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[Pruritus associated with chronic kidney disease in hemodialysis patients: a survey in French nephrologists]. 血液透析患者中与慢性肾脏疾病相关的瘙痒:法国肾脏病学家的调查
Pub Date : 2023-11-02 DOI: 10.1684/ndt.2023.31
Maxime Touzot, Pierre Bataille, Guy Rostoker, Philippe Chauveau, Antoine Lanot, Laurent Misery

Background: Chronic kidney disease-associated pruritus (CKD-aP) is common in hemodialysis patients and severely impairs their quality of life, but the practices of nephrologists remain poorly known.

Methods: The objective of this on-line survey was to describe the management of CKD-aP in French nephrologists affiliated with the French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT) and involved in hemodialysis.

Results: In total, 122 questionnaires were completed and 100 were usable. Nephrologists reported they personally managed a median of 52 patients; they estimated that the CKD-aP prevalence in their hemodialysis patients was a median of 10% (IQR, 6.3-17.2); 6% of nephrologists reported not following any patient with CKD-aP. In case of CKD-aP, the first-intention intervention was the evaluation of phosphocalcic metabolism (53.5%) and verification of dialysis adequacy (52%). For moderate-to-severe CKD-aP, the first-line prescription was topical therapy (71.3%), antihistamine (23.2%) and membrane change (15.9%). Patients were referred to a dermatologist mainly in case of treatment failure (86.9%) or scratching lesions (40.4%). Available treatments were considered ineffective for 50.5% of nephrologists, partially effective for 45.5% and effective for only 4%.

Conclusion: These results show that according to the opinion of nephrologists, the pruritus prevalence is low in dialysis patients. This is inconsistent with studies based on systematic patient interviews, thus suggesting that pruritus is a symptom overlooked by nephrologists. In the context of the arrival of a new drug for pruritus, patients should be more questioned about this symptom in order to propose this treatment.

背景:慢性肾脏病相关瘙痒症(CKD-aP)在血液透析患者中很常见,严重损害了他们的生活质量,但肾脏科医生的做法仍然鲜为人知。方法:本在线调查的目的是描述法语肾脏病、透析和移植学会(SFNDT)附属并参与血液透析的法国肾脏病学家对CKD-aP的管理。结果:共完成问卷122份,可用问卷100份。肾病学家报告说,他们亲自管理了平均52名患者;他们估计血液透析患者的CKD-aP患病率中位数为10%(IQR,6.3-17.2);6%的肾脏科医生报告没有跟踪任何CKD-aP患者。在CKD-aP的情况下,第一意向干预是评估磷钙代谢(53.5%)和验证透析充分性(52%)。对于中重度CKD-aP,一线处方是局部治疗(71.3%)、抗组胺药(23.2%)和膜改变(15.9%)。患者主要在治疗失败(86.9%)或抓挠病变(40.4%)的情况下转诊给皮肤科医生。50.5%的肾科医生认为可用的治疗无效,部分有效45.5%,有效率仅4%。这与基于系统患者访谈的研究不一致,因此表明瘙痒是肾病学家忽视的症状。在一种治疗瘙痒的新药问世的背景下,为了提出这种治疗方法,应该更多地询问患者的这种症状。
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引用次数: 0
[Heart disease in hemodialysis: physiopathology and therapeutic breakthroughs]. 血液透析中的心脏病:生理病理学和治疗突破
Pub Date : 2023-11-02 DOI: 10.1684/ndt.2023.47
Lucile Mercadal, Jean-Jacques Boffa, Jean-Philippe Collet

Especially exposed to frequent cardiovascular events and its related mortality, some cardiovascular therapies of the hemodialyzed population as well as coronary investigations remain controversial. We have collected data and discussed recent trials and guidelines dedicated to this patient subset.

特别是在频繁发生心血管事件及其相关死亡率的情况下,血液透析人群的一些心血管治疗以及冠状动脉研究仍然存在争议。我们已经收集了数据,并讨论了最近专门针对这一患者子集的试验和指南。
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引用次数: 0
[Immune modulation with extracorporeal photopheresis in renal transplantation: proof of concept clinical outcomes and perspective]. 体外光合疗法在肾移植中的免疫调节:概念验证的临床结果和前景
Pub Date : 2023-11-02 DOI: 10.1684/ndt.2023.46
Thomas Crépin, Arnaud Lionet, Jean-François Augusto, Marc Hazzan, Cyril Garrouste, Anne-Elisabeth Heng, Didier Ducloux

For 30 years, photopheresis is used to treat graft versus host disease and heart or lung allograft rejection. In this review, we discuss the place of photopheresis in kidney transplantation both in prevention or treatment of rejection. Mechanisms of action in kidney transplantation are mainly based on results observed in graft versus host disease and in heart or lung transplantation. Photopheresis may induce innate and adaptive immunity changes with restauration of a favourable Th1/Th2 immune balance, an expansion of LT /LB reg subsets, and a local enrichment in IL-10. French national clinical and mechanistic studies are underway to define the place of photopheresis therapy in immunomodulation strategies in kidney transplantation.

30年来,光疗法一直被用于治疗移植物抗宿主疾病和心脏或肺移植物排斥反应。在这篇综述中,我们讨论了光刺激在肾移植中预防或治疗排斥反应的作用。肾移植的作用机制主要基于在移植物抗宿主疾病和心脏或肺移植中观察到的结果。光切可以诱导先天和适应性免疫变化,恢复有利的Th1/Th2免疫平衡,扩大LT/LB-reg亚群,并局部富集IL-10。法国国家临床和机制研究正在进行中,以确定光疗法在肾移植免疫调节策略中的地位。
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引用次数: 0
[Functional vesico-sphincteric disorders in children: clinical, urodynamic and evolutionary profile]. 儿童功能性膀胱括约肌疾病的临床、尿动力学和进化特征
Pub Date : 2023-11-02 DOI: 10.1684/ndt.2023.38
Maryem Ferjani, Yousra Hammi, Taha Sayari, Rym Baati, Naija Ouns, Tahar Gargah

Background: Childhood vesico-sphincteric disorders are the cause of functional and psychological disability. They are also responsible for serious uronephrologic complications akin to neuro-bladder complications. In this study, we looked for the clinical manifestations linked to these disorders as well as the paraclinical and urodynamic anomalies and their therapeutic management.

Methods: We carried out a retrospective and descriptive study of patients with vesico-sphincteric disorders, followed in the pediatrics department of Charles Nicolle hospital in Tunis.

Results: In total 26 patients were included in our study. The median age at the first consultation in a pediatric nephrology department was 9 years (IQR 25 = 6 years; IQR 75 = 11 years). There was a predominance of girls: 19 boys and 43 girls. The filling phase and the voiding phase were dominated by the combination of three or more symptoms. Bladder tenderness was reduced in 12% of cases. Nineteen percent of patients reported post micturition dribble in the post-voiding phase. The flow rate curve was polyphasic in 36% of cases and flat in 11% of cases. The median of the post void residual was 62, 2 mL (IQR 25 = 25 mL; IQR 75 = 102 mL). Cystometry showed reduced bladder sensation in 14% of cases, detrusor overactivity in 65% of cases, bladder hypocontractility in 8% of cases, hypocompliant bladder in 42% of cases and small capacity in 88% of cases. Sphincter dysynergia was noted in 34% of patients. Anticholinergics were the most used in the treatment of disorders (53%). Renal failure was noted in 45% of the patients of which 11% had end-renal stage failure. During follow-up 16% of our patients required kidney replacement therapy.

Conclusion: Given the seriousness of vesico-sphincteric disorders in children and the late discovery in the majority of cases at the complication stage, targeted primary prevention must be carried out based on continuous training of primary care physicians to minimize the appearance of complications involving the functional and vital prognosis of these children.

背景:儿童膀胱括约肌疾病是导致功能和心理残疾的原因。他们还负责类似于神经膀胱并发症的严重的肾功能并发症。在这项研究中,我们寻找与这些疾病相关的临床表现,以及临床旁和尿动力学异常及其治疗方法。方法:我们对突尼斯Charles Nicolle医院儿科的膀胱括约肌疾病患者进行了回顾性和描述性研究。结果:本研究共纳入26例患者。儿童肾脏科首次会诊时的中位年龄为9岁(IQR 25=6岁;IQR 75=11岁)。女孩占多数:19名男孩和43名女孩。充盈期和排尿期以三种或三种以上症状的组合为主。膀胱压痛减少了12%。19%的患者报告在排尿后阶段出现排尿后运球。36%的病例的流速曲线是多相的,11%的病例的流量曲线是平坦的。空隙后残留物的中位数为62.2 mL(IQR 25=25 mL;IQR 75=102 mL)。膀胱测量术显示14%的病例膀胱感觉减轻,65%的病例逼尿肌过度活动,8%的病例膀胱收缩力低下,42%的病例膀胱顺应性低下,88%的病例膀胱容量小。34%的患者出现括约肌功能障碍。抗胆碱能药物是治疗疾病最多的药物(53%)。45%的患者出现肾功能衰竭,其中11%的患者出现终末期肾功能衰竭。在随访期间,16%的患者需要肾脏替代治疗。结论:鉴于儿童膀胱括约肌疾病的严重性,以及大多数病例在并发症阶段发现较晚,必须在初级保健医生的持续培训基础上进行有针对性的初级预防,以尽量减少涉及这些儿童功能和生命预后的并发症的出现。
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引用次数: 0
COVID-19 early curative treatments in kidney transplant recipients: is it really reasonable at the Omicron era? 肾移植受者的新冠肺炎早期治疗:在奥密克戎时代真的合理吗?
Pub Date : 2023-11-02 DOI: 10.1684/ndt.2023.44
Yanis Tamzali, Alexia Lundy, Alexandre Bleibtreu, Maud Cazenave, Inna Mohammadou, Nadia Arzouk, Pierre Galichon, Stéphane Marot, Helga Junot, Benoît Barrou, Valérie Pourcher, Jérôme Tourret

Objective: Data about efficacy and safety of the latest COVID-19 treatments as nirmatrelvir/ritonavir (n/r) or Sotrovimab is scarce in solid organ transplant recipients in the Omicron era. This study aims at describing the outcome of kidney transplant recipients (KTRs) presenting Omicron infection according to their management: n/r, sotrovimab or no specific treatment.

Patients and methods: We conducted a monocentric, retrospective observational study, including KTRs diagnosed Omicron infection between January and May 1st 2022 and compared their outcome (primary outcome defined as hospital admission for COVID-19 within a month after symptoms onset) according to early COVID-19 management.

Results: Forty-five patients were included: 22 treated (12 n/r, 10 sotrovimab) and 23 with no specific treatment. The groups were statistically comparable. Two patients were admitted for COVID-19: one in each group, resulting in a non-different probability of the primary outcome at on month (p=0.9). Three patients presented tacrolimus overdose including two with acute kidney injury.

Conclusions: There was no difference in outcome according to early therapeutic management: n/r, sotrovimab or no specific treatment. Our study both underlines a decreased severity of Omicron COVID-19 in KTRs (probably related to vaccinal immunity and decreased virulence of Omicron) and a potential severe adverse effects with n/r.

目的:在奥密克戎时代,关于最新新冠肺炎治疗的有效性和安全性的数据,如nirmatrevir/利托那韦(n/r)或Sotrovimab在实体器官移植受者中缺乏。本研究旨在描述肾移植受者(KTRs)根据其管理方式出现奥密克戎感染的结果:n/r、sotrovimab或无特定治疗。患者和方法:我们进行了一项单中心回顾性观察性研究,包括2022年1月至5月1日期间诊断为奥密克戎感染的KTR,并根据新冠肺炎早期管理对其结果(主要结果定义为症状出现后一个月内COVID-19]入院)进行了比较。结果:45名患者被纳入:22名接受治疗(12 n/r,10 sotrovimab),23名未接受特定治疗。两组在统计学上具有可比性。两名新冠肺炎患者入院:每组一名,导致当月主要转归的概率无差异(p=0.9)。三名患者出现他克莫司过量,其中两名患者急性肾损伤。结论:根据早期治疗管理(n/r、sotrovimab或无特定治疗),结果没有差异。我们的研究都强调了KTR中奥密克戎新冠肺炎的严重程度降低(可能与疫苗免疫和奥密克龙毒力降低有关),以及潜在的n/r严重不良影响。
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引用次数: 0
[Cardiovascular calcifications in dialysis patients]. 透析患者的心血管钙化
Pub Date : 2023-11-02 DOI: 10.1684/ndt.2023.45
Pablo Ureña Torres, Charles Chazot

Patients with advanced chronic kidney disease and those already on dialysis have an increased prevalence of cardiovascular calcifications. They are the cause of severe complications and are associated with a reduced life expectancy in these patients. Recommendations and imaging scores have been developed to detect and assess their importance, to guide and improve the management of cardiovascular risk. However, despite these recommendations, current practice teaches us that they are only partially applied. The prevention and treatment of cardiovascular calcifications go through the correction of classic risk factors associated with atherosclerosis, mineral and bone metabolism disorders and by optimizing the dose and the efficiency of dialysis. New therapeutic strategies are beginning to emerge, others are being evaluated, such as sodium thiosulfate, rheopheresis, vitamin K, magnesium supplementation, and SNF-472.

晚期慢性肾脏病患者和已经接受透析的患者心血管钙化的患病率增加。它们是严重并发症的原因,并与这些患者的预期寿命缩短有关。已经制定了建议和成像评分,以检测和评估其重要性,指导和改进心血管风险的管理。然而,尽管有这些建议,目前的做法告诉我们,这些建议只是部分适用。心血管钙化的预防和治疗需要纠正与动脉粥样硬化、矿物质和骨代谢紊乱相关的经典风险因素,并优化透析的剂量和效率。新的治疗策略开始出现,其他策略正在评估中,如硫代硫酸钠、流变学、维生素K、补充镁和SNF-472。
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引用次数: 0
Index des auteurs 导演索引
Pub Date : 2023-09-25 DOI: 10.1684/ndt.2023.49
{"title":"Index des auteurs","authors":"","doi":"10.1684/ndt.2023.49","DOIUrl":"10.1684/ndt.2023.49","url":null,"abstract":"","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41127330","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 justifying the measurement of the most relevant biochemical parameters to monitor bone and mineral metabolism in dialysis patients]. [测量最相关的生化参数以监测透析患者的骨骼和矿物质代谢的理由]。
Pub Date : 2023-08-03 Epub Date: 2023-07-17 DOI: 10.1684/ndt.2023.34
Pablo Antonio Ureña Torres, Guillaume Jean
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引用次数: 0
[How and when to use iSGLT2 (gliflozins) in clinical practice: a consensus for clinical practice proposed by the SFD, the SFC, the CNCF and the SFNDT]. 如何以及何时在临床实践中使用iSGLT2(格列酮类):由SFD、SFC、CNCF和SFNDT提出的临床实践共识
Pub Date : 2023-08-03 Epub Date: 2023-07-17 DOI: 10.1684/ndt.2023.25
François Diévart, Patrice Darmon, Jean-Michel Halimi, Samy Hadjadj, Denis Angoulvant, Gaétan Prévost, Pierre Delanaye, Jean-Marc Boivin
{"title":"[How and when to use iSGLT2 (gliflozins) in clinical practice: a consensus for clinical practice proposed by the SFD, the SFC, the CNCF and the SFNDT].","authors":"François Diévart, Patrice Darmon, Jean-Michel Halimi, Samy Hadjadj, Denis Angoulvant, Gaétan Prévost, Pierre Delanaye, Jean-Marc Boivin","doi":"10.1684/ndt.2023.25","DOIUrl":"10.1684/ndt.2023.25","url":null,"abstract":"","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815987","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
[New year, new publisher, new format for Néphrologie & Thérapeutique]. [新的一年,新的出版社,《Néphrologie & Thérapeutique》的新形式]。
Pub Date : 2023-03-16 DOI: 10.1684/ndt.2023.8
Luc Frimat, François Vrtovsnik, Justine Bacchetta, Cécile Vigneau, Valérie Moal
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引用次数: 0
期刊
Nephrologie & therapeutique
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