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Introduction Chez le dialyse, le risque de chute deja eleve pourrait etre majore par des alterations des mecanismes regulateurs de l’equilibration, qui requierent le traitement central d’informations sensorielles, visuelles, vestibulaires et somesthesiques, permettant l’organisation de reponses motrices visant a stabiliser le regard et la posture. Le but de cette etude etait d’identifier les effets de la pathologie renale sur le controle postural dans des situations sensorielles proches de celles de la vie courante chez le dialyse. Patients et methodes Un test d’organisation sensorielle (EquiTest ® , NeuroCom, Clackamas, OR) a ete realise chez 18 patients (9 femmes) dialyses (âge median : 66,5 ans) et 18 temoins (9 femmes, âge median : 69,0 ans). Ce test posturographique se caracterise par la possibilite de placer l’individu dans des situations plus ou moins complexes, avec conflit sensoriel ou non, en fonction de la privation ou de modifications de la fiabilite de certaines informations sensorielles impliquees dans le controle postural. Resultats Les dialyses presentaient une reduction significative des performances posturales par rapport aux temoins. Leurs performances etaient moindres dans la situation standard pour laquelle toutes les informations sensorielles de l’equilibre etaient disponibles et fiables. Les performances des dialyses etaient egalement moindres dans les situations de conflit sensoriel, qu’elles soient simples dans leur gestion lorsque seule l’information proprioceptive est discordante vis-a-vis des autres informations, ou plus complexes lorsque seule l’information vestibulaire est fiable pour assurer le controle postural. Discussion Les capacites posturales plus reduites chez les dialyses pourraient refleter une efficience insuffisante de la commande posturale en lien avec des deficits centraux et peripheriques du controle moteur. Des perturbations de l’information vestibulaire et/ou de son traitement central seraient a l’origine de dysfonctions posturales, en complement avec une efficacite reduite a choisir les informations fiables pour organiser le controle de l’equilibre. Conclusion La difficulte a gerer les situations de conflits sensoriels chez les dialyses pourrait conduire a l’exploration specifique du capteur vestibulaire au niveau peripherique et de son traitement central afin de confirmer l’implication vestibulaire liee a la pathologie.

Calcineurin inhibitor (CNI) toxicity contributes to chronic allograft nephropathy (CAN). In the 2-year, randomized, study, we showed that 50% cyclosporin (CsA) reduction in combination with mycophenolate mofetil (MMF) treatment improves kidney function without increasing the risk for graft rejection/loss. To investigate the long-term effect of this regimen, we conducted a follow up study in 70 kidney transplant patients until 5 years after REFERENCE initiation. The improvement of kidney function was confirmed in the MMF group but not in the control group (CsA group). Four graft losses occurred, 2 in each group (graft survival in the MMF group 95.8% and 90.9% in control group). One death occurred in the control group. There was no statistically significant difference in the occurrence of serious adverse events or acute graft rejections. A limitation is the weak proportion of patient still remaining within the control group. On the other hand, REFERENCE focuses on the CsA regimen while opinions about the tacrolimus ones are still debated. In conclusion, CsA reduction in the presence of MMF treatment seems to maintain kidney function and is well tolerated in the long term.

Kidney transplantation is the treatment of choice to enhance survival, morbidity and quality of life perceived by the patient. Despite improvements in short-term outcomes, a gap persists comparing with health of general population. A stringent collaboration between the family physician, the community nephrologists, the transplant center and others specialists is required. Recent recommendations have been published in France.

To assess incidence of chronic kidney disease in general population and to describe baseline characteristics of incident patients.Between 1st/01/04 and 30/06/06 all incident cases of chronic kidney disease in the Nancy district were prospectively identified. New cases were identified from all medical laboratories in this area and determined by a persistently increased serum creatinine level (or = 150micromol/l, or paediatric levels) for 3 months after the 1st/01/04, and by living in Nancy area.The annual incidence rate of detected chronic kidney disease was 1 per thousand inhabitants (1,3 per thousand for men and 0,7 per thousand for women). Incidents patients were old (mean age: 77 years) and with numerous comorbidities (diabetes: 34 %, cardiac failure: 23 %). More than 30% of incident patients were diagnosed at sever stage of chronic kidney disease (30ml/min/1,73m(2)).The annual incidence of diagnosed chronic kidney disease is common: 10 times more than end-stage renal disease in France. Most of these patients are diagnosed in a severe stage of chronic kidney disease whereas they could be detected earlier and benefit from adequate, appropriate and multidisciplinary take care.

La maladie vasculaire du patient insuffisant renal terminal est caracterisee par la coexistence de lesions d’atherosclerose et d’arteriosclerose, cette derniere conduisant a une rigidite arterielle (RA). On sait que RA est un facteur independant de mortalite cardio-vasculaire chez le patient dialyse. Peu de donnees sont disponibles sur son evolution apres transplantation renale. Objectifs Etudier l’evolution de la RA apres transplantation renale, dans une population de patients en IRCt, et la comparer a celle de patients restant en dialyse. Materiel et Methodes 100 patients en IRCt candidats a une premiere transplantation ont ete inclus, âge compris entre 35 et 65 ans. Une premiere mesure de RA a ete effectuee lors de l’inclusion, la deuxieme 1 an apres. Resultats L’âge moyen : 54 ± 7 ans, 35 patients ont ete transplantes apres un an de suivi. La VOP moyenne tendait a diminuer chez les transplantes entre les 2 visites (10.18 ± 3.41 m/s a V1, 9.90 ± 2.61 m/s a V2) sans difference significative, alors qu’elle restait stable chez les dialyses (10.62 ± 3.76 m/s a V1, 10.50 ± 3.61 m/s a V2). On constatait chez les transplantes une diminution significative des PAD et PAM peripheriques (81 ± 13 mmHg a V1 vs 76 ± 10 mmHg a V2, 99 ± 14 mmHg a V1 vs 94 ± 10 mmHg a V2) et centrales (80 ± 14 mmHg a V1 vs 74 ± 10 mmHg a V2, 99 ± 14 mmHg a V1 vs 94 ± 09 mmHg a V2). La VOP post-greffe etait significativement correlee a la diminution de la PAM, n’etait pas correlee au degre de filtration glomerulaire, au temps d’exposition apres transplantation ou a l’âge du donneur. La diminution de la VOP etait significativement correlee a la diminution de la PAM. Conclusion Dans cette etude, la diminution de la VOP correlee a la diminution de la PAM suggererait un effet indirect possible de la transplantation sur l’evolution de la VOP. L’amelioration du pronostic cardio-vasculaire pourrait etre expliquee chez les transplantes par la diminution des PAD et PAM peripheriques et centrales apres greffe.

Resume De janvier 1983 a decembre 1989, 62 septicemies a staphylocoque ont ete diagnostiquees et traitees chez 39 hemodialyses chroniques dans un service de Nephrologie-Hemodialyse adultes. L'âge moyen des patients etait de 50 ans (ecart type 14.4 — extremes 19–83). Cinquante quatre septicemies ont ete causees par S. aureus (SA), 8 par un staphylocoque a coagulase negative (SCN). Quarante huit des 54 SA et 7 des 8 SCN etaient sensibles a la meticilline. La responsabilite d'un catheter veineux central d'hemodialyse est plus souvent engagee dans les septicemies a SCN (6/8 contre 14/54, p

Population-based study suggests that chronic kidney disease is frequent. Almost one third of people older than 70 years of age would have a significant decrease in renal function. Anemia appears when glomerular filtration rate falls under 40mL per minute per 1.73m(2). Concurrently with supplementary iron, erythropoiesis-stimulating agents (ESA) allow a strict control of hemoglobin. However, incomplete responses to ESA are possible. The following conditions - inflammatory disorders, chronic blood loss, hyperparathyroidism, surgical process, chronic diseases, adverse effects of immunosuppressive agents - may cause apparent resistance to ESA therapy. All these conditions may request transfusion.

Introduction Les perfusions de fer IV sont utilisees largement en dialyse pour traiter l’anemie et limiter les couts lies aux ASE. Les recommandations actuelles ne fixent pas de limites superieures aux cibles de ferritinemie et de CST. Elles peuvent amener les nephrologues a prescrire du fer meme en cas de ferritinemie elevee. Or de recentes publications suggerent des effets secondaires a court et a long termes lies a la surcharge que peut entrainer le fer IV. Dans une approche benefice-risque, nous decrivons l’impact d’une strategie de reduction de la posologie de fer IV. Patients et methodes Nous avons mene une etude prospective monocentrique visant a evaluer sur 8 mois une strategie de reduction des prescriptions de fer IV dans le traitement de l’anemie en dialyse au sein d’un centre de dialyse hospitalier. Nous sommes passes d’une strategie de prescription visant a maintenir un CST entre 30 et 50 %, quel que soit le taux de ferritine, a une strategie de prescription de fer si et seulement si le CST est Resultats Les donnees au cours des 6 mois etaient disponibles pour 45 patients suivis dans le centre. La dose moyenne de fer prescrite passait de 77,7 ± 86,1 mg a 24,4 ± 42 mg par patient et par semaine (p = 0,0003). La ferritinemie diminuait de 947,7 ± 1056,4 μg/L a 572,7 ± 424,4 μg/L (p = 0,0001) et le CST de 41,5 % ± 22,4 a 32,6 % ± 13,7 (p = 0,01). L’hemoglobine restait stable (11,13 ± 1,05 vs 11,0 ± 1,16 g/dL) (p = 0,54) ainsi que la dose d’ASE (126,4 ± 91,93 vs 108,2 ± 112,7 μg/28 jours [p = 0,07]). Discussion Malgre une nette diminution des doses de fer nous n’avons pas constate d’augmentation de besoin en EPO ou d’aggravation de l’anemie. Bien que la taille de l’echantillon reste faible les resultats semblent significatifs. Ces donnees doivent servir de point de depart a des etudes de plus grande envergure avec la presence d’un groupe temoin. Conclusion Notre etude suggere qu’a posologie d’ASE constante, avec une adaptation des posologies de fer IV basee sur les seuils inferieurs de CST et de ferritinemie des recommandations, le taux d’hemoglobine reste constant preservant ainsi le patient de la surcharge ferrique.

Introduction L’objectif etait de comparer les caracteristiques de patients dialyses avec une hyperparathyroidie secondaire (HPTS) entre differents groupes differant selon l’evolution des parametres phosphocalciques. Patients et methodes De decembre 2009 a mai 2012, nous avons inclus prospectivement tous les dialyses avec une HPTS nouvellement diagnostiquee dans une region avec un suivi de 2 ans. Par la methode de group-based trajectory modeling (Jones BL, O’Hare AM), nous avons defini des groupes de patients avec des evolutions biologiques differentes pour la calcemie, la phosphatemie, la PTH. Les donnees socio-demographiques, medicales, d’autres parametres phosphocalciques et les traitements de l’HPTS utilises ont ete compares. Resultats Nous avons inclus 269 patients et identifie 4 groupes : « diminution rapide de la PTH » (n = 34 ; 12,6 %), « diminution progressive de la PTH » (n = 98 ; 36,4 %), « diminution lente avec phosphoremie elevee » (n = 105 ; 39,0 %) et « HPTS non controlee » (n = 32 ; 11,9 %). Les patients du groupe HPTS non controlee etaient significativement plus jeunes que les patients des autres groupes (54,1 ± 19,4 ans contre respectivement 68,8 ± 14,6 ans, 68,5 ± 13,6 ans et 67,2 ± 14,9 ans dans les autres groupes ; p Discussion Ce travail apporte des arguments en faveur de l’heterogeneite des patients atteints d’HPTS. L’association entre HPTS non controlee et plus jeune âge est retrouvee. La methodologie permet d’associer plusieurs parametres et de classer les patients selon leur profil d’evolution biologique et non sur une mesure ponctuelle. Des etudes de plus grands effectifs ou etudiant l’evolution d’autres combinaisons de parametres phosphocalciques seraient pertinentes. La survie sera etudiee grâce au registre REIN. Conclusion Par une methodologie originale, nous avons mis en evidence un plus jeune âge des patients dialyses avec une HPTS non controlee dans les 2 ans suivant le diagnostic.

Summary Objective End-stage renal disease (ESRD) requiring renal replacement therapy (RRT) is a late complication of type 2 diabetes. The correlation between pre-ESRD medical care and outcome has been rarely studied in France. Methods Community-based study of case-incident ESRD patients. Medical care practices were described retrospectively when starting RRT. Medical status, mortality, morbidity, and quality-of-life were recorded prospectively. Results One hundred and fourty-eight ESRD patients with type 2 diabetes were included. Factors independently correlated with mortality within 3 months of RRT onset were presence of physical impairment of ambulation at onset of RRT [odd ratio (OR): 5, (95%CI: 1.9-13.3)], and starting RRT in life-threatening circumstances [OR: 3.6, (95%CI: 1.2-10.7)]. Factors independently correlated with "poor outcome" 1 year after the onset of RRT were BMI less than 20 kg/m 2 [OR: 13.4, (95 %CI: 1.5-120.2)] and presence of 2 [OR: 2.7, (95 %CI: 0.9-8.4)], or 3 or more comorbid conditions [OR: 4, (95% CI: 1.4-11)]. Three months after the first RRT session, survival was 16.4% better for patients who had had regular nephrological care versus none , and 9.1% better for those who had had late nephrological care versus none . Type 2 diabetes patients starting RRT in an emergency setting had had significant less regular nephrological care. Length of their first hospital stay was significantly longer. They were more likely to have lower residual renal function, gastrointestinal symptoms, lower serum albumin, lower hematocrit, lower serum calcium, and higher serum phosphorus. Conclusions During the course of chronic renal failure in type 2 diabetes patients, early implementation of nephrological well-established guidelines is associated with better outcome after starting RRT.

To describe kidney cooling during multi-organ harvesting (MOH) from brain-dead donors and to evaluate harvesting practices.The temperature of 12 kidneys (6 left and 6 right kidneys) was monitored continuously during MOH from brain-dead donors. After in situ cooling, the kidneys were separated on the table and washed for several minutes with UW preservation solution. The kidney temperature was studied as a function of the main phases of the operative procedure.The mean minimum kidney temperature of 10.8 degrees C (3.7 degrees C to 16.6 degrees C) was reached at the beginning of mobilization of the liver, i.e. an average of 20 minutes (13 to 37 min) after cannulation. The mean cooling rate was 1.37 degrees C/min (0.73 to 2.19 degrees C/min). The mean temperature of the UW cooling solution was 9.4 degrees C (3.8 degrees C to 14 degrees C). For hepatic followed by renal dissection, the kidneys slowly reheated at a mean rate of 0.20 degree C/min (0.12 to 0.37 degree C/min) to reach a mean temperature of 21 degrees C (13.5 degrees C to 26.3 degrees C) at the time of resection. The mean kidney temperature at the time of placement in the container was 17.5 degrees C (13.2 degrees C to 22 degrees C).The course of kidney temperature during MOH has not been previously described. This study, performed under usual harvesting conditions, demonstrated sometimes imperfect cooling that could be harmful to he kidneys, but which could be improved by simple measures: rapid dissection of the liver and kidneys and correct application of contact cooling.

Improvement of modern medicine does not make day-to-day practice of nephrology easier. Decision-making remains difficult, often requiring numerical, probabilistic approach. Contribution of clinical epidemiology to evidence-based nephrology is not limited to randomised-controlled trial. The concept of natural history: spontaneous evolution without treatment, has been developed in epidemiology to describe diagnosis and prognosis of diseases. For example, in IgA nephropathy, it allowed to measure the prognostic significance of gross hematuria or to design classification of end-stage renal failure. Epidemiologic studies needs appropriate designs, representative samples and correct methods of analysis. Like other medical research, epidemiology has some important methodological limits that must be taking into account. Practising evidence-based nephrology improves confidence in management decisions.

Chronic alcoholism and malnutrition are uncommon causes of complicated acute pyelonephritis (APN).Since 1997, we have seen 5 patients with chronic alcoholism (3 women and 2 men, mean age 53.4 +/- 13 years) without cirrhosis, diabetes or renal failure who developed severe APN in a state of malnutrition (albumin 22 +/- 3 g/l, total cholesterol 0.86 +/- 0.2 g/l). Diagnosis was made 14.6 +/- 9 days after onset of atypical symptoms which the patients neglected. There was a major bacterial inoculum: Escherichia coli 10(6.2 +/- 2) (3 multisusceptible and 2 amoxicillin-resistant strains); positive blood cultures in 3 cases. The imaging study showed bilateral diffuse lesions with focal swelling and kidney enlargement, without obstacle, abscess, or papillary necrosis. All patients had severe acute renal failure (maximum serum creatinine: 582 +/- 210 mumol/l; 3 patients underwent dialysis). Mean duration of antibiotic therapy was 40 +/- 7 days (i.v.: 22 +/- 3 d). Renal scarring occurred since creatinine clearance was 33 +/- 22 ml/min 2 months after the initial episode. One patient progressed to end-stage renal failure.In malnourished alcoholic patients, APN may be unusually severe due to late diagnosis leading to the risk of irreversible renal damage and severe chronic renal failure.

During periods of transplant organ shortage, techniques designed to "salvage" transplants must be developed. The authors report three cases of renal harvesting from donors in cardiac arrest, in which the use of in situ perfusion-cooling with transfemoral introduction of Gillot's catheter resulted in six good quality transplants. The indications, surgical technique, alternatives and results are discussed.

As yet, no clinical or morphological prognostic classification of IgA nephropathy (IgAN) has been generally accepted. The objective of our study was to quantify the risk of developing end-stage renal failure (ESRF) in IgAN.We report a prospective longitudinal study of 210 patients with IgAN confirmed by biopsy between 1987 and 1991. Thirty-two (15.2%) patients were lost to follow-up. Mean follow-up after renal biopsy was 5.6 (SD = 2.6) years. The variables included age, gender, illnesses prior to discovery of IgAN, clinical features at IgAN discovery, 24-h proteinuria, serum creatinine, IgA level, and antihypertensive drugs taken at the time of renal biopsy. Sixty-six renal biopsies were classified by light-microscopy according to Lee's morphological classification. The end-point was ESRF. Survival was analysed by a backward and forward stepwise procedure using the Cox model. The most accurate determination of relative risk was obtained by assessing collinearity of the variables.Thirty-three patients (15.7%) (31 men) developed ESRF. The five univariately significant variables: gender, gross haematuria, 24-h proteinuria (24-P), serum creatinine (SC), and antihypertensive treatment, were candidates for multivariate analysis. The final model used SC (or = 100, 100-150,150 mumol/l), 24-P (1,or = 1 g/day) and gender (female vs male) as independent variables (relative risk and 95% confidence interval were 3.5 (2.1, 5.9) for SC; 5.1 (1.9, 13.6) for 24-P; and 3.5 (0.9, 15) for gender). These estimates were used to construct a prognostic classification of ERSF for men with IgAN: stage 1 (SCor = 150 mumol/l and 24-P1 g/day), stage 2 ((SC150 mumol/l and 24-P1 g/day) or (SCor = 150 mumol/l and 24-Por = 1 g/day)); stage 3 (SC150 mumol/l and 24-Por = 1 g/day). The ESRF-free survival was estimated with Kaplan-Meier analysis. It was 98.5% for stage 1, 86.6% for stage 2, 21.3% for stage 3 (P0.001), 7 years after histological diagnosis. The validity of Lee's prognostic classification was confirmed using an independent sample.These classifications identify groups at high risk of ESRF. Therapeutic studies should focus on these groups.

The objective of the study was to assess the evolution of renin, angiotensin II, atrial natriuretic factor (ANF) and blood pressure (BP) in the first trimester following renal transplantation in man Thirty-two recipients were investigated for 3 months post-transplantation. Twenty had a history of hypertension with moderate cardiac hypertrophy. Thirty-one retained their native kidneys. Five kidney donors had a history of mild hypertension. The recipients were perioperatively volume-expanded with 0.9% saline and diuresis was maintained for 48 h with furosemide and dopamine. The sodium intake was 25 mEq/24 hours. Prophylactic immunosuppressive therapy was antilymphocyteglobulins (25 cases), or anti-LFA1 (7 cases) and maintenance therapy was cyclosporine-prednisone (8 cases), or cyclosporine-prednisone-azathioprine (24 cases). Mean BP, serum creatinine, urinary sodium excretion (UNA) and hormonal (renin, angiotensin II and ANF) parameters were collected every other day for the first week after transplantation and then twice monthly. Twenty (62.5%) patients developed hypertension and hypertension was more frequent in patients with a delayed graft function, than in patients with immediate good graft function (10/20 vs. 4/12, p0.05%). Both hypertensive (group HBP) and normotensive (group NBP) patients had similar very low renin and angiotensin II plasma levels, after an initial early peak. Analysis of covariance with multiple regression analysis showed that in the HBP patients, BP was negatively correlated with UNA (p = 0.02) and positively with plasma ANF (p0.01). The normal BP patients also showed a correlation between BP and UNA, although it was limit of statistical significance (p = 0.05); there was no correlation between ANF and BP. We conclude that the RAS is rapidly depressed after renal transplantation and does not interfere with BP regulation. The hypertension in the early stage of post-transplantation varies inversely with the urinary sodium excretion. The defective sodium excretion, which dominates the effect of the low sodium diet, results in volume overload, increased ANF and volume-dependent hypertension.

The aim of this study was to analyze whether old age affects the outcome of renal transplantation. Data were presented on all 337 renal allografts performed from January 1, 1987 to November 30, 1992 in the department of Nephrology and Urology, University Hospital of Nancy. Of these, 32 (9.5%) were performed in patients over 60 years old at the time of transplantation (mean duration of follow-up 22.3 +/- 17.1 months). No significant difference was noted in patient and graft survivals between the two groups at 36 months (respectively 83.8% and 76.1% in elderly patients; 96% and 82.8% in younger recipients). In the older group, all grafts were lost due to death (2/5) or nephrectomy (3/5) with a functional transplant (3/5) whereas chronic rejection accounted for the majority of graft loss in the younger group (23/43, p0.05). Episodes of acute rejection occurred with a very low incidence in elderly patients (15.6%). Infections were infrequent in this group and did not represent serious complications. Functional rehabilitation and quality of life were as good in elderly as in younger recipients. These results suggest that renal transplantation is an acceptable form of treatment for patients older than 60 years with end-stage renal disease in the absence of obvious contraindication.

Idiopathic IgA nephropathy of Berger's disease is characterized by prominent and diffuse IgA deposits in the mesangium. In many countries, it is the most common type of primary chronic glomerulonephritis. Typically, it is revealed by recurrent episodes of gross hematuria in association with ENT infection, but it can progress insidiously with microscopic hematuria and proteinuria. Serum IgA levels are increased in about 50% of cases. IgA nephropathy is not a minor condition: 20% of patients develop end-stage chronic renal failure 10 years after diagnosis and 50% after 20 years. IgA nephropathy can recur in a transplanted kidney suggesting that this disease is a systemic disorder although it has a remarkable tropism for the kidney. Even though many points remain to be elucidated, its pathogenesis appears to be linked to a genetic factor responsible for a lymphocyte dysfunction and an acquired environmental factor such as penetration of an antigen via the mucosa which may give rise to an excessive and inappropriate IgA immune response with the deposition of IgA in the mesangium and the development of progressive renal alterations. No treatment has been shown to be effective but tonsillectomy advised in case of a recurrent tonsillar focal infection is most often accompanied by a decrease in the incidence of gross hematuria. Corticosteroid therapy can be of benefit in cases involving a nephrotic syndrome associated with minimal glomerular lesions. In all cases, control of possible hypertension is of value in slowing the progression of this disease.

Delayed renal function (DFG) is known to influence both the short and long-term outcome of transplanted kidneys. Data collected retrospectively on all 129 cadaveric renal transplants performed between January 1991 and January 1993 within a single center were analyzed. 42 (32.55%) cases of acute renal failure (ARF) occurred during the immediate postoperative period and 28 patients required dialysis. When compared with immediate good allograft function, DGF was associated with previous failed transplant (7/15 vs 35/114, p = 0.01), donor age (39.2 +/- 13 vs 30.1 +/- 12 years, p = 0.01), and episodes of collapsus of the donor (11/25 vs 31/104, p0.01). The graft function of the recipient was not correlated with the serum creatinine of the donor. There was no apparent relationship between the cold ischemia or the anastomosis time and the occurrence of DGF. One-year patient and graft survival were similar in the two groups (respectively for the group ARF and without ARF: 96.4% and 96.5%; 88.8% and 89%), but patients with DGF had higher serum creatinine values at 12 months post DGF (185.6 +/- 44.8 mumol/l vs 157.5 +/- 30.8 mumol/l, p = 0.06). This study suggests that DGF is related to the characteristics of the donor graft and is more frequently encountered in previously transplanted recipients.

Background To determine the impact of the quality of pre-dialysis nephrological care on health-related quality of life (HRQoL) at dialysis onset, which has not been well evaluated. Methods All adults who began a dialysis treatment in the administrative region of Lorraine (France) in 2005 or 2006, were enrolled in this prospective observational study. HRQoL was measured using the Kidney Disease Quality of Life V36 questionnaire, which enables calculation of two generic (physical and mental) and three specific dimensions (Symptoms/problems, Effects and Burden of kidney disease). The specific dimensions were scored from 0 to 100 (worst to best possible functioning). Pre-dialysis nephrological care was measured using three indicators: quality of therapeutic practices (evaluated across five main aspects: hypertension/proteinuria, anemia, bone disease, metabolic acidosis and dyslipidemia), time since referral to a nephrologist and number of nephrology consultations in the year preceding dialysis treatment. Results Two thousand and eighty-three (67.4%) patients were referred to a nephrologist more than 1 month before dialysis initiation and completed the HRQoL questionnaire. Quality of therapeutic practices was significantly associated with the Mental component. Time since referral to a nephrologist was associated with Symptoms/problems and the Effects of kidney disease dimensions, but no relationship was found between the number of nephrology consultations and HRQoL. Conclusions HRQoL at dialysis onset is significantly influenced by the quality of pre-dialysis nephrological care. Therefore, disease management should be emphasized.