Nephrologie & therapeutique最新文献

Introduction: Hemodialysis patients have poorer health-related quality of life (HRQOL) compared to the general population. HRQOL is influenced by many sociodemographic and clinical factors. The aim of our study is to describe the HRQOL among adult patients undergoing hemodialysis during a period of economic and health crisis.

Methods: This is a cross-sectional study including patients who had been on hemodialysis for at least 3 months. We interviewed a total of 90 hemodialysis patients using the 36-Item Short Form Health Survey (SF36). The SF-36 measures eight scales and two distinct concepts: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Data analyses was performed with RStudio version 2022.12.0.

Results: The mean age (±SD) was 69.67±12.80 years. The mean PCS score (±SD) was 48.55±24.7 and the mean MCS score (±SD) was 58.62±22.1. The highest scores among the SF-36 were emotional well-being (66.65±20.02) and social functioning (66.53±27.40). Multivariate analysis showed that PTH levels and occupational status are significantly associated with PCS scores (p=0.007 and p=0.03 respectively), and that age at onset of dialysis, PTH levels, occupational status, marital status, and COVID-19 infection are significantly associated with MCS scores (p=0.04, p<0.001, p=0.003, p=0.006 and p=0.007 respectively).

Conclusion: The overall PCS and MCS scores were low, indicating poor HRQOL. However, the crises did not appear to directly worsen it, due to a strong social support system. A multidisciplinary team approach may improve the HRQOL of these patients.

Introduction: Peritoneal dialysis (PD) is an effective treatment option for patients with kidney failure and offers them a better quality of life. Despite its advantages, PD remains underutilized, particularly in Morocco. The aim of our study was to evaluate the impact of catheter placement by nephrologists on the number of incident PD patients, compare the success rates of this technique with those of surgical placement, and assess the short- and long-term complications associated with the two approaches.

Methods: This was a single-center retrospective study including 69 PD patients, conducted from January 2008 to December 2022.

Results: A total of 28 patients received PD catheter placement by nephrologists (Group A), while 41 underwent the procedure performed by urologists (Group B). Since the introduction of nephrologist-led catheter placement, the incidence of patients starting PD significantly increased, with a growth rate of over 100% every two years. The waiting time for catheter placement was significantly shorter in Group A (5 days versus 20 days; p < 0.001). No significant difference was observed in the incidence of short-term mechanical and infectious complications between the two groups. Although univariable analysis revealed a higher incidence of long-term mechanical and infectious complications in Group B compared to group A, this difference was not statistically significant in multivariable analysis (p > 0.05). The success rate of PD catheter placement in Group A was 92.85%, while it was 97.56% in Group B. The one-year catheter survival rate was significantly higher in Group B than in Group A (100% versus 75%; p = 0.031), and mean catheter survival was significantly longer in Group B (17 months versus 11 months; p = 0.026).

Conclusion: PD catheter placement by nephrologists proved to be a safe and effective approach.

Background: Lumasiran is a small interfering RNA molecule indicated for the treatment of primary hyperoxaluria type 1 (PH1).

Case diagnosis/treatment: We report a case of infantile PH1 in a 3-month-old girl admitted with anuria and kidney failure. Peritoneal dialysis (PD) and conservative treatment were immediately initiated. The first dose of lumasiran was administered at 12 months, while the patient was still on PD. Despite very high baseline plasma oxalate (POx) levels of around 200 µmol/L, treatment with lumasiran led to a nearly 50% reduction in POx levels, even during PD. Once the patient reached a sufficient body weight to safely initiate hemodialysis (HD), she was switched to HD; POx levels remained around 100 µmol/L, despite an intensive HD regimen.

Conclusion: This is one of the first reported cases of lumasiran therapy during PD in an infant with PH1; even with this dialysis modality, POx levels can be decreased to a certain extent.

This study investigates ethnic differences in vitamin D levels and bone-related biomarkers among Algerian CKD patients, focusing on the interactions between vitamin D, anemia, and FGF23. A multicenter, cross-sectional study involved 284 CKD patients in stages 3 and 4, with a mean age of 54±1.17 years. Participants were recruited from nephrology units in three distinct geographic regions of Algeria: Algiers (Mediterranean), Ghardaïa (sub-Saharan), and Tamanrasset (Saharan). Biochemical analyses included serum levels of 25OH vitamin D, iPTH, iFGF23, calcium, phosphorus, and hemoglobin. Multiple logistic regression was used to assess the association between anemia and vitamin D levels. Linear regression analysis identified predictors of iFGF23 in hemoglobin levels. A two-way ANOVA was performed to examine the influence of vitamin D levels across different ethnic groups. Patients from Tamanrasset exhibited significantly lower levels of 25OH vitamin D and hemoglobin, and higher levels of phosphorus, iFGF23, and iPTH, compared to those from Ghardaïa and Algiers. Anemia was independently associated with lower serum 25OH vitamin D concentrations (β=-0.11, P=0.001), while iFGF23 levels were inversely associated with hemoglobin levels (β=-3.3, P=0.01). A significant interaction between anemia and vitamin D status was observed among Black patients (P=0.0001), but not among white patients (P=0.7). These findings underscore notable ethnic disparities in vitamin D status and mineral biomarkers among Algerian CKD patients. The interplay between vitamin D, anemia, and FGF23 highlights the need for ethnically tailored care, particularly for patients in the Saharan region of Tamanrasset.

Background: End-stage chronic kidney disease affects millions of people worldwide, and its treatment through hemodialysis results in a high rate of depression and anxiety. To address these disorders, virtual reality can be used as a non-pharmacological psychological intervention.

Objective: To describe the effectiveness of virtual reality interventions on depression and anxiety symptoms in hemodialysis patients.

Methods: A systematic review was conducted in the PubMed, Embase, ScienceDirect, and PsycInfo databases. Six quantitative studies published between 2019 and 2024 that address the impact of virtual reality on anxiety and depressive symptoms in hemodialysis patients were included according to the PRISMA method. A methodical analysis of these studies was performed.

Results: These studies utilize various virtual reality interventions, both immersive and non-immersive, such as “exergaming.” They predominantly report a significant improvement in depression and anxiety scores in hemodialysis patients. The benefit of these studies varies according to the type and duration of the intervention. The main limitations include the small number of available studies and limited sample sizes.

Conclusion: Virtual reality interventions show promising potential for improving anxiety and depressive symptoms in hemodialysis patients. They can find a place in non-pharmacological management. Large additional studies are needed to better understand their potential benefits and to optimize their handling by patients and caregivers.

Despite advances in the physiopathological understanding of kidney transplantation immunology, kidney transplant rejection remains the leading cause of allograft loss. The current gold standard for diagnosing rejection is histological assessment of kidney transplant biopsies.Biopsy-based transcriptomics have been the subject of numerous studies, enabling the analysis of hundreds of transcripts expressed in biopsy samples. These tools allow for the identification of new pathophysiological pathways, providing a better understanding of rejection and potentially revealing therapeutic targets.Biopsy-based transcriptomics may also improve the diagnosis of rejection, in particular antibody-mediated rejection. However, the use of these tools in routine practice is limited due to restricted availability, the challenge of interpreting data from hundreds of transcripts without clear guidelines, and their cost. In addition, due to the limited accessibility of molecular tools, their exact impact on patient management has not yet been determined.This update provides an overview of biopsy-based transcriptomics in 2025, focusing on the limitations of current diagnostic methods for rejection, the molecular biology tools available, and their use in clinical practice.

Early detection of kidney disease can protect kidney health, prevent kidney disease progression and related complications, reduce the risk of cardiovascular disease, and decrease mortality. We must ask, “Are your kidneys ok?” by using serum creatinine to estimate kidney function and urine albumin to assess kidney and endothelial damage. Evaluation of causes and risk factors for chronic kidney disease (CKD) includes testing for diabetes, as well as measuring blood pressure and body mass index. This World Kidney Day we assert that case-finding in high-risk populations – or even population-level screening – can significantly reduce the global burden of kidney disease. Early-stage CKD is asymptomatic and simple to test for. Recent paradigm-shifting CKD treatments, such as sodium-glucose cotransporter-2 inhibitors, dramatically improve outcomes and favor the cost-benefit analysis for screening or case-finding programs. Despite this, numerous barriers exist, including resource allocation, health care funding, infrastructure, and both health care professionals’ and the public’s awareness of kidney disease. Coordinated efforts by major kidney-focused non-governmental organizations to prioritize kidney health within government agendas and align early detection efforts with other current programs will maximize efficiencies.