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Association between iron deficiency and risk of major events in chronic kidney disease 慢性肾病患者缺铁与重大事件风险之间的关系
Pub Date : 2024-11-19 DOI: 10.1684/ndt.2024.91
Gabriel Choukroun, Yasmine Baghdadi, Pascaline Rabiéga, Elise Cazaubon, Serge Maillet, Luc Frimat, Bénédicte Stengel

Introduction: Iron deficiency (ID) is common in patients with chronic kidney disease (CKD) but remains under-diagnosed and its prognosis poorly documented in the absence of anemia. The aim of the study was to assess the relationship between ID and the risk of major adverse outcomes in patients with CKD.

Methods: Using data from the French Chronic Kidney Disease - Renal Epidemiology and Information Network (CKD-REIN) cohort which included and followed over five years, 3,033 patients with CKD stages 2 to 5 CKD, we estimated the prevalence of ID, defined by a ferritin level < 100 mg/L and/or a transferrin saturation < 20%, and associated hazard ratios (HR) of kidney failure with replacement therapy, kidney failure defined by an eGFR < 15 mL/min per 1.73 m2 or initiation of kidney replacement therapy, all-cause mortality, and death or hospitalization for heart failure.

Results: Baseline prevalence of ID in the cohort (66% men; mean age 67 ± 13 years) was 50% (48-52). Mean hemoglobin was 13 ± 1.7 g/dL, and only 31% of patients with ID also had a hemoglobin < 12 g/dL. In 2,803 patients with CKD stages 2-4 at baseline, ID was associated with significant increased risk of kidney failure, and of kidney failure with replacement therapy, with HRs adjusted for confounders and hemoglobin level of 1.22 (1.03-1.45) and 1.57 (1.27-1.94), respectively. Adjusted HRs for all-cause mortality and hospitalization or death for heart failure, were 1.31 (1.04-1.66) and 1.38 (1.07-1.80), respectively.

Conclusion: This study shows that ID is significantly associated with the risk for kidney failure, all-cause mortality, and heart failure, independent of the presence of anemia.

简介:铁缺乏症(ID)在慢性肾脏病(CKD)患者中很常见,但诊断率仍然很低,而且在没有贫血的情况下,铁缺乏症的预后也很少被记录。本研究旨在评估缺铁与 CKD 患者主要不良预后风险之间的关系:利用法国慢性肾脏病-肾脏流行病学和信息网络(CKD-REIN)队列的数据,我们估算了ID(定义为铁蛋白水平<100 mg/L和/或转铁蛋白饱和度<20%)的患病率,以及接受替代治疗后肾衰竭、肾衰竭(定义为eGFR<15 mL/min per 1.73 m2 或开始肾脏替代疗法的肾衰竭、全因死亡率以及因心力衰竭死亡或住院:队列中 ID 的基线患病率为 50%(66% 为男性;平均年龄为 67 ± 13 岁)(48-52)。平均血红蛋白为 13 ± 1.7 g/dL,只有 31% 的 ID 患者血红蛋白低于 12 g/dL。在 2,803 名基线期为 2-4 期 CKD 的患者中,ID 与肾衰竭风险显著增加以及肾衰竭替代疗法相关,根据混杂因素和血红蛋白水平调整后的 HR 分别为 1.22 (1.03-1.45) 和 1.57 (1.27-1.94)。全因死亡率和因心力衰竭住院或死亡的调整HR分别为1.31(1.04-1.66)和1.38(1.07-1.80):本研究表明,ID与肾衰竭、全因死亡率和心力衰竭的风险显著相关,与贫血的存在无关。
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引用次数: 0
LUMIDIAL: feasibility of light therapy in hemodialysis, pilot study and real-life experience LUMIDIAL:光疗在血液透析中的可行性、试点研究和实际经验
Pub Date : 2024-11-19 DOI: 10.1684/ndt.2024.94
Benoit Franko, Marianne Jund, Cécile Herlet, Violaine Delsante, Lucas Pires, Anne-Laure Claudel, Tristan Delory

Introduction: Sleep and mood disorders are common in hemodialysis, but the effect of light therapy remains unknown in this population.

Methods: We conducted a randomized, controlled, open-label pilot trial comparing two group of either 30 minutes of light therapy three times a week, or no exposure. The primary endpoint was change in sleep quality (PSQI) after five weeks of light therapy, with change in mood (DASS-21) as a secondary endpoint. We added the description of the same criteria in a prospective, non-randomized, real-life post-trial cohort.

Study results: We included 28 analyzable patients in the pilot study. Light therapy had no significant effect on PSQI reduction (p = 0.496). There was a trend towards a reduction in depression (-6.2 [95% CI, -12.5 to -0.05], p = 0.058). In the real-life cohort, out of 27 patients, 12 had a significant reduction in depression score (≥ 6 points).

Discussion: Light therapy performed in hemodialysis three times a week appears to have no effect on sleep quality, but could reduce depressive states. The technique is easy to implement, well tolerated and inexpensive. A multicenter randomized trial against the sham device will be needed to validate its effect on depression.

简介:睡眠和情绪障碍是血液透析患者的常见病,但光疗对这一人群的影响仍然未知:睡眠和情绪障碍在血液透析患者中很常见,但光疗对这一人群的影响仍然未知:我们进行了一项随机、对照、开放标签试验,比较了每周三次每次 30 分钟的光疗或不进行光疗的两个组别。主要终点是光疗五周后睡眠质量(PSQI)的变化,情绪变化(DASS-21)是次要终点。我们在一项前瞻性、非随机、真实的试验后队列中增加了相同标准的描述:研究结果:我们在试点研究中纳入了 28 名可分析的患者。光疗对降低 PSQI 没有明显效果(p = 0.496)。抑郁症有减轻趋势(-6.2 [95% CI, -12.5 to -0.05],p = 0.058)。在实际队列中,27 名患者中有 12 人的抑郁评分显著降低(≥ 6 分):讨论:每周三次在血液透析中进行光疗似乎对睡眠质量没有影响,但可以减轻抑郁状态。该技术易于实施、耐受性好且成本低廉。要验证其对抑郁症的疗效,还需要进行多中心随机试验,与假装置进行对比。
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引用次数: 0
Primary hyperoxaluria: results of a retrospective survey of the diagnostic practices of nephrologists 原发性高草酸尿症:肾病专家诊断方法回顾性调查的结果
Pub Date : 2024-11-19 DOI: 10.1684/ndt.2024.93
Sandrine Lemoine, Alexia Bakdache, Gabriel Choukroun

Introduction: Primary hyperoxalurias (PH) are rare and serious genetic diseases. Their prognosis is improved with early medical management. However, diagnosis often occurs at the end-stage of renal failure. To understand this delay, collecting real-world data on the clinical practices of nephrologists may be helpful.

Materials and methods: Between October 2021 and October 2022, a retrospective survey was conducted in France among 76 nephrologists to assess management practices for patients with chronic kidney disease (CKD) of unknown aetiology, associated with urinary lithiasis and/or nephrocalcinosis. Data on patient profiles, tests conducted, diagnoses considered, and management of suspected PH cases were collected.

Results: 97% of patients (n = 386/400) underwent a renal examination, 92% (n = 370/400) a thorough urinary check-up, and 65% (n = 260/400) had an interpretable oxaluria value from a 24-hour urine sample (Uox24h). Of these 260 patients, 50% (n = 130/260) had Uox24h > 500 µmol/24 h: 23% (n = 30/130) were suspected of PH by the nephrologists, and 15% (n = 19/130) were referred for genotyping. Considering all criteria, 52 patients were suspected of PH (42% of whom did not have Uox24h > 500 µmol/24 h), and 33% (n = 17/52) were not referred for genotyping.

Discussion: The survey highlights nephrologists' adherence to recommendations for prescribing biological tests. However, in cases of hyperoxaluria or suspected PH, genotyping was not always prescribed. The barriers to this prescription need further exploration.

简介原发性高氧血症(PH)是一种罕见的严重遗传性疾病。早期治疗可改善其预后。然而,诊断往往发生在肾衰竭晚期。要了解这种延误,收集肾科医生临床实践的真实数据可能会有所帮助:2021 年 10 月至 2022 年 10 月期间,在法国对 76 名肾科医生进行了一项回顾性调查,以评估对病因不明、伴有尿路结石和/或肾钙化的慢性肾病 (CKD) 患者的管理方法。收集的数据包括患者概况、所做检查、考虑的诊断以及对疑似 PH 病例的处理:97%的患者(n = 386/400)进行了肾脏检查,92%的患者(n = 370/400)进行了全面的泌尿系统检查,65%的患者(n = 260/400)通过 24 小时尿样(Uox24h)获得了可解释的草酸尿值。在这 260 名患者中,50%(n = 130/260)的 Uox24h > 500 µmol/24 h:23%(n = 30/130)的患者被肾病专家怀疑患有 PH,15%(n = 19/130)的患者被转诊进行基因分型。考虑到所有标准,52 名患者被怀疑患有 PH(其中 42% 的患者 Uox24h > 500 µmol/24 h),33%(n = 17/52)的患者未转诊进行基因分型:讨论:该调查强调了肾科医生对生物检测处方建议的遵守情况。然而,在高草酸尿症或疑似 PH 的病例中,并不总是开具基因分型处方。需要进一步探讨开具这种处方的障碍。
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引用次数: 0
Acute immuno-allergic tubulo-interstitial nephritis due to amoxicillin confirmed by rechallenge 通过再挑战确认阿莫西林引起的急性免疫过敏性肾小管间质性肾炎
Pub Date : 2024-11-19 DOI: 10.1684/ndt.2024.92
Laure Mondo, Amira Bendjama, Maxime Taghavi, Evelyne Maillart, Lucie Bienfait, Marie-Dominique Gazagnes, Philippe Clevenbergh

Acute kidney injury is a common drug adverse reaction and may concerned antibiotics. We report a case of an acute renal failure due to amoxicillin occurring twice in the same patient. Two mechanisms have been described for amoxicillin, with an immuno-allergic origin observed in our case. The diagnosis, supported by kidney biopsy, was confirmed by rechallenge with this patient.

急性肾损伤是一种常见的药物不良反应,可能与抗生素有关。我们报告了一例因阿莫西林导致急性肾衰竭的病例,该病例在同一患者身上发生了两次。阿莫西林引起急性肾衰竭的机制有两种,在我们的病例中观察到的是免疫过敏。肾活检证实了这一诊断,并通过对该患者的再次挑战得到了证实。
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引用次数: 0
Systematic review of mobile health applications in transplant patients. 移植患者移动医疗应用系统综述。
Pub Date : 2024-11-19 DOI: 10.1684/ndt.2024.95
Florian Laval, Camille Boissière, Elouan Demay, Cécile Vigneau, Léonard Golbin, Roxane Lhermitte, Brendan Le Daré, Astrid Bacle

Context: Poor medication management can lead to adverse outcomes for transplant patients, including acute rejection and graft loss. In recent years, mobile applications have been proposed as innovative tools to improve patient treatment management.

Objective: This review aimed to systematically evaluate the available research evidence on the relationship between mobile applications and treatment management in transplant patients.

Methods: The following databases were systematically searched for relevant publications on April 8, 2022, using the PRISMA method: PubMed, Embase, and Google Scholar. The Cochrane risk of bias tool was used to assess the included studies. Observational or interventional studies focusing on the use of mobile applications in adult solid organ transplant patients were included for analysis.

Results: A total of 28 articles met the inclusion criteria. The overall methodological quality of the evidence was assessed as low. Most studies were monocentric (n = 23, 82%). The majority of follow-ups focused on kidney transplants (n = 12, 42.9%) with small sample sizes (54%, n < 99), including participants < 60 years old (n = 26, 93%) with follow-up ≤ 6 months (61%). Medication adherence rates showed significant improvements in seven out of 13 trials compared to standard care or placebo. Several features were reported to be most effective in improving patient treatment management, such as self-registration and monitoring, medication reminders based on alerts, and caregiver monitoring to check patients' health indicators or medication adherence.

Conclusion: Mobile applications tended to improve medication management in transplant patients compared to standard care. However, due to the heterogeneity of the objectives of the analyzed studies, which do not allow for meta-analysis, further high-level evidence studies evaluating the effects of mobile applications in this area are needed to support effective interventions.

背景:药物管理不善可导致移植患者出现不良后果,包括急性排斥反应和移植物丢失。近年来,移动应用被认为是改善患者治疗管理的创新工具:本综述旨在系统评估有关移动应用与移植患者治疗管理之间关系的现有研究证据:采用 PRISMA 方法,系统检索了以下数据库中 2022 年 4 月 8 日的相关出版物:PubMed、Embase 和 Google Scholar。使用 Cochrane 偏倚风险工具对纳入的研究进行评估。结果显示,共有28篇文章符合纳入条件:共有 28 篇文章符合纳入标准。证据的总体方法学质量被评定为低。大多数研究都是单中心研究(n = 23,82%)。大多数随访研究侧重于肾移植(n = 12,42.9%),样本量较小(54%,n < 99),包括年龄小于60岁的参与者(n = 26,93%),随访时间≤6个月(61%)。与标准护理或安慰剂相比,13 项试验中有 7 项的用药依从率有明显提高。据报道,有几项功能对改善患者的治疗管理最为有效,如自我登记和监控、基于警报的用药提醒、护理人员监控检查患者的健康指标或用药依从性等:结论:与标准护理相比,移动应用往往能改善移植患者的用药管理。然而,由于所分析研究的目标存在异质性,无法进行荟萃分析,因此需要进一步开展高水平的实证研究,评估移动应用在这一领域的效果,以支持有效的干预措施。
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引用次数: 0
Malformative uropathies in children: epidemiological, clinical, therapeutic and evolutive aspects in an ivoirian hospital setting 儿童畸形性尿路病变:科特迪瓦医院的流行病学、临床、治疗和演变情况
Pub Date : 2024-08-19 DOI: 10.1684/ndt.2024.88
Emmanuella Bouah-Kamon, Assamala Marielle Sophie Ehile-Kacou, Gnenefoly Diarrassouba, Tanoh Kassi François Eboua, Evelyne Lasme-Guillao

Introduction: Congenital anomalies of the kidney and the urinary tract are a major cause of chronic kidney failure in children. Prevalence in paediatrics varies according to studies. The data being rare in the ivorian context, this study aims to describe these defects' epidemiological, clinical, therapeutic and evolutionary aspects in children in a reference hospital setting.

Methods: We performed a retrospective and descriptive study held in the Yopougon's Teaching Hospital Pediatric Nephrology Unit from December 1st 2008 to December 31st 2020. It involved 152 children aged 0 to 15 years, admitted to the unit, with a congenital anomaly of the kidney and the urinary tract diagnosed with radiology.

Results: Socio-demographic characteristics: congenital anomalies of the kidney and urinary tract's prevalence was 11%. The median age at admission was 36 months. The median age at diagnosis of malformative uropathy was 17.5 months. The sex ratio (M/F) was 2.3. Clinical characteristics: posterior urethra valves were the most common malformative uropathy (38%). Malformative uropathy was associated with other defects in 4% of cases. The antenatal diagnosis involved 24% of patients. The average gestational age of discovery was 32 weeks of amenorrhea. In the postnatal period, abdominal pain was the main circumstance for discovery (39%). Therapeutic characteristics: surgery was indicated in 58% of patients and performed in 64% of cases. Evolutionary characteristics: evolution was better in patients who had received surgical treatment (asymptomatic in 83% of cases, occurrence of urinary tract infection in 35% of cases and chronic renal failure in 23% of cases). 72% of the study population was lost.

Conclusion: In Côte d'Ivoire, malformatives uropathies are late-discovered and are dominated by posterior urethra valves. Knowledge and management of these renal and urinary tract defects deserve to be improved through the development of antenatal diagnosis and training of practitioners in early recognition of clinical signs. The high rate of lost patients must be reduced by the implementation of an active patients' follow-up system.

简介先天性肾脏和泌尿道异常是导致儿童慢性肾衰竭的主要原因。儿科的发病率因研究而异。这些数据在科特迪瓦非常罕见,本研究旨在描述这些缺陷在参考医院儿童中的流行病学、临床、治疗和演变方面的情况:2008年12月1日至2020年12月31日,我们在约普贡教学医院小儿肾脏科进行了一项回顾性和描述性研究。研究涉及152名0至15岁的儿童,他们都是经放射学诊断患有肾脏和泌尿道先天性异常的患者:社会人口特征:肾脏和泌尿道先天性异常的发病率为 11%。入院时的中位年龄为 36 个月。诊断为畸形尿路病变的中位年龄为 17.5 个月。性别比例(男/女)为 2.3。临床特征:后尿道瓣膜是最常见的畸形尿路病变(38%)。畸形尿道病变与其他缺陷相关的病例占 4%。产前诊断涉及 24% 的患者。发现时的平均妊娠年龄为闭经 32 周。产后发现的主要原因是腹痛(39%)。治疗特点:58%的患者有手术指征,64%的病例进行了手术治疗。病情发展特点:接受过手术治疗的患者病情发展较好(83%的病例无症状,35%的病例出现尿路感染,23%的病例出现慢性肾功能衰竭)。72%的研究对象死亡:结论:在科特迪瓦,畸形尿道病发现较晚,主要是后尿道瓣膜病。对这些肾脏和泌尿道缺陷的认识和处理应通过发展产前诊断和培训从业人员早期识别临床症状来加以改进。必须通过实施积极的患者随访制度来降低高流失率。
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引用次数: 0
Recent data on atypical hemolytic uremic syndrome associated with pregnancy, kidney transplantation or hypertensive emergency 与妊娠、肾移植或高血压急症有关的非典型溶血性尿毒症的最新数据
Pub Date : 2024-08-12 DOI: 10.1684/ndt.2024.83
Khalil El Karoui

Les microangiopathies thrombotiques (MAT) sont un groupe hétérogène de pathologies caractérisées à différents degrés par une anémie hémolytique mécanique, une thrombopénie et une occlusion microvasculaire histologique. Les MAT peuvent se compliquer de multiples atteintes d’organe, principalement neurologiques et néphrologiques (définissant alors le syndrome hémolytique et urémique). La classification fondée sur la physiopathologie de la maladie a mis en évidence l’importance de la dérégulation de la voie alterne du complément dans les SHU atypiques (SHUa) (non-liés aux infections). Cependant, la physiopathologie et le traitement de nombreuses formes de SHUa dans des contextes spécifiques (tels que la grossesse, la transplantation rénale ou l’urgence hypertensive) restent mal caractérisés. Dans cet article, nous reprenons les avancées diagnostiques et thérapeutiques récentes dans ces trois formes de SHUa aux contextes spécifiques. Nous montrons les spécificités de ces formes et décrivons les enjeux actuels et futurs de leur prise en charge.

血栓性微血管病(TMAs)是一组异质性疾病,在不同程度上以机械性溶血性贫血、血小板减少和组织学微血管闭塞为特征。溶血性贫血可并发多器官疾病,主要是神经和肾脏疾病(定义为溶血性贫血综合征)。基于疾病病理生理学的分类强调了非典型 HUS(aHUS)(与感染无关)中替代补体途径失调的重要性。然而,在特定情况下(如妊娠、肾移植或高血压急症)多种形式的 aHUS 的病理生理学和治疗方法仍不甚明了。在本文中,我们回顾了在这三种特定情况下 HUS 诊断和治疗的最新进展。我们展示了这些形式的具体特征,并描述了当前和未来在其管理方面所面临的挑战。
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引用次数: 0
Novelties for the management of cytomegalovirus after kidney transplantation 肾移植后巨细胞病毒治疗的新方法
Pub Date : 2024-08-01 Epub Date: 2024-08-12 DOI: 10.1684/ndt.2024.84
Nassim Kamar, Olivier Marion, Arnaud Del Bello

Cytomegalovirus (CMV) infection is the main opportunistic infection observed after kidney transplantation. Despite the use of prevention strategies, CMV disease still occurs, especially in high-risk patients (donor seropositive/recipient seronegative). Patients may develop complicated CMV, i.e. recurrent, refractory or resistant CMV infection. CMV prevention relies on either universal prophylaxis or preemptive therapy. In high-risk patients, universal prophylaxis is usually preferred. Currently, valganciclovir is used in this setting. However, valganciclovir can be responsible for severe leucopenia and neutropenia. A novel anti-viral drug, letermovir, has been recently compared to valganciclovir. It was as efficient as valganciclovir to prevent CMV disease and induced less hematological side-effects. It is still not available in France in this indication. Recent studies suggest that immune monitoring by ELISPOT or Quantiferon can be useful to determine the duration of prophylaxis. Other studies suggest that prophylaxis may be skipped in CMV-seropositive kidney-transplant patients given mTOR inhibitors.Refractory CMV is defined by the lack of decrease of CMV DNAemia of at least 1 log10 at 2 weeks after effective treatment. In case of refractory CMV infection, drug resistant mutations should be looked for. Currently, maribavir is the gold standard therapy for refractory/resistant CMV. At 8 weeks therapy and 8 weeks later, it has been shown to be significantly more effective than other anti-viral drugs, i.e. high dose of ganciclovir, foscarnet or cidofovir. However, a high rate of relapse was observed after ceasing therapy. Hence, other therapeutic strategies should be evaluated in order to improve the sustained virological rate.

巨细胞病毒(CMV)感染是肾移植后出现的主要机会性感染。尽管采取了预防策略,但 CMV 病仍时有发生,尤其是在高危患者(供体血清反应阳性/受体血清反应阴性)中。患者可能会出现复杂的 CMV,即复发性、难治性或耐药性 CMV 感染。预防 CMV 主要依靠普遍预防或先期治疗。对于高危患者,通常首选普遍预防。目前,缬更昔洛韦被用于这种情况。然而,缬更昔洛韦会导致严重的白细胞减少症和中性粒细胞减少症。最近,一种新型抗病毒药物--来特莫韦与缬更昔洛韦进行了比较。在预防 CMV 疾病方面,它与缬更昔洛韦一样有效,而且引起的血液学副作用较小。法国目前仍未将其用于这一适应症。最近的研究表明,通过 ELISPOT 或 Quantiferon 进行免疫监测有助于确定预防性治疗的持续时间。其他研究表明,对于接受 mTOR 抑制剂治疗的 CMV 血清阳性肾移植患者,可以不进行预防性治疗。对于难治性 CMV 感染,应寻找耐药突变。目前,马立巴韦是治疗难治/耐药 CMV 的金标准疗法。在治疗 8 周和 8 周后,其疗效明显优于其他抗病毒药物,如大剂量更昔洛韦、福斯卡尼或西多福韦。然而,在停止治疗后发现复发率很高。因此,应评估其他治疗策略,以提高持续病毒学率。
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引用次数: 0
Management of immunosuppressive therapy after functional renal graft failure: results of a practice survey of French-speaking nephrologists 功能性肾移植失败后的免疫抑制治疗管理:法语区肾病专家的实践调查结果
Pub Date : 2024-06-26 DOI: 10.1684/ndt.2024.79
Cyril Garrouste, Marine Freist, Mathilde Prezelin-Reydit, Antoine Bouquegneau, Thomas Fournier, Betoul Schvartz, Antoine Thierry, Virginie Paumier Sanson, Valentin Mayet, Bruno Pereira, Christophe Mariat

The management of patients with kidney transplant failure (KTF) remains a complex process involving multiple stakeholders. A working group of the Transplantation Commission of the French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT) conducted a survey on the management of immunosuppressants (IS) after KTF among nephrologists at transplant centres and general nephrologists in France, Switzerland and Belgium between March and June 2023.We analysed 232 replies from 58 nephrologists at transplant centres and 174 general nephrologists, aged 43.6 (+10.6) years. In the first three months following KTF, nephrologists reported discontinuing antimetabolite, calcineurin inhibitor (CNI) and corticosteroid treatment in 83%, 39.9% and 25.8% of cases respectively. Conversely, some nephrologists reported that they were continuing to use CNI (14%) and corticosteroids (19.1%) on a long-term basis. The patient’s comorbidities associated with the discontinuation of IS treatment are cancer and opportunistic infections as KT’s complications and presence of diabetes mellitus at KTF, whereas humoral rejection encourages the IS to be maintained. Transplantectomy is proposed by nephrologists most often for graft intolerance syndrome (86.5%), more rarely to discontinue IS (17.6%) or in the absence of plans of new transplantation (9.3%). In multivariate analyses, the presence of a protocol in the centre facilitated the management of IS by the general nephrologists.The management of IS after AFG by French-speaking nephrologists is heterogeneous. Specific prospective studies are needed to establish new best practice recommendations, based on more robust evidence, which could encourage better adherence by nephrologists.

肾移植失败(KTF)患者的管理仍然是一个复杂的过程,涉及多个利益相关方。法语区肾脏病学、透析和移植学会(SFNDT)移植委员会的一个工作组在2023年3月至6月期间对法国、瑞士和比利时的移植中心肾脏病学家和普通肾脏病学家进行了一次关于KTF后免疫抑制剂(IS)管理的调查。我们分析了来自58名移植中心肾脏病学家和174名普通肾脏病学家的232份答复,他们的年龄为43.6(+10.6)岁。在 KTF 术后的头三个月,肾病专家报告停止抗代谢药、降钙素抑制剂 (CNI) 和皮质类固醇治疗的比例分别为 83%、39.9% 和 25.8%。相反,一些肾病专家表示,他们仍在长期使用 CNI(14%)和皮质类固醇(19.1%)。与停止IS治疗相关的患者合并症有癌症和机会性感染(KT并发症),以及在KTF时存在糖尿病,而体液排斥反应则促使IS得以维持。肾脏病专家最常因移植物不耐受综合征(86.5%)而建议进行移植切除术,更少的情况是为了中止 IS(17.6%)或没有新的移植计划(9.3%)。在多变量分析中,中心内有协议有利于普通肾病专家对 IS 的管理。法语区肾病专家对AFG术后IS的处理方法各不相同,需要进行具体的前瞻性研究,以便根据更可靠的证据制定新的最佳实践建议,从而鼓励肾病专家更好地遵守这些建议。
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引用次数: 0
Nurse-assisted arterio-venous fistula cannulation during home hemodialysis: first results of the DIADIDEAL study 家庭血液透析期间护士协助动静脉瘘插管:DIADIDEAL 研究的初步结果
Pub Date : 2024-06-26 DOI: 10.1684/ndt.2024.82
Laurence Pautret, Anne-Céline Galle, Anne Radiguet, Catherine Thibault, Ludivine Videloup, Sonia Guillouët, Thierry Lobbedez, Patrick Henri, Maxence Ficheux, Clémence Béchade

Introduction: We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients. The aim of the present study was to describe enrollment of the patients and their nurses.

Materials: All prevalent HD patients on 30th November 2018 with no medical contraindication to HDD treatment and all incident patients on dialysis from the 30th November 2018 to the 21st April 2023 were eligible.

Results: Among 155 prevalent HD patients, 4 patients were included. Among the 276 incident patients on dialysis during the study period, 6 were included. We have phoned 23 nurse centers during the recruitment period. Eight of them agreed to learn in our unit how to cannulate AVF; 27 private nurses were enrolled.

Discussion: The results of the DIADIDEAL study will be available in 2024; we hope it will lead to a reimbursement of nurse-AVF cannulation at home in HDD.

导言:我们发起了一项名为 "DIADIDEAL "的试验性研究,建议护士协助家庭血液透析(HHD)患者在家中进行动静脉瘘(AVF)插管。本研究旨在描述患者及其护士的注册情况:2018年11月30日所有流行的HHD患者,且无HDD治疗的医学禁忌症,以及2018年11月30日至2023年4月21日所有透析的事件患者均符合条件:在155名流行的HD患者中,有4名患者被纳入。在研究期间进行透析的 276 名事件患者中,有 6 名患者被纳入。在招募期间,我们给 23 个护士中心打了电话。讨论:讨论:DIADIDEAL 研究结果将于 2024 年公布;我们希望该研究能为 HDD 患者在家中进行护士动静脉瓣膜置管提供报销。
{"title":"Nurse-assisted arterio-venous fistula cannulation during home hemodialysis: first results of the DIADIDEAL study","authors":"Laurence Pautret, Anne-Céline Galle, Anne Radiguet, Catherine Thibault, Ludivine Videloup, Sonia Guillouët, Thierry Lobbedez, Patrick Henri, Maxence Ficheux, Clémence Béchade","doi":"10.1684/ndt.2024.82","DOIUrl":"10.1684/ndt.2024.82","url":null,"abstract":"<p><strong>Introduction: </strong>We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients. The aim of the present study was to describe enrollment of the patients and their nurses.</p><p><strong>Materials: </strong>All prevalent HD patients on 30th November 2018 with no medical contraindication to HDD treatment and all incident patients on dialysis from the 30th November 2018 to the 21st April 2023 were eligible.</p><p><strong>Results: </strong>Among 155 prevalent HD patients, 4 patients were included. Among the 276 incident patients on dialysis during the study period, 6 were included. We have phoned 23 nurse centers during the recruitment period. Eight of them agreed to learn in our unit how to cannulate AVF; 27 private nurses were enrolled.</p><p><strong>Discussion: </strong>The results of the DIADIDEAL study will be available in 2024; we hope it will lead to a reimbursement of nurse-AVF cannulation at home in HDD.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":"20 3","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Nephrologie & therapeutique
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