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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:法语肾病专家实践调查结果
Pub Date : 2024-06-14 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
Prevalence of stage 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 : 2024-06-13 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 例,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。估计值是根据在普通成年人口中进行的两次 "成人健康晴雨表 "调查中收集的数据进行评估的。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
Mind the gap in kidney care: translating what we know into what we do. 关注肾脏护理中的差距:将我们的知识转化为我们的行动。
Pub Date : 2024-06-01 Epub Date: 2024-06-13 DOI: 10.1684/ndt.2024.80
Valerie A Luyckx, Katherine R Tuttle, Dina Abdellatif, Ricardo Correa-Rotter, Winston W S Fung, Agnès Haris, Li-Li Hsiao, Makram Khalife, Latha A Kumaraswami, Fiona Loud, Vasundhara Raghavan, Stefanos Roumeliotis, Marianella Sierra, Ifeoma Ulasi, Bill Wang, Siu Fai Lui, Vassilios Liakopoulos, Alessandro Balducci

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.

从历史上看,新疗法从临床证据转化为日常实践平均需要 17 年的时间。鉴于目前已有的高效疗法可以预防或延缓肾病的发生和发展,这个时间太长了。现在是缩小我们所知道的与我们所做的之间差距的时候了。对于高血压和糖尿病等肾脏病常见风险因素的预防和管理,已有明确的指导方针,但全世界只有一小部分肾脏病患者被确诊,接受目标治疗的患者则更少。同样,绝大多数肾病患者都不知道自己的病情,因为肾病在早期往往是无声无息的。即使在已经确诊的患者中,许多人也没有接受适当的肾病治疗。考虑到肾病恶化、肾衰竭或死亡的严重后果,必须及早开始适当的治疗。必须从初级保健开始,最大限度地利用早期诊断和治疗肾病的机会。从患者到临床医生,从医疗系统到社会因素,存在着许多系统性障碍。为了维护和改善世界各地每个人的肾脏健康,必须认识到这些障碍中的每一个,以便制定和实施可持续的解决方案,不再拖延。
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引用次数: 0
Factors associated with therapeutic non-adherence in renal transplant patients: a bicentric study in Algeria 肾移植患者不坚持治疗的相关因素:阿尔及利亚的一项双中心研究
Pub Date : 2024-05-15 Epub Date: 2024-04-04 DOI: 10.1684/ndt.2024.69
Akli Islem Chebli, Zeyneb Chelighem, Emad Shalabi, Younes Zebbiche, Nada Boubidi, Bahi Baraa, Nechoia Boumalha, Djihad Bouhlassa, Sara Abdennour

Introduction: Medication non-adherence is a global concern, particularly in the context of renal transplantation, where it leads to graft failures, increased hospitalizations, diminished quality of life for patients, and higher healthcare costs. The aim of this study was to assess the level of therapeutic adherence among Algerian kidney transplant recipients and identify potential influencing factors.

Methods: A descriptive, cross-sectional bicenter study was conducted among kidney transplant patients receiving outpatient care at two specialized medical centers in Algeria: the Urology Department of the Hospital Establishment for Urology, Nephrology, and Renal Transplantation in Constantine, and the Nephrology and Renal Transplantation Department of the University Hospital Center (CHU) in Blida, spanning from January to December 2022. Therapeutic adherence was assessed using the 8-item Morisky questionnaire, while the level of knowledge was analyzed through a 12-item questionnaire. Logistic regression was used to identify factors associated with non-adherence to therapy.

Results: This study included 130 patients with an average age of 47 years and a sex ratio of 1.7. The results revealed therapeutic non-adherence in 40.8% of the patients. Multivariate analysis identified several potentially associated factors, including residence, unemployment status, lack of affiliation with a health insurance fund, the use of a therapeutic regimen involving triple therapy, the occurrence of adverse effects, limited education level, and insufficient disease knowledge. Furthermore, non-adherence was associated with an increased risk of graft rejection.

Conclusion: The findings of this study highlight concerning therapeutic adherence among kidney transplant recipients, emphasizing the crucial importance of therapeutic education to improve treatment adherence and underscoring the need to integrate these factors into clinical patient management.

导言:不遵医嘱用药是一个全球关注的问题,尤其是在肾移植领域,它会导致移植失败、住院次数增加、患者生活质量下降以及医疗费用增加。本研究旨在评估阿尔及利亚肾移植受者的治疗依从性水平,并找出潜在的影响因素:这项描述性横断面双中心研究的对象是在阿尔及利亚两家专科医疗中心接受门诊治疗的肾移植患者,这两家医疗中心分别是君士坦丁市泌尿学、肾脏病学和肾移植医院的泌尿科和布利达市大学医院中心(CHU)的肾脏病学和肾移植科,研究时间跨度为 2022 年 1 月至 12 月。治疗依从性通过 8 项莫里斯基问卷进行评估,知识水平则通过 12 项问卷进行分析。采用逻辑回归法确定与不坚持治疗相关的因素:本研究共纳入 130 名患者,平均年龄 47 岁,男女比例为 1.7。结果显示,40.8%的患者不坚持治疗。多变量分析发现了几个潜在的相关因素,包括居住地、失业状况、未加入医疗保险基金、使用涉及三联疗法的治疗方案、出现不良反应、教育水平有限以及疾病知识不足。此外,不坚持治疗与移植排斥风险增加有关:本研究结果强调了肾移植受者治疗依从性的问题,强调了治疗教育对提高治疗依从性的重要性,并强调了将这些因素纳入临床患者管理的必要性。
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引用次数: 0
Improving pre-emptive access to the kidney transplant waiting list between 2017 and 2021: assessment of a regional program in Aquitaine 在 2017 年至 2021 年间改善肾移植候选名单的抢先访问:对阿基坦大区计划的评估。
Pub Date : 2024-05-15 DOI: 10.1684/ndt.2024.64
Mathilde Prezelin-Reydit, Karine Moreau, Frederic Jambon, Eric Alezra, Grégoire Robert, Jean-Christophe Bernhard, Savva Assatourian, Cécile Degryse, Noëlle Boulonne, Arlette Communier, Brigitte Bonpunt, Benjamin Daviller, Olivier Delorme, Xabina Larre, Hannah Kaminski, Karen Leffondré, Pierre Merville, Lionel Couzi

Introduction: Pre-emptive access to the kidney transplant (KT) waiting list remains limited in France, with only 3.9% of patients on pre-emptive KT and 5.6% of patients registered at the time of initiation of dialysis. A similar trend was observed in Aquitaine. The aim of this study was to assess the impact of a regional program in terms of access to the waiting list for patients initiating a kidney replacement therapy (KRT).

Methods: We included all patients assessed for registration on the list between 2017 and 2020, 2017 being the reference year and 2018 the beginning of the program. Using the CRISTAL and REIN registries, we assessed changes in the number of patients on the list at the time of initiation of dialysis or transplantation.

Results: The number of new assessed candidates increased gradually each year from 255 in 2017 to 352 in 2020 (+38%). The number of patients on the list sharply increased in 2018 from 229 in 2017 to 319 in 2018 (+39.3%) and then remained stable. At the initiation of KRT, the proportion of patients registered on the waiting list increased gradually from 7.1% in 2017 to 18.2% in 2020. The proportion of pre-emptive KT remained stable between 2017 and 2021 (around 7%) with a decrease in 2020 (4.6%). Approximately 60% of patients had a contraindication to transplantation throughout the study.

Conclusion: This study showed that a regional program aimed at providing better information to healthcare professionals and patients and encouraging rapid assessment of transplant candidates could increase the rate of pre-emptive registration on the KT waiting list for eligible patients over 4 years.

导言:在法国,肾移植(KT)候选名单中的先期肾移植患者仍然有限,只有 3.9% 的先期肾移植患者和 5.6% 的患者在开始透析时进行了登记。阿基坦大区也出现了类似的趋势。本研究旨在评估一项地区计划对肾脏替代治疗(KRT)患者进入候诊名单的影响:我们纳入了所有在2017年至2020年期间被评估登记的患者,其中2017年为基准年,2018年为该计划的起始年。通过 CRISTAL 和 REIN 登记,我们评估了开始透析或移植时名单上患者人数的变化:新评估的候选者人数每年逐渐增加,从2017年的255人增加到2020年的352人(+38%)。2018年,名单上的患者人数从2017年的229人急剧增加到2018年的319人(+39.3%),随后保持稳定。在启动 KRT 时,登记在候诊名单上的患者比例从 2017 年的 7.1%逐渐增加到 2020 年的 18.2%。2017 年至 2021 年期间,先期 KT 的比例保持稳定(约 7%),2020 年有所下降(4.6%)。在整个研究过程中,约60%的患者有移植禁忌症:这项研究表明,一项旨在为医护人员和患者提供更多信息并鼓励对移植候选者进行快速评估的地区性计划,可以在4年内提高符合条件的患者在KT候选名单上的优先登记率。
{"title":"Improving pre-emptive access to the kidney transplant waiting list between 2017 and 2021: assessment of a regional program in Aquitaine","authors":"Mathilde Prezelin-Reydit, Karine Moreau, Frederic Jambon, Eric Alezra, Grégoire Robert, Jean-Christophe Bernhard, Savva Assatourian, Cécile Degryse, Noëlle Boulonne, Arlette Communier, Brigitte Bonpunt, Benjamin Daviller, Olivier Delorme, Xabina Larre, Hannah Kaminski, Karen Leffondré, Pierre Merville, Lionel Couzi","doi":"10.1684/ndt.2024.64","DOIUrl":"10.1684/ndt.2024.64","url":null,"abstract":"<p><strong>Introduction: </strong>Pre-emptive access to the kidney transplant (KT) waiting list remains limited in France, with only 3.9% of patients on pre-emptive KT and 5.6% of patients registered at the time of initiation of dialysis. A similar trend was observed in Aquitaine. The aim of this study was to assess the impact of a regional program in terms of access to the waiting list for patients initiating a kidney replacement therapy (KRT).</p><p><strong>Methods: </strong>We included all patients assessed for registration on the list between 2017 and 2020, 2017 being the reference year and 2018 the beginning of the program. Using the CRISTAL and REIN registries, we assessed changes in the number of patients on the list at the time of initiation of dialysis or transplantation.</p><p><strong>Results: </strong>The number of new assessed candidates increased gradually each year from 255 in 2017 to 352 in 2020 (+38%). The number of patients on the list sharply increased in 2018 from 229 in 2017 to 319 in 2018 (+39.3%) and then remained stable. At the initiation of KRT, the proportion of patients registered on the waiting list increased gradually from 7.1% in 2017 to 18.2% in 2020. The proportion of pre-emptive KT remained stable between 2017 and 2021 (around 7%) with a decrease in 2020 (4.6%). Approximately 60% of patients had a contraindication to transplantation throughout the study.</p><p><strong>Conclusion: </strong>This study showed that a regional program aimed at providing better information to healthcare professionals and patients and encouraging rapid assessment of transplant candidates could increase the rate of pre-emptive registration on the KT waiting list for eligible patients over 4 years.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140915887","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
Argument for the annual monitoring of specialized biological examinations carried out in hemodialysis 对血液透析中进行的专门生物检查进行年度监测的论据
Pub Date : 2024-05-15 DOI: 10.1684/ndt.2024.75
Antoine Braconnier, Lucile Mercadal, Jean-Michel Poux
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引用次数: 0
Argument justifying the measurement of routine biochemical markers in hemodialysis 血液透析中常规生化指标测量的合理性论证
Pub Date : 2024-05-15 Epub Date: 2024-04-04 DOI: 10.1684/ndt.2024.74
Céline Nodimar, Philippe Chauveau
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引用次数: 0
Second wave of the repository of biological examinations in hemodialysis 关于血液透析患者生物监测的论证--SFNDT 透析委员会为提高透析质量而起草的第二批建议。
Pub Date : 2024-05-15 DOI: 10.1684/ndt.2024.76
Thierry Lobbedez, Jean-Michel Poux
{"title":"Second wave of the repository of biological examinations in hemodialysis","authors":"Thierry Lobbedez, Jean-Michel Poux","doi":"10.1684/ndt.2024.76","DOIUrl":"10.1684/ndt.2024.76","url":null,"abstract":"","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916517","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
Arguments for the screening of essential viral markers in the context of chronic hemodialysis patient surveillance 在慢性血液透析患者监测中筛查基本病毒标记物的论据
Pub Date : 2024-05-15 DOI: 10.1684/ndt.2024.73
Vincent Thibault
{"title":"Arguments for the screening of essential viral markers in the context of chronic hemodialysis patient surveillance","authors":"Vincent Thibault","doi":"10.1684/ndt.2024.73","DOIUrl":"https://doi.org/10.1684/ndt.2024.73","url":null,"abstract":"","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140924142","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
Fibromuscular dysplasia of the renal arteries: what do we know in 2024? 肾动脉纤维肌性发育不良:2024 年我们知道些什么?
Pub Date : 2024-05-15 DOI: 10.1684/ndt.2024.70
Corentin Tournebize, Sandrine Lemoine, Caroline Pelletier

Fibromuscular dysplasia (FMD) is a rare nonatherosclerotic, noninflammatory vascular disease affecting mostly renal and carotid arteries and is the second most frequent cause of renal artery stenosis. The symptomatology is dominated by arterial hypertension due to the frequent involvement of the renal arteries and depends on the location of the lesions. Most of the cases are middle-aged women of Caucasian origin. There are two subtypes based on angiographic aspect: multifocal FMD (80% of the cases) and focal FMD (rarer with a more balanced sex ratio). Angioplasty of the renal arteries is generally disappointing with less than 50% cure of hypertension. It appears necessary to improve our knowledge of the FMD and to optimize the selection of eligible patients for revascularization with transdisciplinary collegial therapeutic decision.

纤维肌性发育不良(FMD)是一种罕见的非动脉粥样硬化性、非炎症性血管疾病,主要累及肾动脉和颈动脉,是导致肾动脉狭窄的第二大原因。由于肾动脉经常受累,症状以动脉高血压为主,并取决于病变的位置。大多数病例为高加索血统的中年女性。根据血管造影可分为两种亚型:多灶性 FMD(占 80% 的病例)和局灶性 FMD(较少见,性别比例更均衡)。肾动脉血管成形术通常效果不佳,高血压治愈率不到 50%。看来,我们有必要提高对 FMD 的认识,并通过跨学科联合治疗决策,优化对符合血管重建条件的患者的选择。
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引用次数: 0
期刊
Nephrologie & therapeutique
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