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The utilization of behavioral medicine, like Ericksonian hypnosis and mindfulness meditation, in the patient care is increasing. Psychological disorders associated with chronic renal failure are similar to the post-traumatic stress disorder and need a continuous personnel adjustment. Preventing depression, managing stress, pain and emotions, like anger, guiltiness and shame, is of importance in individual who suffer of chronic kidney disease, but also in their family caregivers and in health-care workers. The objective of this report is to describe how Ericksonian hypnosis, mindfulness meditation and compassion meditation could support chronic kidney disease patients, their caregivers and the health-care professional.

Resume Plusieurs modalites de traitement de l’insuffisance renale chronique terminale sont aujourd’hui disponibles. La transplantation renale a partir de donneurs vivants est la plus avantageuse pour les receveurs en termes de survie et de qualite de vie, en plus d’etre la plus economiquement viable pour la societe. Cette option souleve la question du devenir des donneurs vivants, sujets sains qui se soumettent a une procedure chirurgicale lourde. Plusieurs travaux ont ete menes comparant le devenir de donneurs de rein a celui de sujets controles. Les criteres d’evaluation etaient les potentielles complications de la nephrectomie a court comme a long termes : survenue d’une insuffisance renale, d’une hypertension arterielle, d’une proteinurie, possibilite de grossesse ulterieure, qualite de vie, survie du patient. Les resultats des premieres etudes ne mettaient pas en evidence de risque lie au don par rapport a celui existant dans la population generale. Mais depuis 2013, des publications ont rapporte l’existence d’un risque plus eleve d’insuffisance renale chronique, voire de mortalite, chez les donneurs de rein compares a des sujets controles selectionnes comme des candidats au don. Le risque lie au don est estime acceptable et minime, aux seules conditions d’une evaluation et d’une selection rigoureuse des candidats et d’un suivi regulier des donneurs indispensable.

Resume Introduction L’epuration extrarenale ou la greffe renale ne peuvent etre considerees comme le seul traitement pour les sujets atteints d’une insuffisance renale chronique terminale. Le traitement conservateur est devenu une alternative therapeutique legitime et doit etre expose de facon objective aux patients atteints d’une maladie renale chronique. Cette etude avait pour objectif de realiser un etat des lieux des pratiques medicales concernant le traitement conservateur par les equipes de nephrologie d’une region francaise. Materiel et methodes Il s’agissait d’une enquete de pratique transversale realisee en 2015 a l’aide d’un questionnaire envoye a 66 nephrologues de la region Normandie de 14 centres de traitement de l’insuffisance renale. Resultats Parmi les 48/66 nephrologues ayant repondu aux questionnaires, 38 (79,2 %) n’utilisaient pas d’outils d’aide a la decision pour la mise en place d’un traitement conservateur. De plus, 42/48 (87,5 %) nephrologues ne proposaient pas de reflexion collective autour de la prise en charge de ces patients. Dans la totalite des centres, il n’existait pas de reunion dediee a la decision de traitement conservateur. En cas de decision d’un tel traitement, 34/48 nephrologues (70,8 %) abordaient le pronostic vital avec le patient, 31/48 nephrologues (64,6 %) utilisaient les termes « mort » ou « deces » pour preciser le devenir sous traitement conservateur. Conclusion Les resultats de cette etude montrent que le parcours des patients dans le traitement conservateur est heterogene et n’est pas formalise dans notre region. Des ameliorations sont necessaires afin d’integrer le traitement conservateur dans l’offre de soins du patient atteint d’une maladie renale chronique.

Objective: Depression is underdiagnosed and thus undertreated. This study aimed to validate the French version of the PHQ-2 (Patient Health Questionnaire-2) and BDF-FS-Fr (Beck Depression Inventory-Fast Screen-France) on patients with chronic kidney disease (CKD) living in France. Method: A cross-sectional study was conducted on 109 patients of the Centre universitaire de maladies rénales, Centre Hospi­talier Universitaire (CHU) de Caen (37 patients with CKD on pre-dialysis and grafting stage, 36 grafted patients, and 36 dialyzed patients). Statistical Approach: Test parameters and statistical aspects of assessing diagnostic and screening tests were used, including knowledge of and ability to calculate, sensitivity, specificity, positive and negative predictive values, diagnostic odds ratios, and the use of ROC (receiver operating characteristic) curves. Results: PHQ-2 and BDI-FS-Fr statistical parameters for depression tested very positively and had a satisfactory AUC (area under the curve). The PHQ-2 had a satisfactory AUC > 0.70, sensitivity > 0.60, and specificity > 0.80. The BDI-FS-Fr had a satisfactory area under the curve (0.859) with sensitivity (83%) and specificity (0.859); and internal consistency (α = 0.668). The PHQ-2 and BDI-FS-Fr showed good internal and external validity of structure, construct validity, criterion validity, discriminant validity, internal consistency, and factorial validity. Conclusion: The French versions of the PHQ-2 and BDI-FS have highly favorable psychometric properties. These instruments are valid self-assessment tools for screening and evaluating depression, its intensity, and its evolution. The PHQ-2 and BDI-FS-Fr thus have very good psychometric properties and are useful tools for researchers and practitioners. Regarding clinical practice in the hospital, clinicians and nurses can use the PHQ-2 to screen quickly for depression during routine consultations, during hospitalization, and in dialysis centers. The 7 items of the BDI-FS-Fr enable us to assess the depressive state, thereby avoiding a false diagnosis of depression among CKD patients in a clinical setting.

SUMMARY Background Starting dialysis in a non-planned manner or in a ‘suboptimal’ manner is a frequent situation in dialysis centres, even for patients with a regular nephrology follow-up. Unplanned dialysis initiation can be defined as a patient beginning dialysis with no functional vascular access or peritoneal dialysis catheter. These patients start haemodialysis with a temporary catheter, frequently converted to a tunnelled catheter pending native fistula creation or whilst waiting for fistula maturation. In this case, conventional in-centre haemodialysis (ICH) is more frequently used than peritoneal dialysis (PD) or home haemodialysis (HHD). Review findings This review found that patients who start dialysis in an unplanned way are significantly older and have more heart and peripheral vascular diseases. Home-based dialysis therapies showed better outcomes than ICH (PD for the first two to three years and HHD for the long-term). Recommendations This review proposes a paradigm shift in the initial form of dialysis offered to new patients starting dialysis in an unplanned way. Even if they require a temporary catheter, it is possible for them to receive a pre-dialysis education programme (PDEP). The PDEP should be based on both individualised information session(s) given by an experienced nurse to the patient and family and therapeutic education (educative diagnosis, individualised and group session(s)) in order to relieve anxiety and promote home modalities.

Nowadays, several treatments exist to treat terminal chronic renal failure. Best results for the recipients are obtained with kidney transplantation concerning mortality and quality of life. Transplantation is also the cheaper option for society. Living kidney donation raises the issue of the becoming of the donor, an absolutely healthy subject who gets to a surgical procedure. The becoming of living kidney donors has been compared with the one of controls subjects in several studies. The evaluations focused on the complications of nephrectomy in the short and long-term: kidney failure, hypertension, proteinuria, possibility of pregnancy, quality of life, and mortality. The first results did not show any risk linked to kidney donation, compared to general population. However, since 2013, kidney donors were found at higher risk for kidney failure and even for mortality, compared with controls selected like donor candidates. The risk of kidney donation is nevertheless acceptable and minimal, on the condition of rigorous selection of candidates and regular follow-up.

Resume Introduction Le fer dextran de bas poids moleculaire peut etre administre en une perfusion unique d’une dose totale correspondante a la carence en fer. L’objectif de cette etude observationnelle etait de determiner si l’administration unique d’une dose totale de fer dextran permettait de corriger la carence martiale du patient en dialyse peritoneale pendant une duree de quatre mois. Patients et methodes Les patients traites par dialyse peritoneale depuis plus de trois mois et ayant une anemie (hemoglobine Resultats Douze des dix-sept patients inclus terminaient l’etude. La dose totale moyenne administree etait de 742 ± 150 mg sans effet indesirable rapporte. Quatre mois apres l’injection on observait une augmentation significative de la moyenne de l’hemoglobinemie (10,1 ± 0,7 g/dL vs 11,4 ± 1,2 g/dL, p Conclusion Chez le patient traite par dialyse peritoneale, le fer dextran de faible poids moleculaire en injection unique d’une dose totale permet de corriger l’anemie ferriprive pendant une duree de quatre mois.

Gueutin V, Ficheux M, Châtelet V, Lecouf A, Henri P, Hurault de Ligny B, Ryckelynck J-P, Lobbedez T. Hydration status of patients with end-stage renal disease after kidney transplantation. Clin Transplant 2011: 25: E656–E663. © 2011 John Wiley & Sons A/S. Abstract: Background: This study was carried out to estimate the modification of hydration status within the first three months of renal transplantation. Subjects and methods: Fifty patients who underwent a first kidney allograft were prospectively followed for three months after renal transplantation to assess hydration status by bioimpedance spectroscopy. Results: Two hours before the transplant procedure, 10/42 (23.8%) patients were overhydrated. Two days after surgery, 32/40 (80.0%) patients were overhydrated and at three months, 14/27 (51.9%) patients remained fluid-overloaded. Peritoneal dialysis (PD) patients had a lower hydration status (−0.60 L) than hemodialysis (HD) patients (0.70 L; p

Resume Le nombre de patients retournant en dialyse apres transplantation renale est en augmentation constante. Neanmoins il existe peu de donnees disponibles concernant la prise en charge specifique de cette population. Les patients en echec de greffe ont pour particularite d’avoir un suivi nephrologique regulier. Cependant, l’initiation de l’epuration extrarenale intervient souvent tardivement exposant le patient aux complications de l’uremie. Il apparait comme necessaire de preparer le retour en dialyse plus en amont et de debuter le traitement de suppleance plus precocement. La possibilite de beneficier d’une transplantation renale avant le stade de la dialyse doit etre evaluee de facon plus systematique car une proportion importante de patient beneficie d’une reinscription sur liste d’attente apres le retour en dialyse. Il n’existe pas de modalite d’epuration extrarenale preferentielle. La dialyse peritoneale est cependant sous utilisee dans cette population. Les modalites d’arret du traitement immunosuppresseur sont mal codifiees et peu documentees dans la litterature bien qu’elles puissent avoir un impact significatif sur le devenir des patients en dialyse. Le maintien du traitement immunosuppresseur apres le retour en dialyse pourrait permettre de maintenir la fonction residuelle du greffon renale mais est associe a une augmentation du risque infectieux. Des etudes prospectives et retrospectives concernant cette population particuliere sont clairement necessaires.

Introduction L’hemodialyse quotidienne (HDQ) a bas debit de dialysat presente de nombreux avantages notamment en termes de qualite de vie. Mais son developpement necessite d’affiner les modalites de sa prescription. En ce sens, nous avons conduit une etude prospective pour evaluer l’impact des variations du debit de la pompe a sang (Qs) sur la dose de dialyse. Patients et methodes Nous avons inclus 17 patients incidents en hemodialyse quotidienne, âges en moyenne de 42,9 ± 13,7 ans, en IRCT depuis 65 mois ± 94 mois, 53 % d’homme, 62,5 % des patients avaient une diurese residuelle. Chaque patient a beneficie de 3 seances d’hemodialyse consecutive en modifiant uniquement le Qs (300, 350 et 450 mL/min) sur une Nx stage system one. Le debit de dialysat etait arbitrairement fixe a 180 mL/min et la duree de seance a 2 heures. L’uree, la β2microglobuline (β2m) et le phosphore etaient mesures dans le sang avant et apres la seance de dialyse. Resultats Nous avons observe un Kt/V uree passant de 0,54 ± 0,10 a 0,58 ± 0,08 et 0,61 ± 0,09 pour des Qs respectivement a 300, 400 et 450 mL/min. Pour les memes variations de debits pompe a sang, le pourcentage de reduction de la β2m passait respectivement de 0,40 ± 0,07 a 0,45 ± 0,06 et 0,48 ± 0,06 et le pourcentage de reduction du phosphore de 0,46 ± 0,1 a 0,48 ± 0,08 et 0,49 ± 0,07. En analyse bivariee, tenant compte des donnee repetees, l’augmentation du Qs de 100 mL/min permettait d’augmenter de facon significative le Kt/V uree de 4,8 % (p Discussion Nous retrouvons une augmentation de 10 % de l’epuration des petites et moyennes molecules pour une augmentation de 30 % de la pompe a sang. Nous pensons que cette augmentation est peu pertinente cliniquement et que la dialyse quotidienne a bas debit de dialysat peut etre proposee a des patients ayant un abord vasculaire ne permettant pas des Qs eleves. Conclusion L’augmentation du debit de la pompe a sang permet d’ameliorer l’epuration des petites et moyennes molecules en HDQ a bas debit de dialysat mais pour un faible impact clinique.

This study was carried out to estimate the modification of hydration status within the first three months of renal transplantation.Fifty patients who underwent a first kidney allograft were prospectively followed for three months after renal transplantation to assess hydration status by bioimpedance spectroscopy.Two hours before the transplant procedure, 10/42 (23.8%) patients were overhydrated. Two days after surgery, 32/40 (80.0%) patients were overhydrated and at three months, 14/27 (51.9%) patients remained fluid-overloaded. Peritoneal dialysis (PD) patients had a lower hydration status (-0.60 L) than hemodialysis (HD) patients (0.70 L; p0.05) and better residual diuresis (41.7 vs. 8.3 mL/h for HD patients, p0.01). Compared with patients who had a delayed graft function (DGF) or a slow graft function (SGF), the immediate graft function (IGF) group had a better hydration status before transplantation (p = 0.031). At three months, 12/14 of the overhydrated patients had a creatinine clearance between 30 and 60 mL/min/1.73 m(2) .Patients receiving a first kidney transplant frequently have a hydration disorder. Transplantation is associated with increased hydration status, which seems to persist if DGF or SGF occurs.

The main objective of this study is to determine whether a single dose of iron dextran can correct iron deficiency during a period of four months in peritoneal dialysis patients.This was a prospective observational study in peritoneal dialysis patients who had anemia (hemoglobin11g/dL) and iron deficiency (ferritin100μg/L and/or transferrin saturation20%). Patients who were resistant to oral iron or who could not tolerate oral iron were included in the study. At baseline, based on the iron deficiency estimation, a single dose of iron dextran was infused over four hours.Of 17 patients included, 12 completed the study. The mean iron dose infused was 742±150mg. No clinically significant adverse event was reported during the infusion. Four months after the iron dextran infusion there was a significant increase of the mean hemoglobin level (10.1±0.7g/dl vs 11.4±1.2g/dL, P0.05), the mean blood ferritin level (66±46mg/L vs 212±121mg/L, P0.05) and the mean transferrin saturation (14±5% vs 23±8, P0.05). Four months after the iron infusion 10 patients had a blood ferritin level higher than 100μg/L and a transferrin saturation higher than 20%. There was no significant modification of the erythropoietin dose during the four months period.In patients treated by peritoneal dialysis, the anemia due to iron deficiency can be treated by a single infusion of iron dextran for a period of four months.

Peritoneal dialysis is commonly used in patients awaiting renal transplantation. The occurrence of delayed graft function is lower in CAPD patients than in hemodialysis patients. This could be explained by the fluid expansion observed in CAPD patients before renal transplantation. Acute allograft rejection incidence is similar in peritoneal dialysis patients and hemodialysis patients. There are controversial data regarding the rate of renovascular thrombosis after renal transplantation in peritoneal dialysis patients. The dialysis modality selected prior to transplantation may explain the rate of renovascular thrombosis in peritoneal dialysis patients. There is an increasing number of patients returning to dialysis after transplantation failure. However, peritoneal dialysis is underused in failed transplant patients. There are few data available regarding the impact of dialysis modality on the outcome of failed transplant patients. Immunosuppression and transplant nephrectomy may affect the outcome of these patients on peritoneal dialysis. The aim of this article is to review the use of peritoneal dialysis in patients awaiting renal transplantation and in failed transplant patients.

Peritoneal dialysis is commonly used in patients awaiting renal transplantation. The occurrence of delayed graft function is lower in CAPD patients than in hemodialysis patients. This could be explain

Starting dialysis in an unplanned manner is a frequent situation in a dialysis centre even for patients with a regular nephrology follow-up. For no clear reason, chronic haemodialysis (HD) is more frequently used than peritoneal dialysis for unplanned dialysis patients.The purpose of this study was to evaluate the results of a dialysis policy dedicated to unplanned dialysis patients. The aim of this policy was to increase the use of peritoneal dialysis (PD) in an attempt to reduce the need for tunnelled catheter.One hundred seventy-one patients from a single centre, who started dialysis between 1 January 2004 and 31 December 2006, were prospectively followed until 31 December 2006. Unplanned dialysis patients were defined as patients entering in dialysis with no vascular access or peritoneal dialysis catheter. PD was presented as a modality of choice for renal replacement therapy to avoid the need for a tunnelled HD catheter.There were 60 unplanned dialysis patients during the study period. Among these patients, 34 agreed to be treated by PD. Compared with unplanned peritoneal dialysis patients, unplanned haemodialysis patients had a greater modified Charlson's comorbidity index (5.9 +/- 2.4 versus 4.4 +/- 1.9, P0.05). The mean duration of the temporary catheter period was 32 +/- 29 days (median: 24 days) for haemodialysis patients compared with 26 +/- 21 days (median: 25 days) for peritoneal dialysis patients (P = NS). The initial hospitalization duration was similar in haemodialysis patients and peritoneal dialysis patients (24 +/- 28 versus 30 +/- 33 days; median value: 17 versus 20 days, P = NS). PD was started 8.6 +/- 10 days (median: 4 days) after catheter insertion. A tunnelled catheter was used only in three patients until peritoneal dialysis was initiated. Acute automated peritoneal dialysis was used in 19 patients. Among 26 haemodialysis patients, 23 were dialyzed through a tunnelled catheter. Of these 23 patients, 15 were successfully converted to fistula. Median time for fistula creation was 2.6 months after dialysis initiation; median time for fistula utilization was 4.4 months. Actuarial patients survival at 1 year was 79% on haemodialysis compared with 83% on peritoneal dialysis (P = NS). After adjustment of the initial modified Charlson's comorbidity index, dialysis modality had no impact on patient's survival. There was no significant difference between haemodialysis patients and peritoneal dialysis patients regarding survival free of re-hospitalization. Actuarial survival free of peritonitis was 73% at 6 months and 58% at 1 year.Peritoneal dialysis is a safe and efficient alternative to haemodialysis for unplanned dialysis patients. Peritoneal dialysis offers the advantage of reducing the need for tunnelled catheter in unplanned dialysis patients.

Cyclosporine (CsA) has potent immunosuppressive properties, reflecting its ability to block the transcription of cytokine genes (mainly interleukin 2) in CD4+ T lymphocytes, markedly improving transplantation outcomes in the past 20 years. CsA pharmacokinetic variability and renal toxicity require whole blood (WB) monitoring by 4-hour area under the drug concentration curves (AUC0-4) or 2-hour postdose concentration (C2) monitoring. Nevertheless, graft rejection can occur despite target blood levels, suggesting that WB monitoring does not guarantee optimal immunosuppression. For a decade, pharmacologists and clinicians have worked to optimize CsA doses; some authors, inspired by its mechanism of action, have proposed therapeutic drug monitoring using peripheral blood mononuclear cells (PBMC; lymphocytes and monocytes). The aim of this study was to assess the feasibility and interest of CsA monitoring in PBMC ([CsA]PBMC). We also measured in vitro distribution of CsA in CD4+ and CD4- subsets.