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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":null,"pages":null},"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}
引用次数: 0
Prevalence of stages 3-5 chronic kidney disease in New Caledonia 新喀里多尼亚慢性肾病 3-5 期的发病率
Pub Date : 2024-06-26 DOI: 10.1684/ndt.2024.77
Noémie Baroux, Élodie Magnat, Marina Cauchy, Jean-François Cantin, Raphael Cohen, Pascale Domingue-Mena

New Caledonia is a French territory located in the South Pacific Ocean. The prevalence rate of end-stage renal disease is nearly 3,000 per million inhabitants, making it one of the highest prevalence rates in the world. Preventing chronic kidney disease is a major public health issue. This article presents prevalence rates of chronic kidney disease (CKD) stages 3-5 for New Caledonia defined by a glomerular filtration rate estimated below 60 mL/min/1.73 m2. Estimation was assessed from data collected during two “Adult health barometer” surveys carried out in the general adult population. Therefore, our study assessed two prevalence rates: 7.8% [6.1; 10.1] and 5.3% [3.3; 8.5]. Those prevalence rates were two to four times higher than in mainland France which is consistent with the high prevalence rate of end stage renal disease treated in New Caledonia. Hence, CKD prevention is essential for New Caledonia.

新喀里多尼亚是位于南太平洋的法国领土。新喀里多尼亚的终末期肾病发病率接近每百万居民 3,000 人,是世界上发病率最高的地区之一。预防慢性肾病是一个重大的公共卫生问题。本文介绍了新喀里多尼亚慢性肾脏病(CKD)3-5 期的患病率,其定义是肾小球滤过率低于 60 mL/min/1.73 m2。估计值是根据两次 "成人健康晴雨表 "调查中收集到的数据进行评估的。因此,我们的研究评估了两个患病率:分别为 7.8% [6.1; 10.1] 和 5.3% [3.3; 8.5]。这些患病率比法国本土高出 2 到 4 倍,这与新喀里多尼亚治疗终末期肾病的高患病率是一致的。因此,在新喀里多尼亚,预防慢性肾功能衰竭至关重要。
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引用次数: 0
Withholding or withdrawing life support in nephrology: a perspective in the French-speaking background 肾脏病学中暂停或撤消生命支持:法语背景下的视角
Pub Date : 2024-06-26 DOI: 10.1684/ndt.2024.81

Chronic kidney disease (CKD) characterized by long duration, simplicity at beginning versus complexity at advanced stages. Hemodialysis and peritoneal dialysis are renal replacement therapy allowing life extension, but comorbidities and frailty could be burdensome over time. The academic society, Société Francophone de Néphrologie, Dialyse, Transplantation (SFNDT), publishes clinical practice guidelines to optimize CKD treatment in this context, to support shared decision-making in the appropriate initiation of and withdrawal from dialysis, and to supervise end-of-life cares in the French-speaking countries.

慢性肾脏病(CKD)的特点是病程长、初期简单而晚期复杂。血液透析和腹膜透析是肾脏替代疗法,可以延长患者的生命,但随着时间的推移,合并症和虚弱可能会成为患者的负担。法语国家肾脏病、透析和移植学会(SFNDT)发布了临床实践指南,以优化在这种情况下的 CKD 治疗,支持在适当开始和退出透析时共同决策,并监督法语国家的临终关怀。
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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 : 2024-06-19 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。
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引用次数: 0
Withholding or withdrawing life support in nephrology: a perspective in the French-speaking background 肾脏病学中暂停或撤消生命支持:法语背景下的视角
Pub Date : 2024-06-19 DOI: 10.1684/ndt.2024.81
L Frimat

Chronic kidney disease (CKD) characterized by long duration, simplicity at beginning versus complexity at advanced stages. Hemodialysis and peritoneal dialysis are renal replacement therapy allowing life extension, but comorbidities and frailty could be burdensome over time. The academic society, Société Francophone de Néphrologie, Dialyse, Transplantation (SFNDT), publishes clinical practice guidelines to optimize CKD treatment in this context, to support shared decision-making in the appropriate initiation of and withdrawal from dialysis, and to supervise end-of-life cares in the French-speaking countries.

慢性肾脏病(CKD)的特点是病程长、初期简单而晚期复杂。血液透析和腹膜透析是肾脏替代疗法,可以延长患者的生命,但随着时间的推移,合并症和体弱会给患者带来沉重的负担。法语国家肾脏病、透析和移植学会(SFNDT)发布了临床实践指南,以优化在这种情况下的 CKD 治疗,支持在适当开始和退出透析时共同决策,并监督法语国家的临终关怀。
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引用次数: 0
Difelikefalin and treatment of severe pruritus associated with chronic kidney disease - Real-life retrospective study in a dialysis center 地匹福林与慢性肾病相关严重瘙痒症的治疗--透析中心的真实回顾性研究
Pub Date : 2024-06-14 DOI: 10.1684/ndt.2024.78
Rémi Brasme, Claire Cartery, Marlène Goubet, Marie-Flore Hennino, Nathalie Maisonneuve

Introduction: Difelikefalin is to date the first and only specific treatment to be approved for the treatment of moderate-to-severe chronic kidney disease-associated pruritus (CKD-aP) in adult patients on hemodialysis.

Patients and methods: This was a retrospective, single-center, real-life study in hemodialysis patients with CKD-aP treated with difelikefalin. The primary objective was to evaluate the evolution of the intensity of pruritus during treatment with difelikefalin using the Worst Itch Intensity-Numerical Rating Scale (WI-NRS). Adult patients were included if they had been on hemodialysis for at least 3 months and were suffering from moderate to severe CKD-aP (objectified by the WI-NRS score) for which difelikefalin had been prescribed.

Results: 11 patients (7 men and 4 women; mean age, 63.8 years) with a mean (SD) weekly dialysis time of 13 h (2.4) were included. The mean hemodialysis duration was 5 (3.6) years and the mean pruritus duration was 4.3 (3.2) years. At inclusion, on-going treatments of CKD-aP were emollients in all patients and antihistamines in 9 patients. The mean WI-NRS score was 7.4 (1.1) at initiation of difelikefalin. At last assessment after a median follow-up of 9.0 months, the mean change of WI-NRS score was -5.1 (2.9) and 82% of patients had a decrease ≥ 3 points. Mild to moderate adverse reactions to difelikefalin were reported in 4 patients, all of whom recovered without sequelae.

Conclusion: These results show that difelikefalin, prescribed according to its therapeutic indication, is effective in the treatment of CKD-aP under real-life conditions, outside the controlled conditions of a clinical trial.

简介地匹福林是迄今为止第一种也是唯一一种获准用于治疗成年血液透析患者中重度慢性肾病相关性瘙痒症(CKD-aP)的特效药物:这是一项回顾性、单中心、真实生活研究,研究对象是接受地匹法林治疗的慢性肾脏病相关性瘙痒症(CKD-aP)血液透析患者。研究的主要目的是使用最严重瘙痒强度数字评定量表(WI-NRS)评估地匹福林治疗期间瘙痒强度的变化情况。纳入的成年患者必须至少接受过 3 个月的血液透析,并患有中度至重度 CKD-aP(以 WI-NRS 评分为指标),且处方为地非司酮:共纳入 11 名患者(7 名男性,4 名女性;平均年龄 63.8 岁),平均(标清)每周透析时间为 13 小时(2.4)。平均血液透析时间为 5 (3.6) 年,平均瘙痒持续时间为 4.3 (3.2) 年。纳入时,所有患者正在接受的 CKD-aP 治疗均为润肤剂治疗,9 名患者接受了抗组胺剂治疗。开始使用地匹福林时,平均 WI-NRS 评分为 7.4(1.1)分。在中位随访9.0个月后的最后一次评估中,WI-NRS评分的平均变化为-5.1(2.9)分,82%的患者评分下降≥3分。据报道,4名患者出现了轻度至中度的地非司酮不良反应,但他们均已康复,没有留下后遗症:这些结果表明,在临床试验的受控条件之外,根据其治疗适应症处方的地非司酮在实际生活条件下治疗 CKD-aP 是有效的。
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引用次数: 0
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Nephrologie & therapeutique
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