Nephrologie & therapeutique最新文献

Background: Nutritional recommendations exist in France for patients with chronic kidney disease (CKD) to help slow its progression. However, how health care professionals (HCPs) perceive and implement these recommendations is unknown at the national level.

Objective: This study aimed to document the practices and perceptions of HCPs providing nutritional care to patients with CKD.

Methods: In September 2024, two anonymous online questionnaires were distributed: one to approximately 1400 nephrologists via the Société francophone de néphrologie, dialyse et transplantation (Francophone Society of Nephrology, Dialysis and Transplantation), and the other to approximately 165 dietitians via the Association des diététiciens de néphrologie et nutrition (Association of Nephrology and Nutrition Dietitians). Data collected included respondent characteristics, training in renal nutrition, use of low-protein diets (LPDs), perceived effectiveness and patient adherence, as well as perceived barriers.

Results: A total of 178 nephrologists (19% trained in renal nutrition) and 127 dietitians (59% trained) responded. Between 50% and 75% considered LPDs to be effective. These diets were mainly prescribed to patients with stage 3 to 5 CKD, perceived as motivated and aware of the importance of slowing CKD progression. According to HCPs, about half of patients initiate an LPD, but only 15% to 30% of HCPs believe that as many as half of these patients actually achieve protein intake targets. The main barriers identified were difficulty in changing dietary habits, lack of understanding, concerns about impacting household routines, lack of educational resources, and the absence of reimbursement for specialized products.

Conclusion: HCPs acknowledge the value of LPDs in the nutritional management of CKD, but several barriers hinder their broader implementation and effectiveness.

Introduction: The health crisis linked to the COVID-19 pandemic and the changes in practices it imposed in dialysis centers were accompanied by observable psychological repercussions for both patients and caregivers. Our aim was to assess the evolution of these repercussions in these two populations, to identify the coping strategies used, and to study the association between psychological symptoms and coping strategies.

Method: This multi-center, French, non-interventional study was conducted in two phases (T1: April 2020 and T2: April 2022) in 13 volunteer dialysis facilities. Pseudonymized questionnaires were used to collect sociodemographic data, self-reported psychological history, and, at both study times, stress levels (simple numerical stress scales), anxiety and depressive symptomatology (Hospital Anxiety and Depression Scale), and coping strategies (Brief COPE). Factors associated with anxiety and depression were studied with a multivariable logistic regression model.

Results: 177 patients and 99 caregivers participated in both phases of the study. In each population, stress and anxiety scores decreased significantly between T1 and T2 (p<0.001), while depression scores remained stable. The most frequently used coping strategy was the use of positive thoughts and was associated with lower anxiety and depression symptoms. By contrast, the avoidance strategy was associated with more anxiety-depressive symptoms.

Conclusion: By April 2022, in France, hemodialysis caregivers' and patients' health crisis-related stress and anxiety levels had decreased compared with April 2020. Positive thinking coping strategies should be promoted among patients and caregivers because they have been shown to protect mood.

Glomerular filtration rate (GFR) is the best indicator of kidney function. In clinical practice, it is most often estimated using equations derived from serum creatinine levels. The objective of our study was to evaluate the performance of two GFR estimators in a pediatric hospital setting in Ouagadougou.This was a prospective study conducted from October 1, 2018 to April 4, 2019. It included children aged 5 to 15 years hospitalized in the medical pediatrics department of the Charles de-Gaulle Pediatric University Hospital. The gold standard was creatinine clearance calculated from a 24-hour urine collection.One hundred patients were included in the study. The median age was 9 years and the sex ratio was 1.5. The median creatinine clearance was 79.69 mL/min/1.73 m2. The median GFR estimated using the Schwartz-2009 and Pottel formulas were 86.07 and 84.31 mL/min/1.73 m2, respectively. For 95% of patients, the differences between the GFR estimated by the Schwartz formula and the measured creatinine clearance ranged from -95.55 to 105.52 mL/min/1.73 m2. These differences range from -101.38 to 102.52 mL/min/1.73 m2 for the GFR estimated by the Pottel formula.Although the Schwartz-2009 and Pottel formulas were developed from populations different from our own, they are suitable for our context. However, the Pottel formula appears to have a certain superiority over the Schwartz formula, with narrower limits of agreement and a lower degree of overestimation of creatinine clearance.

Introduction: Renal replacement therapy (RRT) ensures the survival of patients with end-stage renal disease. It requires vascular access, such as an arteriovenous fistula or a tunneled central venous catheter. Catheters are inserted by different specialists using different techniques.

Materials and methods: We conducted a practice survey on tunneled catheter placement in France developed by the French Intensive Renal Network (FIRN) commission. A comprehensive questionnaire was distributed via social networks to all dialysis centers in France.

Results: Given the low response rate from other facilities, only responses from university hospitals were analyzed. Tunneled catheters are inserted by nephrologists in 68% of French university hospitals, of which only 20% use fluoroscopy for right jugular and femoral placement, and 40% for left jugular placement. The procedure is most often performed outside the operating room, in a dedicated room. Of the centers studied, 19% use antibiotic prophylaxis. The average time to insertion is around 48 hours for nephrologists, compared to 1 to 2 weeks for other specialists. Serious complications are rare but do occur and can be life-threatening. Anticoagulation and dual antiplatelet therapy are discontinued for this procedure. A few centers use tunneled catheters in acute renal failure and for plasma exchange.

Conclusion: Our survey shows that nephrologists place tunneled dialysis catheters in the majority of French university hospitals, enabling rapid access to the procedure. This procedure is often performed without fluoroscopy but under ultrasound guidance. Fluoroscopy remains the gold standard. Echocardiography, being less invasive than fluoroscopy, could improve guidance and enable early diagnosis of serious complications. The rest of the survey presents the various types of practices observed and could serve as a basis for developing best practice recommendations.

Glomerular filtration rate (GFR) is the best indicator of kidney function. In clinical practice, it is most often estimated using equations derived from serum creatinine levels. The objective of our study was to evaluate the performance of two GFR estimators in a pediatric hospital setting in Ouagadougou.This was a prospective study conducted from October 1, 2018 to April 4, 2019. It included children aged 5 to 15 years hospitalized in the medical pediatrics department of the Charles de-Gaulle Pediatric University Hospital. The gold standard was creatinine clearance calculated from a 24-hour urine collection.One hundred patients were included in the study. The median age was 9 years and the sex ratio was 1.5. The median creatinine clearance was 79.69 mL/min/1.73 m2. The median GFR estimated using the Schwartz-2009 and Pottel formulas were 86.07 and 84.31 mL/min/1.73 m2, respectively. For 95% of patients, the differences between the GFR estimated by the Schwartz formula and the measured creatinine clearance ranged from -95.55 to 105.52 mL/min/1.73 m2. These differences range from -101.38 to 102.52 mL/min/1.73 m2 for the GFR estimated by the Pottel formula.Although the Schwartz-2009 and Pottel formulas were developed from populations different from our own, they are suitable for our context. However, the Pottel formula appears to have a certain superiority over the Schwartz formula, with narrower limits of agreement and a lower degree of overestimation of creatinine clearance.

Introduction: The health crisis linked to the COVID-19 pandemic and the changes in practices it imposed in dialysis centers were accompanied by observable psychological repercussions for both patients and caregivers. Our aim was to assess the evolution of these repercussions in these two populations, to identify the coping strategies used, and to study the association between psychological symptoms and coping strategies.

Methods: This multi-center, French, non-interventional study was conducted in two phases (T1 : April 2020 and T2 : April 2022) in 13 volunteer dialysis facilities. Pseudonymized questionnaires were used to collect sociodemographic data, self-reported psychological history, and, at both study times, stress levels (simple numerical stress scales), anxiety and depressive symptomatology (Hospital Anxiety and Depression Scale), and coping strategies (Brief COPE). Factors associated with anxiety and depression were studied with a multivariable logistic regression model.

Results: 177 patients and 99 caregivers participated in both phases of the study. In each population, stress and anxiety scores decreased significantly between T1 and T2 (p<0.001), while depression scores remained stable. The most frequently used coping strategy was the use of positive thoughts and was associated with lower anxiety and depression symptoms. By contrast, the avoidance strategy was associated with more anxiety-depressive symptoms.

Conclusion: By April 2022, in France, hemodialysis caregivers' and patients' health crisis-related stress and anxiety levels had decreased compared with April 2020. Positive thinking coping strategies should be promoted among patients and caregivers because they have been shown to protect mood.

The working group of the Francophone Society of Nephrology, Dialysis, and Transplantation (SFNDT) recently published a guide for the reasoned adaptation of therapies (ART) in nephrology, which takes up the legal framework of the Claeys–Leonetti Law (2016) and highlights the specificities of palliative care in the context of a long-term chronic illness. In this literature review—drawing from both medical research and the humanities and social sciences—we offer a complementary perspective on the complex decision-making process from dialysis withdrawal to death (DWD), in the sense of sociologist and philosopher Edgard Morin’s concept of complex thought. Quantitative studies, both national and international, highlight the role of cultural differences between countries as well as the influence of legal frameworks on DWD, but other factors are also at play. Patient characteristics associated with DWD as well as differences in regional practices are identified. Qualitative studies and research in the humanities and social sciences further explore the experiences of caregivers, marked by uncertainty and complexity, as decisions unfold among patients, families or caregivers, and health care professionals. This literature review serves as a foundation for an ongoing mixed methods study on the variability of DWD practices in France.