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Chronic kidney disease (CKD) treated by hemodialysis (HD) is a worldwide major public health problem. Its incidence is getting higher and higher, leading to an alarming social and economic impact. The survival of these patients is significantly low, especially during the first year of treatment. The purpose of our study was to identify the epidemiological and clinico-biological characteristics of patients at the HD initiation and to reveal the predictive factors of mortality at three months and one year of HD. This is a prospective, analytical, and descriptive study dealing with 229 patients with an end-stage renal disease (ESRD), followed up in the Nephrology Department of Charles Nicolle Hospital and La Rabta Hospital in Tunisia, that was started HD between January and June 2017. A multivariate logistic regression analysis allowed us to identify the independent predictors of mortality at three months and one year. The average age was 60.2 ± 15.3 years, with a gender ratio of 1.41. Seventy-eight percent of patients had more than two comorbidities, 59% had diabetes, and 88% had hypertension. Diabetic nephropathy was the leading etiology of kidney disease (48.9%), while 11% of nephropathies were of unknown etiology. Only 58% were early referred to a nephrologist. The average glomerular filtration rate at HD initiation was 6.06 ± 2.33 mL/min/1.73 m

Introduction:hospital readmission after kidney transplantation is an important metric for health care quality, which associated with increased morbidity, costs and transition-of-care errors. It is influenced by population demographics and the comprehensiveness of the healthcare system. The aim of this study was to evaluate incidence causes and risk factors associated with hospital readmission within the first year after transplantation. Methods:all patients undergoing kidney transplantation at a single center over a ten-year period were analyzed via retrospective chart review. A multivariable logistic regression analysis was performed to identify associated factors. Results:in 86 patients, the incidence of unplanned readmissions within the first year was 68.6% (n = 59). The main reasons for HR were infection (33%), renal events (32%), surgical complications (16%), and metabolic disturbances (9%). In univariate analyses, hospital readmission was associated with Dyslipidemia p=0.04; OR=2.6; 95% CI= [1.93-13.17], anemia p=0.011; OR=4.5; 95% CI = [1.33-15.6], hemodialysis p=0,012; OR=4.8 ; 95% CI= [1.3-18.5], new onset diabetes after transplantation p=0.05 ; OR=3.5 ; 95% CI= [1.6-13,80], medical history of cardiomyopathy p=0,016 ; OR=6.4 ; 95% CI = [5.4-7.5]. While independent risk factors were: hemodialysis vintage and cardiomyopathy. There were no difference in One-year patient survival and death-censored graft survival in HR group and non-HR group. Conclusion:hospital readmissions severely affect a patient's physical and mental well-being after kidney transplantation, which is also independently associated with morbidity. Our study showed that risk factors associated with hospital readmission often reflect pretransplant comorbidity.

Renal involvement in spondyloarthritis is dominated by amyloidosis, IgA nephropathy and urolithiasis. Other nephropathies are rare . A patient followed for SpA consults with edema , hydrocele and a pleural effusion. A FSGS was confirmed by renal biopsy and the etiological investigation has ruled out the causes of secondary FSGS.

BackgroundHypertension is the leading cause of morbi-moratlity in low, middle as well as high incomes countries. Tunisia is a developing country with a high cardiovascular profile and the prevalence of hypertension has widely increased during the last decades. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. MethodsNature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90mmHg. Our objective is to assess the predictors of uncontrolled hypertension in our population. Results Three hundred twenty one investigators from all the Tunisian governorates participated in the study. We enrolled 25890 patients with a female predominance (Sex ratio 1.21) and an average age 64.4±12.2 year-old. Most of individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as BP target and only in 18.6% if we consider 130/80 as a target. The independents predictors of uncontrolled blood pressure were male sex (OR=1.09, 95%CI [1.02-1.16]), age> 65 year-old (OR=1.07, 95% CI[1.01-1.13], diabetes (OR=1.18, 95% CI [1.11-1.25], Smoking (OR=1.15, 95% CI [1.05-1.25]), Obesity (OR=1.14, 95% CI[1.07-1.21]), management in public sector (OR=1.25, 95% CI [1.16-1.34]) and Heart rate >80bpm (OR=1.59, 95% CI [1.48-1.71]). Contrarily, high educational level (OR=0.9, 95% CI [0.84-0.97], absence of history of coronary disease (OR=0.86, 95% CI [0.8-0.93]), salt restriction (OR=0.48, 95% CI [0.45-0.51]), drug compliance (OR=0.57, 95% CI[0.52-0.61]) and regular physical activity (OR=0.77, 95% CI[0.71-0.84]) are strong predictors of blood pressure control. Conclusion Nature HTN showed a remarkable improvement of blood pressure control amongst Tunisian people. The control remains low in patients with high cardiovascular profile and those treated in the public sector. A national health program based on therapeutic education, regular control and continuous giving much support to the public institutions is needed to decrease the hypertension burden affection rate in our population.

Background Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. Methods Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Results Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02–1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01–1.13], diabetes (OR = 1.18, 95% CI [1.11–1.25], Smoking (OR = 1.15, 95% CI [1.05–1.25]), Obesity (OR = 1.14, 95% CI[1.07–1.21]), management in public sector (OR = 1.25, 95% CI [1.16–1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48–1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84–0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8–0.93]), salt restriction (OR = 0.48, 95% CI [0.45–0.51]), drug compliance (OR = 0.57, 95% CI[0.52–0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71–0.84]) are strong predictors of blood pressure control. Conclusion NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.

Granulomatosis reaction associated with tumor has been designated as sarcoid-like reaction. Very few cases of association of systemic sarcoidosis and neoplasia have been reported. We reported two cases of sarcoidosis and renal cell carcinoma.

Resume Introduction Le sarcome de Kaposi iatrogene est une tumeur angiogenique de mecanisme complexe, decrite essentiellement chez les patients transplantes d’organes. Il entrave exceptionnellement l’evolution des vascularites a ANCA. Observation Nous rapportons le cas d’une patiente âgee de 58 ans, en hemodialyse chronique, suivie pour une vascularite a ANCA et un prurigo chronique sous traitement immunosuppresseur, ayant developpee sept semaines apres le debut du traitement, un sarcome de Kaposi cutane. La recherche du virus HHV8 etait negative. Les lesions du sarcome de Kaposi ont regressees apres l’arret du cyclophosphamide et la reduction des corticoides. Conclusion La maladie sous-jacente, le traitement immunosuppresseur et l’insuffisance renale au stade d’hemodialyse ont favorise le developpement de cette neoplasie chez ce malade.

Background and Aims Acute kidney injury (AKI) is a complex disorder that occurs in several clinical settings. During pregnancy, there are additional unique conditions that contribute to AKI. The clinical manifestations of Pregnancy related acute kidney injury(PRAKI) range from a minimal elevation in serum creatinine to severe renal failure requiring renal replacement therapy and may be associated with significant morbidity and mortality in young healthy women. This study aims to describe epidemiologic features, study clinical profile and outcomes of women with PRAKI and identify risk factors related to requiring hemodialysis among patients. Method We performed a retrospective study over a 5-year period (2015–2019) in a Tunisian intensive care unit. All patients presenting PRAKI were included. Results Ninety-six cases of PRAKI were listed. The rate of AKI during pregnancy-related hospitalizations was 16% .the average age was 31 ± 5 years. Most women were from urban areas (62%) but with insufficient prenatal care (57%).Seventy-eight percent underwent cesarean section delivery. PRAKI occurred in the postpartum in 79%of the cases. Oligo-anuria was the most common clinical feature of PRAKI, noted in 82% of our patients. The leading etiological causes were pre eclampsia, eclampsia, postpartum haemorrhage and sepsis respectively, in 49%, 38%, and 24% of the cases. Hemodialysis was required in 23% of cases. In the adjusted regression analysis, factors associated with dialysis were insufficient prenatal care (p=0,010 ; O Ra=24,113), HELLP syndrome (p=0,003 ; ORa=35,129), disseminated intravascular coagulation (p=0,007 ; OR=11,854), average duration of oliguria (p=0,001; ORa=3,025) , Failure stage of RIFLE criteria while admitted (p=0,009; ORa=2,09) and length of ICU stay (p=0,042 ; ORa=1,118). Renal outcome was favorable, with a complete renal function recovery for 72 patients (75%). Only four patients (4%) developed chronic renal failure. Mortality rate was 13%. Conclusion PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation in order to prompt management of the underlying risk factors

Introduction Le controle de l’hypertension arterielle (HTA) constitue l’un des piliers essentiels de la prise en charge de la maladie renale diabetique afin de ralentir sa progression. Description Le but de ce travail etait de decrire nos pratiques professionnelles dans la prise en charge de l’HTA chez les diabetiques suivis en nephrologie. Methodes Il s’agissait d’une etude retrospective, descriptive et evaluative, incluant les sujets diabetiques hypertendus, suivis pour une maladie renale chronique stade 1, 2 et 3 au service de Nephrologie entre janvier 2015 a decembre 2017. L’evaluation des pratiques professionnelles a ete realisee en se referant aux recommandations de l’ESC/ESH de 2018 et celles des KDIGO de 2012. Resultats Un total de 120 patients a ete inclus. L’âge moyen etait de 63,1 ± 9,6 ans avec un sexe ratio de 1,55. L’equilibre tensionnel a ete atteint dans 80 % des cas. Les methodes de mesure utilisees pour la surveillance de la pression arterielle au cours du suivi n’etaient pas conformes aux recommandations avec une utilisation restreinte des automesures et de la MAPA dans respectivement 16,7 % et 6,7 % des cas. Le traitement medicamenteux de l’HTA etait conforme aux recommandations chez 82 % des sujets. La prescription des mesures hygieno-dietetiques etait conforme aux recommandations dans 33,3 % des cas. L’evaluation de l’atteinte des organes cibles etait conforme dans 40 % des cas. La prise en charge de la dyslipidemie etait conforme dans 76,7 % des cas, celle de l’hyperuricemie dans 14,8 % des cas et un sevrage du tabac a ete note dans 56,7 % des cas. Une inertie therapeutique a ete observee dans 18,5 % des cas apres un an de suivi malgre l’absence d’atteinte des cibles tensionnelles. Conclusion L’evaluation des pratiques professionnelles est un concept emergent. Son application dans la prise en charge de l’HTA chez les sujets diabetiques suivis en nephrologie permet de ralentir la progression de la maladie.

BACKGROUND The present study was designed to evaluate the care of hypertensive patients in daily clinical practice in public and private centers in all Tunisian regions. It will allow us to have an overview of the Tunisian hypertensive patient in order to optimize treatment and to know the degree of adherence of practitioners to international recommendations in the care of the hypertension in Tunisia. OBJECTIVE he present study was designed to evaluate the care of hypertensive patients in daily clinical practice in public and private centers in all Tunisian regions. METHODS National, observational, cross-sectional, and multicenter study that will include patients older than 18 years with hypertension for duration of 4 weeks, following up in public and private centers and after signing a consent form. The study will exclude patients undergoing dialysis. The parameters that will be evaluated include demographic and anthropometric data, lifestyle habits, BP levels, lipid profile, treatment and adherence to treatment. The data are collected via the DACIMA Clinical Suite® web interface. RESULTS At the end of the study, we will find the demographic and anthropometric characteristics of the patients, their past medical history, clinical features and their paraclinical exploratory characteristics (biology, EKG and / or holter blood pressure, transthoracic echocardiography (TTE),). We will provide a description of the therapeutic environment and of adverse events occurring during medical treatment and recommendations. CONCLUSIONS We will provide a description of the therapeutic environment and of adverse events occurring during medical treatment and recommendations. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT04013503.

Background and Aims Current literature suggests the arteriovenous fistula (AVF) to be the preferred type of vascular access for hemodialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. The aim of this study is to compare the clinical and echocardiographic evolution after creation of a proximal AVF and a radial AVF. Method We conducted a retrospective descriptive study including all chronic hemodialysis patients through AVF. Group 1 (G1) included patients with proximal AVF and group 2 (G2) patients with radial AVF. Results Twenty-four patients were collected in G1 and the average age was 55 years. G2 included 13 patients with a mean age of 44 years. Systolic blood pressure decreased after AVF creation in both groups (G1: 62.5%, G2: 45%, NS). A dyspnea was noted in 70% of cases of G1 and 38.4% of cases of G2 (NS). The interventricular septum was thickened in 20.8% of cases of G1 and 38.4% of G2 (NS). Left ventricular (LV) dilatation was observed in both groups with LV diastolic telegram diameter increase of 58% in G1 versus 10% in G2 (p = 0.04). A decrease in LV ejection fraction was found in 62.5% in G1 and 46.1% in G2 (p = 0.066). The major cardiac complications in G1 were acute coronary syndrome in 5 patients and atrial fibrillation in 4 cases after an average of 60 months and 35 months, respectively. No cardiac complications were noted in G2. Conclusion AVFs remain the preferred type of vascular access for chronic hemodialysis therapy because they are associated with better long-term patency and fewer complications compared with synthetic grafts. Its seat will depend on the vascular state and the cardiac status of the dialysis patient.

A 57-year-old male who had been working in masonry for 33 years was hospitalized for renal function decline associated with exertional dyspnea. He presented with hypertension and limb edema. Urinalysis revealed an active urine sediment with glomerular proteinuria at 1.5 g/24h and the renal biopsy identified mesangial IgA Nephropathy. Chest tomography scans showed signs of silicosis. The patient received Angiotensin-Converting Enzyme Inhibitors with stable renal function. To our knowledge, the association of silicosis-IgA nephropathy has rarely been reported in the literature. This case highlights the effect of chronic exposure to silica dust and its association with both silica and renal disease.

Introduction L’insuffisance renale aigue (IRA) est associee a une lourde morbimortalite. Le recours a l’hemodialyse (HD) constitue un tournant evolutif de l’IRA. Malgre la gravite de cette pathologie, on ne dispose pas d’etudes tunisiennes concernant l’epidemiologie et le pronostic de l’IRA necessitant le recours a l’HD dans un milieu de nephrologie. L’objectif de ce travail etait d’etudier le profil epidemiologique et de determiner les facteurs de recuperation et de mortalite chez ces patients. Description Nous avons mene une etude prospective, descriptive, analytique, a l’unite d’hemodialyse durant l’annee 2019. Methodes Nous avons inclus les patients ayant beneficie d’une seance d’HD en urgence pour IRA. Les patients ayant un antecedent d’insuffisance renale chronique avec un DFG Resultats Nous avons collige 121 patients d’âge moyen 59 ± 18 ans et de genre-ratio (H/F) 1,42. Une IRC etait notee dans 22,3 % des cas. L’oligoanurie etait trouvee chez 68,6 % des patients. L’IRA etait obstructive dans 19 % des cas, fonctionnelle dans 16,5 % des cas et organique dans 64,5 % des cas. Les indications de l’HD etaient l’oligoanurie, l’acidose metabolique, l’hyperkaliemie, l’œdeme des poumons et l’hyperuremie dans respectivement 60,3 %, 51,2 %, 42,1 %, 22,3 %, 20,7 % des cas. Apres 3 mois, 36,4 % ont repris leurs fonctions renales et 7,4 % etaient dependants de l’HD. La mortalite globale etait de 52,1 %. Le facteur independant de non recuperation etait l’uree ≥ 41 mmol/L (ORa = 11,4 [2,36–54,88]). Les facteurs independants de mortalite sont la PAM Conclusion L’IRA necessitant l’HD est associee a une lourde mortalite. Les scores clinicobiologiques SOFA et APACHEII, ainsi que la diurese et la PAM sont des outils simples pour predire la mortalite chez cette population.

Introduction Malgre l’amelioration du pronostic de la nephropathie lupique (NL), la morbi-mortalite cardiovasculaire reste elevee et d’origine multifactorielle. Le but de notre etude etait de decrire ces evenements cardiovasculaires et de rechercher les facteurs predictifs. Patients et methodes Il s’agit d’une etude retrospective menee sur une periode de 13 ans et ayant inclus tous les patients ayant un lupus erythemateux systemique avec une atteinte renale. Une regression logistique multivariee a ete utilisee pour evaluer les facteurs de risque de manifestations CV. Resultats Notre etude a inclus 50 patients avec une predominance feminine (94 %). L’âge moyen au moment du diagnostic de la NL etait de 25,8 ans allant de 19 a 44 ans. Quarante pour cent des patients avaient une hypertension arterielle systemique. Le taux de diabete et de dyslipidemie etait respectivement de 6,3 % et 25,5 %. Neuf pourcent etaient des patients etaient obeses et 19 % etaient en surpoids. La prevalence globale des evenements cardiovasculaires etait de 22 % et incluait des syndromes coronariens aigus dans 4,9 % des cas, un angor stable dans 6 % et des accidents thromboemboliques chez 16 % des patients. Une insuffisance cardiaque congestive etait presente chez 3 % et une hypertension arterielle pulmonaire chez 6 % des malades. Le genre feminin (p = 0,005), l’obesite (p = 0,01), la presence d’anticorps antiphospholipides (p = 0,02),) etaient des facteurs de risque independants de survenue d’evenement cardiovasculaires. Il n’y avait pas d’association statistiquement significative entre le profil cardiovasculaire et la fonction renale (p = NS) ni la survie des patients (p = NS). Conclusion Nos donnees suggerent que la nephropathie lupique etait associee a un risque eleve de survenue d’evenements cardio-vasculaires ce qui implique un meilleur controle des facteurs de risque.

Introduction La microangiopathie thrombotique (MAT) est une pathologie rare associee d’une facon quasi constante avec un pronostic grave. Elle represente une complication tres grave du lupus erythemateux dissemine (LED). Le but de cette etude etait d’identifier les facteurs de risque et les resultats cliniques de la MAT renale chez les patients atteints de nephropathie lupique (NL). Patients et methodes Les donnees histopathologiques cliniques et renales de 50 patients atteints de NL prouvee par biopsie ont ete analysees retrospectivement afin de comparer les caracteristiques cliniques et les resultats dans le groupe avec et sans MAT. Resultats Onze patients (22 %) ont ete diagnostiques avec une micro angiopathie thrombotique renale. Cinq patients (45,4 %) presentaient un Anticorps anti phospholipides concomitant. L’âge moyen du patient etait de 27,4 ± 9,8 ans. Huit patients (72,7 %) avaient une fonction renale alteree. La biopsie renale a montre que la plupart des patients avaient une glomerulonephrite lupique de classe IV (9 patients, 81, 8 %). Tous les patients ont ete traites avec des glucocorticoides en association avec un agent immunosuppresseur. Aucun patient n’a ete traite par echange plasmatique. Un patient etait decede suite a un etat de choc hemorragique. Par rapport aux patients sans MAT, il n’y avait aucune difference dans le debit de filtration glomerulaire, le pourcentage de patients necessitant une dialyse, la survie renale ou des patients, l’incidence de la maladie renale chronique au dernier recul et les taux d’echec du traitement. La MAT etait associee a une prevalence plus elevee d’hypertension (p = 0,030 ; OR = 5,6), de pericardite (p = 0,007 ; OR = 11,11), d’anemie (p = 0,024 ; OR = 6,8) et de vascularite (p = 0,005 OR = 10,8). Conclusion L’identification du mecanisme sous-jacent a la pathogenese des lesions renales MAT dans la NL pourrait fournir des cibles potentielles pour le developpement de nouvelles therapies.

The incidence of tuberculosis (TB) is high in patients undergoing chronic dialysis than it is in the general population. The diagnosis of TB is often difficult and extrapulmonary involvement is predominant. This study investigates the spectrum of clinical presentations and outcome in dialysis patients during a nine-year period. TB was diagnosed in 41 patients. Anti-TB drugs, adverse effects of therapy, and outcome were noted. Thirty-eight patients (92.6%) were on hemodialysis and three were on peritoneal dialysis (7.3%). The mean age at diagnosis was 50.8 years and the male/female ratio was 1.16. Four patients had a history of pulmonary TB. Extrapulmonary involvement was observed in 32 (78 %) patients. The bacteriological confirmation was made in 41.46% and histological confirmation was made in 26.83%, and in the rest, the diagnosis was retained on the criterion presumption. Nineteen patients (46.34%) developed adverse effects of antitubercular drugs. Eight patients (19.51%) died during the study from TB or adverse effects of treatment. Low urea reduction ratio and female sex were associated with poor prognosis in our study. The clinical manifestations of TB in patients on dialysis are quite nonspecific, making timely diagnosis difficult, and delaying the initiation of curative treatment, which is a major determinant of the outcome.

Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic disorder associated with various extrarenal complications. There is little information regarding the occurrence and distribution of cardiovascular abnormalities during the course of ADPKD. The major cardiovascular complications of ADPKD include valvulopathies and vascular ectasia. Aneurysm of the atrial septum (ASA) is a very rare manifestation in ADPKD. A 37-year-old woman who was diagnosed with ADPKD was admitted to our hospital for advanced renal failure. Pelvic computed tomography revealed multiple variable-sized cysts in both kidneys. Trans-thoracic echocardiography showed ASA while the patient was completely asymptomatic.

Introduction L’intoxication au methanol est rare mais grave. Le traitement repose sur l’inhibition de l’alcool deshydrogenase et/ou l’epuration extrarenale (EER). L’objectif de notre etude etait d’etudier les particularites de l’EER au cours de l’intoxication au methanol. Description Il s’agissait d’une etude descriptive transversale colligeant les patients presentant une intoxication au methanol et necessitant le recours a l’EER, au service de nephrologie La Rabta, durant la periode entre janvier et mai 2020. Methodes Les indications de l’EER sont celles du groupe EXTRIP. Resultats Nous avons collige 7 hommes d’âge moyen 38 ± 11 ans. Les signes cliniques etaient le flou visuel chez un patient et des convulsions avec coma chez 2 autres. Une instabilite hemodynamique a ete observee chez 1 patient. On a eu recours a l’intubation chez 2 patients. La moyenne de la methanolemie etait de 1,31 ± 0,4 g/L avec un minimum de 0,6 et un maximum de 1,78. La lactatemie moyenne etait de 2,71 ± 0,83 mmol/L. La moyenne du PH etait de 7,32 ± 0,22 et des reserves alcalines 19 ± 6,8 mmol/L. Un seul patient avait un PH 0,6 g/L sous ethanol chez tous nos patients associes a un flou visuel chez 1 patient et des convulsions avec coma chez 2 patients. La duree moyenne de la seance etait de 5,5 ± 1 heures [4–6 heures]. Les complications perdialytique etaient une hypokaliemie malgre une supplementation potassique systematique chez 2 patients et une instabilite hemodynamique chez 1 patient. Apres un suivi de 7 jours, on a eu 1 deces. Conclusion L’intoxication au methanol touche des sujets jeunes. L’EER ameliore le pronostic vital mais la hantise majeure du praticien est l’hypokaliemie.

Background Cardiac involvement in hemodialysis patients is a serious condition with poor prognosis. The impact of chronic kidney disease and hemodialysis on heart function is not well understood. The transthoracic echocardiography (TTE) is performed when cardiac involvement is suspected. Recently, the development of (2D) strain imaging facilitated the simple and independent measurement of left ventricular (LV) deformation parameters in the longitudinal, circumferential and radial directions. Purpose To analyse LV systolic function in hemodialysis patients in two-dimensional (2D) TTE and with 2D speckle tracking (2D-STI) Methods Twenty-eight chronic hemodialysis patients were included prospectively from November 2017 to December 2017 at the Nephrology department. Twenty-one patients comprised the control group. Conventional 2D-TTE was performed followed by two-dimensional strain imaging (2D-STI). A complete TTE was conducted, including LVEF by Simpson biplane method, calculation of indexed left ventricular mass, analysis of Diastolic function with evaluation of filling pressures and finally the study of the longitudinal deformation of the LV (GLS) by the speckle tracking technique. Results The average age of patients in our sample was 49.7 ± 9.7 years with a sex ratio of 2,5. All patients were dialyzed 3 times a week with a mean duration of hemodiaylyse of 60 months. All patients had a conserved LVEF with a mean value of 60.3 ± 7%. The prevalence of LVH was 60.7%. Segmental kinetic disorders were found in 3 patients. The average value of GLS was −14.9 ± 3.2, which was impaired compared to that of the control group. GLS is decreased in 40% of the population. Conclusion The evaluation of longitudinal function by 2D strain gives a new insight into myocardial function in hemodialysis patients, which could improve pathophysiological understanding and identify patients at high risk of heart failure who can benefit from preventive strategies.