients, prey to unbearable anxieties, exposing them to formlessness and a vacillating identity., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Résumé Introduction Préserver la fonction rénale et améliorer la transition de la maladie rénale chronique vers le stade terminal constituent un défi pour la néphrologie. La cohorte nationale Chronic Kidney Disease–Réseau Épidémiologie et Information en Néphrologie (CKD-REIN) a été mise en place pour identifier les déterminants, les biomarqueurs et les profils de pratiques associés au pronostic de la maladie rénale chronique. Méthodes L’étude vise à inclure plus de 3000 patients adultes avec une maladie rénale chronique modérée ou avancée suivis dans 40 consultations de néphrologie représentatives du point de vue des régions et du statut public ou privé des établissements. Les patients sont inclus à l’occasion d’une consultation de routine et suivis pendant 5 ans, avant et après l’initiation éventuelle d’un traitement de suppléance rénale. Des données cliniques, biologiques, sur la santé perçue et le mode de vie des patients sont recueillies annuellement, ainsi que sur les pratiques, en coordination avec l’étude internationale Chronic Kidney Disease Outcome and Practice Pattern Study. Une biothèque d’échantillons de sang et d’urine est constituée. Les principaux évènements étudiés sont la survie, la qualité de vie, la progression de la maladie et les hospitalisations. Résultats Plus de 13 000 patients éligibles ont été identifiés, 60 % au stade 3 et 40 % au stade 4 de la maladie rénale, d’âge médian 72 ans [interquartile, 62–80 ans], dont 60 % sont de sexe masculin et 38 % ont un diabète. Fin décembre 2015, 2885 patients étaient inclus. Conclusion La cohorte CKD-REIN servira à mieux connaître la maladie rénale chronique et à apporter des données probantes pour améliorer la santé et la qualité de vie des patients ainsi que les performances du système de santé dans ce domaine. Background Preserving kidney function and improving the transition from chronic kidney disease to end stage is a research and healthcare challenge. The national Chronic Kidney Disease–Renal Epidemiology and Information Network (CKD-REIN) cohort was established to identify the determinants, biomarkers and practice patterns associated with chronic kidney disease outcomes. Methods The study will include more than 3000 adult patients with moderate to advanced chronic kidney disease from a representative sample of 40 nephrology clinics with respect to regions and legal status, public or private. Patients are recruited during a routine visit and followed for 5 years, before and after starting renal replacement therapy. Patient-level clinical, biological, and lifestyle data are collected annually, as well as provider-level data on clinical practices, coordinated with the International Chronic Kidney Disease Outcomes and Practice Pattern Study. Blood and urine samples are stored in a biobank. Major studied outcomes include survival, patient-reported outcomes, disease progression and hospitalizations. Results More than 13,000 eligible patients with chronic kidney disease were identified, 60% with stage 3 and 40% with stage 4. Their median age is 72 years [interquartile range, 62–80 years], 60% are men and 38% have diabetes. By the end of December 2015, 2885 patients were included. Conclusion The CKD-REIN cohort will serve to improve our understanding of chronic kidney disease and provide evidence to improve patient survival and quality of life as well as health care system performances. [ABSTRACT FROM AUTHOR]

In renal transplant medicine, several scores have been recently developed in order to help decision-making in clinical practice. The aim of this update is to focus on these new scores that allow to better estimate the quality of the renal transplant, to refine the allocation policy, to help registration of old recipients on the waiting list, or to evaluate the risk to develop end-stage renal failure after living donation., (Copyright © 2017 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.)

Early information about the kidney transplant is recommended to begin quickly the process of registration on the kidney transplantation waiting list, even for the patients not dialyzed at stage V of the renal insufficiency. It is a strategic choice for the patient care. From the arrival of all the patients in our center of dialysis, a systematic evaluation of the access to the kidney transplant waiting list is organized thanks to a clinical pathway. The impact of this new organization was estimated at 18 months with regard to the information about the kidney transplant transmitted to the patient, of the time required for the assessment of pre-kidney transplant evaluation, and of putting in contraindication. On 78 incident patients, 64 received the information concerning the kidney transplant. After 18 months, 50 clinical pathways are finalized at the time of the analysis among which 25 with a period lower than 6 days and 25 with a median of 169 days. A significant difference of age exists between both groups. The main causes of definitive medical contraindications were estimated. Twenty-two percent of the clinical pathway finalized is awaiting lifting of temporary contraindication. The management of the patient is improved, due to motivation of all the medical teams and a considerable work of coordination between the secretarial department and the department of transplantation in teaching hospital., (Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Background: Preserving kidney function and improving the transition from chronic kidney disease to end stage is a research and healthcare challenge. The national Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort was established to identify the determinants, biomarkers and practice patterns associated with chronic kidney disease outcomes., Methods: The study will include more than 3000 adult patients with moderate to advanced chronic kidney disease from a representative sample of 40 nephrology clinics with respect to regions and legal status, public or private. Patients are recruited during a routine visit and followed for 5 years, before and after starting renal replacement therapy. Patient-level clinical, biological, and lifestyle data are collected annually, as well as provider-level data on clinical practices, coordinated with the International Chronic Kidney Disease Outcomes and Practice Pattern Study. Blood and urine samples are stored in a biobank. Major studied outcomes include survival, patient-reported outcomes, disease progression and hospitalizations., Results: More than 13,000 eligible patients with chronic kidney disease were identified, 60% with stage 3 and 40% with stage 4. Their median age is 72 years [interquartile range, 62-80 years], 60% are men and 38% have diabetes. By the end of December 2015, 2885 patients were included., Conclusion: The CKD-REIN cohort will serve to improve our understanding of chronic kidney disease and provide evidence to improve patient survival and quality of life as well as health care system performances., (Copyright © 2016 Association Société de néphrologie. All rights reserved.)

Résumé: Ce chapitre a pour but de fournir un ensemble d’indicateur permettant de décrire le devenir des patients prévalents et incidents dans les différentes modalités de traitement. Parmi les 36 849 patients dialysés au 31/12/2010, 79% étaient déjà en insuffisance rénale terminale au 31/12/2009. Respectivement 91%, 85% et 93% des patients en HD en centre, en HD autonome, en DP étaient déjà dans la même modalité de traitement. Parmi les 29 758 patients porteurs d’un greffon rénal fonctionnel au 31/12/2010, 98% étaient déjà en insuffisance rénale terminale au 31/12/2009, dont 95% déjà porteur d’un greffon rénal. 72%, 72% et 74% des patients en HD en centre, HD en UDM et HD autonome étaient dans la même modalité au 31/12/2011. En revanche, 37% des malades qui étaient en DP au 31/12/2010 ne l’étaient plus au 31/12/2011. En 2011, les nouveaux patients représentaient 89% des entrées en dialyse péritonéale. La transplantation rénale représente 10% des sorties de l’hémodialyse autonome (autodialyse, domicile). [Copyright &y& Elsevier]

Résumé: Ce chapitre a pour but de fournir un ensemble d’indicateur permettant de décrire les spécificités de l’insuffisance rénale terminale à l’âge pédiatrique en France et d’étudier le devenir de ces patients ainsi que les choix fait concernant les modalités de suppléance. En 2011, l’incidence et la prévalence de l’insuffisance rénale terminale (IRT) chez les moins de 20 ans sont restées stables à 8 et 53 pmh respectivement. Les premières causes d’IRT restent les uropathies et hypodysplasies suivies par les glomérulopathies acquises et les maladies génétiques. Concernant les traitements de suppléance, la France se caractérise par un taux d’hémodialyse très élevé et un faible recourt à la dialyse péritonéale qui est presque exclusivement utilisée chez les jeunes enfants. Le nombre de greffe préemptive en 2011 est de 31 patients soit 27,7% des incidents. Enfin, les données de survie confirment que les jeunes enfants (moins de 4 ans) sont les plus à risque de décès (survie de 88% à 2 ans vs 98% pour les patients de plus de 4 ans) et que la modalité de traitement de choix est la transplantation rénale puisqu’elle augmente l’espérance de vie de 20 à 40 années en fonction de l’âge considéré. [Copyright &y& Elsevier]

Résumé: Ce chapitre fournit un ensemble d’indicateurs sur la survie, l’espérance de vie et les causes de décès des patients en insuffisance rénale chronique terminale traitée par dialyse ou greffe ayant débuté un premier traitement de suppléance entre 2002 et 2011. L’âge influence fortement la survie en dialyse. Ainsi, à un an, la survie des patients de moins de 65 ans est de plus de 90%. Après 5 ans, chez les plus de 85 ans, elle n’est plus que de 15%. La présence d’un diabète ou d’une ou plusieurs comorbidités cardiovasculaires détériore également significativement la survie des patients. En termes de tendance, on ne note pas d’amélioration significative de la survie à 2 ans entre les patients de la cohorte 2006-2007 et ceux de la cohorte 2008-2009. Les maladies cardiovasculaires représentent 27% des causes de décès, devant les maladies infectieuses (12%) et les cancers (10%). L’espérance de vie des patients dépend fortement de leur traitement. Ainsi, un patient greffé âgé de 30 ans a une espérance de vie de 41 ans, versus 23 ans pour un patient dialysé. Les patients greffés ont un taux de mortalité très inférieur à ceux des patients en dialyse. Ainsi, entre 60 et 69 ans, pour 1 000 patients dialysés en 2011, 127 sont décédés dans l’année. Pour 1 000 patients du même âge, porteurs d’un greffon rénal fonctionnel, 24 sont décédés dans l’année. [Copyright &y& Elsevier]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)