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This experimental study examined the effects of curcumin-loaded iron oxide nanoparticles (CUR), photobiomodulation (PBM), and CUR + PBM treatments on mast cells (MC)s numbers and degranulation, inflammatory cells (macrophages, neutrophils), and wound strength in the last step of the diabetic wound repair process (maturation phase) in a rat model of type one diabetes mellitus (T1DM). T1DM was induced in 24 rats, and 1 month later, an excisional wound was created on each rat's back skin. The rats were then distributed into four groups: (1) untreated diabetic control group (UDCG); (2) rats treated with CUR (CUR); (3) rats exposed to PBM (890 nm, 80 Hz, 0.2 J/cm

International audience; Objectives: Pneumococcal immunization is recommended in dialysis patients. We aimed to estimate pneumococcal vaccination coverage among patients who initiate dialysis in France, and its association with mortality. Methods: Data were extracted from two prospective national databases, merged using a deterministic linkage method: renal epidemiology and information network (REIN) registry, which includes all patients on dialysis and kidney transplants recipients in France, and the national health insurance information system (SNIIRAM) which collects individual data on health expenditure reimbursement, including vaccines. We enrolled all patients who initiated chronic dialysis in 2015. Data on health status at dialysis initiation, dialysis modalities, and pneumococcal vaccine prescribed from 2 years before to 1 year after dialysis start were collected. Univariate and multivariate Cox proportional hazard models were used to assess one-year all-cause mortality. Results: Among the 8,294 incident patients included, 1,849 (22.3 %) received at least one pneumococcal vaccine before (n = 542, 6.5 %), or after (n = 1,307, 15.8 %) dialysis start, as follows: 13-valent pneumococcal conjugated vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23), n = 938 (50.7 %); only PPSV23, n = 650 (35.1 %); or only PCV13, n = 261 (14.1 %). Vaccinated patients were younger (mean, 66.5 ± 14.8 years vs. 69.0 ± 14.9 years, P ≤ 0.001), more likely to suffer from glomerulonephritis (17.0 % vs. 11.0 %, P ≤ 0.001), and less likely to start dialysis in emergency (27.2 % vs. 31.1 %, P = 0.001). On multivariate analysis, patients who received PCV13 and PPSV23, or only PCV13 were less likely to die (respectively, HR = 0.37; 95 %CI 0.28–0.51, and HR = 0.35; 95 %CI 0.19–0.65). Conclusions: Pneumococcal immunization with PCV13 followed by PPSV23, or with PCV13 alone, but not with PPSV23 alone, is independently associated with decreased one year-mortality in patients who start dialysis.

International audience; OBJECTIVES: We assessed the direct and indirect effect of social deprivation mediated by modifiable markers of nephrological follow-up on registration on the renal transplantation waiting-list. STUDY DESIGN AND SETTINGS: From the Renal Epidemiology and Information Network, we included French incident dialysis patients eligible for a registration evaluation between January 2017 and June 2018. Mediation analyses were conducted to assess effects of social deprivation estimated by quintile 5 (Q5) of the European Deprivation Index on registration defined as wait-listing at dialysis start or within the first 6 months. RESULTS: Among the 11655 included patients, 2410 were registered. Q5 had a direct effect on registration (OR 0.82 [0.80-0.84]) and an indirect effect mediated by emergency start dialysis (OR 0.97 [0.97-0.98]), hemoglobin < 11 g/dL and/or lack of EPO (OR 0.96 [0.96-0.96]) and albumin < 30 g/L (OR 0.98 [0.98-0.99]). CONCLUSION: Social deprivation was directly associated with a lower registration on the renal transplantation waiting-list but its effect was also mediated by markers of nephrological care, suggesting that improving the follow-up of the most deprived patients should help to reduce disparities in access to transplantation.

International audience; End-stage kidney disease (ESKD) is a major challenge for health care systems around the world because of its ever-rising rates and the ensuing rise in health care costs. In France, the cost of caring for patients with ESKD was estimated at €4.1 billion in 2019, which is 2.5% of the total budget of the health insurance funds that is spent on 1.4% of the general population.Health care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and desires of patients with ESKD. Patients aspire to remain independent if at all possible, continuing to have a social life and pursue their profession.1, 2, 3The objective of this study was to compare the cost of 4 dialysis modalities that enable patients to play a substantial role in their own care and have social and professional lives. The dialysis modalities include the following: (i) nonassisted hemodialysis in self-care units (scHD), (ii) nonassisted automated peritoneal dialysis (naAPD), (iii) daily home hemodialysis (dhHD), and (iv) non–facility-based nocturnal extended hours hemodialysis (neHD) (Supplementary Population and Method).(introd.)

BACKGROUND: Published algorithms for identifying chronic kidney disease in healthcare claims databases have poor performance except in patients with renal replacement therapy. We propose and describe an algorithm to identify all stage chronic kidney disease in a French healthcare claims databases and assessed its performance by using data from the Renal Epidemiology and Information Network registry and the French Childhood Cancer Survivor Study cohort.METHODS: A group of experts met several times to define a list of items and combinations of items that could be related to chronic kidney disease. For the French Childhood Cancer Survivor Study cohort, information on confirmed chronic kidney disease cases extracted from medical records was considered the gold standard (KDIGO definition). Sensitivity, specificity, and positive and negative predictive value and kappa coefficients were estimated. The contribution of each component of the algorithm was assessed for 1 and 2 years before the start of renal replacement therapy for confirmed end-stage kidney disease in the Renal Epidemiology and Information Network registry.RESULTS: The algorithm’s sensitivity was 78%, specificity 97.4%, negative predictive value 98.4% and positive predictive value 68.7% in French Childhood Cancer Survivor Study cohort and the kappa coefficient was 0.79 for agreement with the gold standard. The algorithm 93.6% and 55.1% of confirmed incident end-stage kidney disease cases from the Renal Epidemiology and Information Network registry when considering 1 year and 2 years, respectively, before renal replacement therapy start.CONCLUSIONS: The algorithm showed good performance among younger patients and those with end-stage kidney disease in the twol last years prior to renal replacement therapy. Future research will address the ability of the algorithm to detect early chronic kidney disease stages and to classify the severity of chronic kidney disease., Contexte: Les algorithmes publiés pour identifier les patients avec une maladie rénale chronique (MRC) dans les bases de données médico-administratives ont de mauvaises performances, sauf chez les patients traités par suppléance. Nous proposons et décrivons un algorithme permettant d’identifier les patients MRC de tout stade dans la base française du Système National de Données de Santé et d’évaluer sa performance en utilisant les données du registre du Réseau d’épidémiologie et d’information rénales (REIN) et de la cohorte Français Childhood Cancer Survivor Study (FCCSS).Méthodes : Un groupe d’experts s’est réuni à plusieurs reprises pour définir une liste de variables et des combinaisons variables qui pourraient être liés à la MRC. Pour la cohorte FCCSS, l’information sur les cas confirmés de MRC extraits des dossiers médicaux a été considérée comme la référen (définition de KDIGO). La sensibilité, la spécificité et les coefficients de prédiction positifs et négatifs (PPV, VAN) et kappa ont été estimés. La contribution de chaque composante de l’algorithme a été évaluée à 1 et 2 ans avant le début de la suppléance à partir du registre REIN.Résultats : La sensibilité de l’algorithme était de 78%, la spécificité de 97,4%, la VPN de 98,4% et la VPP de 68,7% dans la cohorte FCCSS et le coefficient kappa était de 0,79 pour l’accord avec la référence. L’algorithme a permis de détecter 93,6% et 55,1% des cas incidents du registre REIN en considérant 1 an et 2 ans, respectivement, avant le début de la suppléance.Conclusions : L’algorithme a montré de bonnes performances chez les patients plus jeunes et ceux atteints de MRC au cours des deux dernières années précédant la suppléance. Les recherches futures porteront sur la capacité de l’algorithme à détecter les premiers stades de l’IRC et à classer la gravité de l’IRC.

Introduction Emergency dialysis start (EDS) is frequent for patients with chronic kidney disease (CKD). To improve CKD management, new trajectory-based care policies are currently being introduced both in France and in the United States. This study describes the different types of predialysis care trajectories and factors associated with EDS. Methods Adults patients who started dialysis in France in 2015 were included. Individual clinical and health care consumption data were retrieved from the French national end-stage kidney disease (ESKD) registry (Renal Epidemiology and Information Network [REIN]) and the French National Health Data system (SNDS), respectively. Hierarchical Clustering on Principal Component was used to identify groups of patients with the same health care consumption profile during the 2 years before dialysis start. Logistic regression analysis was used to identify factors associated with EDS. Results Among the 8856 patients included in the analysis, 2681 (30.3%) had EDS. The Hierarchical Clustering on Principal Component identified six types of predialysis care trajectories in which EDS rate ranged from 13.8% to 61.8%. After adjustment for the patients’ characteristics, less frequent or lack of follow-up with a nephrologist was associated with higher risk of EDS (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.17–1.50 and OR: 1.83; 95% CI: 1.58–2.12), but not follow-up with a general practitioner. Conclusions The care trajectories during the 2 years before dialysis start were heterogeneous and patients with a lesser or lack of follow-up with a nephrologist were more likely to start dialysis in emergency, regardless of the frequency of follow-up by a general practitioner (GP). New CKD policies should include actions to strengthen CKD screening and referral to nephrologists., Graphical abstract

Aims RAR‐related orphan receptor (RORA) involves in regulation of several biological processes including inflammation and circadian rhythm that probably are involved in migraine pathophysiology. In the current study, the association between RORA rs11639084 and rs4774388 variants and susceptibility to migraine were investigated in a sample of Iranian migraine patients for the first time. Methods In a case‐control study including 400 participants, 200 migraineurs and 200 healthy controls, genotyping of RORA rs4774388 and rs11639084 polymorphisms was performed using tetra‐primer amplification refractory mutation system–polymerase chain reaction (TP‐ARMS‐PCR). Results The distribution of rs4774388 C/T and T/T genotypes differed significantly between the studied groups. Moreover, an association was observed between rs4774388 and migraine under the recessive mode of inheritance (P = 0.002; OR = 1.89.; CI = 1.25‐2.87). The distribution of rs11639084 alleles and genotypes was not significantly different between migraineurs and healthy controls. Conclusion Current results suggest RORA, as a molecular link, may explain inflammation and circadian rhythm dysfunction in migraine. Further studies in different ethnicities are required to confirm the function of RORA in migraine development., This study, for the first time, confirmed the association between RORA and migraine.

Ion mobility spectra of citric acid (CA) are complex, and several peaks are observed for CA and its fragments in both the positive and negative modes. Using DFT calculations, we found that the fragments are both less acidic and less basic than CA in gas phase. Hence, we used a strong base, NH3, in positive mode to produce NH4+ as an alternative reactant ion (RI) and prevent protonation of the fragments. In the presence of NH4+, only one peak for CA was observed because of its higher proton affinity (873 kJ mol-1) compared to NH3 (854 kJ mol-1). In the negative mode, CHCl3, CHBr3, and CHI3 were used as dopant gases to produce Cl-, Br-, and I- as RIs. These halides have less basicity than the common RIs in negative mode (NO2-, NO3-, O2-) and selectively deprotonated CA in the presence of its fragments. Hence, using dopants with appropriate basicity, we could suppress the fragment peaks and obtain a plain IMS spectrum for CA containing only one peak in both the positive and negative modes. Using NH3 and CHCl3 dopants, the amount of CA in fresh lemon juice was determined as 39.5-42 g L-1 by direct injection without any purification. The effect of hydration of the reactant and product ions on the ionization mechanism in both negative and positive modes was investigated theoretically.

Resume L’acces a la greffe renale pour les patients insuffisants renaux chroniques terminaux est un enjeu majeur en France. L’inscription sur liste d’attente de greffe est une etape obligatoire pour pouvoir acceder a cette technique. La Haute Autorite de sante a mis a jour, en 2015, les contre-indications a l’acces a cette liste. Dans ce contexte, nous avons voulu realiser un etat des lieux des motifs de non-inscription sur la liste d’attente de greffe renale chez les patients dialyses depuis au moins un an, âges de moins de 80 ans, en France. Tous les patients inclus dans le registre d’epidemiologie et d’information en nephrologie (REIN), devant avoir leur point annuel de suivi du 1er aout au 30 novembre 2016 repondant aux criteres, ont ete inclus et un questionnaire dedie a ete rempli par leur centre de dialyse. Ainsi, 3172 patients ont ete analyses : 2302 (73 %) avaient une contre-indication medicale a la greffe, le plus souvent (33 %) vasculaire, 458 (14 %) refusaient d’etre inscrits, avec proportionnellement plus de femmes dans cette categorie et enfin, chez 412 patients (13 %), on ne retrouvait pas de motif renseigne dans notre questionnaire. Neanmoins, pour 65 % des patients de cette derniere categorie, un bilan en vue d’une inscription etait debute. Il y avait donc, dans notre cohorte, seulement 144 patients (4,5 %) sans explication a la non-inscription. Cette etude nationale est la premiere a donner a un etat des lieux des motifs de non-inscription sur liste de greffe renale en France. Sans surprise, la contre-indication medicale est le premier motif de non-inscription dans cette population de patients chroniques. Le fort taux de refus doit etre souligne et analyse plus precisement, notamment avec le ressenti du patient. Et enfin, tres peu de patients n’ont pas de motif renseigne ou de bilan en cours.

International audience; Background: Recently, many research groups have tried to develop emergency department triage decision support systems based on big volumes of historical clinical data to differentiate and prioritize patients. Machine learning models might improve the predictive capacity of emergency department triage systems. The aim of this review was to assess the performance of recently described machine learning models for patient triage in emergency departments, and to identify future challenges.Methods: Four databases (ScienceDirect, PubMed, Google Scholar and Springer) were searched using key words identified in the research questions. To focus on the latest studies on the subject, the most cited papers between 2018 and October 2021 were selected. Only works with hospital admission and critical illness as outcomes were included in the analysis.Results: Eleven articles concerned the two outcomes (hospital admission and critical illness) and developed 55 predictive models. Random Forest and Logistic Regression were the most commonly used prediction algorithms, and the receiver operating characteristic-area under the curve (ROC-AUC) the most frequently used metric to assess the algorithm prediction performance. Random Forest and Logistic Regression were the most discriminant models according to the selected studies.Conclusions: Machine learning-based triage systems could improve decision-making in emergency departments, thus leading to better patients’ outcomes. However, there is still scope for improvement concerning the prediction performance and explicability of ML models.

International audience; Background: Recently, many research groups have tried to develop emergency department triage decision support systems based on big volumes of historical clinical data to differentiate and prioritize patients. Machine learning models might improve the predictive capacity of emergency department triage systems. The aim of this review was to assess the performance of recently described machine learning models for patient triage in emergency departments, and to identify future challenges.Methods: Four databases (ScienceDirect, PubMed, Google Scholar and Springer) were searched using key words identified in the research questions. To focus on the latest studies on the subject, the most cited papers between 2018 and October 2021 were selected. Only works with hospital admission and critical illness as outcomes were included in the analysis.Results: Twenty-one articles concerned the two outcomes (hospital admission and critical illness) and developed 75 predictive models. Random Forest and Logistic Regression were the most commonly used prediction algorithms, and the receiver operating characteristic-area under the curve (ROC-AUC) the most frequently used metric to assess the algorithm prediction performance. Boosting, Random Forest and Logistic Regression were the most discriminant models according to the selected studies.Conclusions: Machine learning-based triage systems could improve decision-making in emergency departments, thus leading to better patients’ outcomes. However, there is still scope for improvement concerning the prediction performance and explicability of ML models.

International audience; Background: The COVID-19 pandemic has resulted in worldwide kidney transplantation (KT) moratoriums. The impacts of these moratoriums on the life expectancy of KT candidates remain unclear.Methods: We simulated the evolution of several French candidate populations for KT using a multistate semi-Markovian approach and according to moratorium durations ranging from 0 to 24 mo. The transition rates were modeled from the 63 927 French patients who began dialysis or were registered on the waiting list for KT between 2011 and 2019.Results: Among the 8350 patients active on the waiting list at the time of the French KT moratorium decided on March 16, 2020, for 2.5 mo, we predicted 4.0 additional months (confidence interval [CI], 2.8-5.0) on the waiting list and 42 additional deaths (CI, -70 to 150) up to March 16, 2030, compared with the scenario without moratorium. In this population, we reported a significant impact for a 9-mo moratorium duration: 135 attributable deaths (CI, 31-257) up to March 16, 2030. Patients who became active on the list after March 2020 were less impacted; there was a significant impact for an 18-mo moratorium (175 additional deaths [CI, 21-359]) in the 10 862 prevalent end-stage renal disease patients on March 16, 2020 and for a 24-mo moratorium (189 additional deaths [CI, 10-367]) in the 16 355 incident end-stage renal disease patients after this date.Conclusion: The temporary moratorium of KT during a COVID-19 peak represents a sustainable decision to free up hospitals' resources if the moratorium does not exceed a prolonged period.

International audience; Kidney transplantation is the best renal replacement therapy (medically and economically) for eligible patients with end-stage kidney disease. Studies in some French regions and in other countries suggest a lower access to the kidney transplant waiting listing and also to kidney transplantation, once waitlisted, for women. Using a mixed methods approach, this study aims to precisely understand these potential sex disparities and their causes. The quantitative study will explore the geographic disparities, compare the determinants of access to the waiting list and to kidney transplantation, and compare the reasons and duration of inactive status on the waiting list in women and men at different scales (national, regional, departmental, and census-block). The qualitative study will allow describing and comparing women’s and men’s views about their disease and transplantation, as well as nephrologists’ practices relative to the French national guidelines on waiting list registration. This type of study is important in the current societal context in which the reduction of sex/gender-based inequalities is a major social expectation.

Herein are reported the effects of photobiomodulation (PBM) on adenosine triphosphate (ATP) and reactive oxygen species (ROS) quantification and mitochondria membrane potential (MMP) of the mitochondria of diabetic adipose-derived stem cells (ADSCs) in vitro. Additionally, the expression of PTEN-induced kinase 1 (PINK1) and RBR E3 ubiquitin-protein ligase (PARKIN) genes, which are involved in mitochondrial quality, were quantified. First, type one diabetes was induced in 10 rats. The rats were then kept for 1 month, after which fat tissue was excised from subcutaneous regions, and stem cells were selected from the fat, characterized as ADSC, and cultivated and increased in elevated sugar conditions in vitro; these samples were considered diabetic-ADSC. Two groups were formed, namely, diabetic-control-ADSC and PBM-diabetic-ADSC. ATP, ROS quantification, and MMP of mitochondria of diabetic ADSCs in vitro were measured, and the expression of PINK1 and Parkin genes was quantified in vitro. The results revealed that PBM significantly increased ATP quantification (p = 0.05) and MMP activity (p = 0.000) in diabetic-ADSCs in vitro compared to the control diabetic-ADSCs; however, it significantly decreased ROS quantification (p = 0.002) and PINK1(p = 0.003) and PARKIN gene expression (p = 0.046) in diabetic-ADSCs. The current findings indicate for the first time that PBM has the potential to maintain the function and quality of mitochondrial diabetic-ADSCs by significantly increasing ATP quantification and MMP activity in diabetic-ADSCs in vitro while significantly decreasing ROS quantification and PINK1 and PARKIN gene expression, making PBM an attractive candidate for use in improving the efficacy of autologous stem cell remedies for diabetic patients with infected diabetic foot ulcers.

International audience; Background The association between the use of potentially nephrotoxic drugs [Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Iodinated Contrast Agents, Proton Pump Inhibitors (PPIs)] and emergency start of dialysis in patients with chronic kidney disease has not been well explored, although these compounds are commonly prescribed or available without prescription. Methods In this study, the Renal Epidemiology Information Network (REIN) registry data of all patients >= 18 years of age who started dialysis in France in 2015 were matched with those in the French National Health Insurance Database. The association between clinical characteristics, nephrotoxic drug exposure and emergency dialysis start was investigated. Patients were categorized into four classes of NSAID and PPI exposure (new, current, past, no user) on the basis of the pre-dialysis exposure period (1-30, 31-90, and 91-365 days). For iodinated contrast agents, exposure in the 72 h and 7 days before dialysis was analyzed. Results Among the 8805 matched patients, 30.2% needed to start dialysis in emergency. After adjustment for socio-demographic and clinical variables, new NSAID users were more likely to experience emergency dialysis start [OR = 1.95; 95% CI (1.1-3.4)]. This association was higher for new than for current users [OR: 1.44; 95% CI (1.08-1.92)]. Emergency dialysis start was also associated with iodinated contrast agent exposure in the previous 7 days [OR: 1.44; 95% CI (1.2-1.7)]. No significant relationship was detected between PPIs and emergency dialysis start. Conclusions Using both clinical and healthcare data, this study shows that emergency dialysis start is independently associated with recent exposure to NSAIDs and iodinated contrast agents. This suggests the need to strengthen the information given to healthcare professionals and patients with regard to nephrotoxic drugs. [GRAPHICS] .

Background: Numerous people suffer from diabetes mellitus (DM) and resultant diabetic foot ulcers (DFU), which lack effective treatment. Photobiomodulation (PBM) has accelerated wound heal...

Recent studies reported that some recovered COVID‐19 patients have tested positive for virus nucleic acid again. A systematic search was performed in Web of Science, PubMed, Scopus, and Google Scholar up to March 6, 2021. The pooled estimation of reinfection, recurrence, and hospital readmission among recovered COVID‐19 patients was 3, 133, and 75 per 1000 patients, respectively. The overall estimation of reinfection among males compared to females was greater. The prevalence of recurrence in females compared to males was more common. Also, hospital readmission between sex groups was the same. There is uncertainty about long‐term immunity after SARS‐Cov‐2 infection. Thus, the possibility of reinfection and recurrence after recovery is not unexpected. In addition, there is a probability of hospital readmission due to adverse events of COVID‐19 after discharge. However, with mass vaccination of people and using the principles of prevention and appropriate management of the disease, frequent occurrence of the disease can be controlled., Highlights The pooled estimation of re‐infection rate among recovered COVID‐19 patients was 3 per 1000 patients.The pooled estimation of recurrence rate among recovered COVID‐19 patients was 133 per 1000 patients.Hospital readmission among recovered COVID‐19 patients was 75 per 1000 patients.The possibility of re‐infection, recurrence and hospital readmission after recovery is not unexpected. Thus, adherence to principles of prevention besides vaccination is essential.

International audience; Despite national guidelines, medical practices and kidney transplant waiting list registration policies may differ from one dialysis/transplant unit to another. Benefit risk assessment variations, especially for elderly patients, have also been described. The aim of this study was to identify sources of variation in early kidney transplant waiting list registration in France. Among 16,842 incident patients during the period 2016-2017, 4,386 were registered on the kidney transplant waiting list at the start of, or during the first year after starting, dialysis (26%). We developed various log-linear mixed effect regression models on 3 levels: patients, dialysis networks and transplant centers. Variability was expressed as variance from the random intercepts (+/- standard error). Although patient characteristics have an important impact on the likelihood of registration, the overall magnitude of variability in registration was low and shared by dialysis networks and transplant centers. Between-transplant center variability (0.23 +/- 0.08) was 1.8 higher than between-dialysis network variability (0.13+/- 0.004). Older age was associated with a lower probability of registration and greater variability between networks (0.04 , 0.20, 0.93 in the 18-64, 65-74 and 75-84 age groups) . Targeted interventions should focus on elderly patients and/or certain regions with greater variability in waiting list access.

Background and Aims Nephrologists and General Practitioners (GP) are critical in the care trajectory of patients with CKD through the medical work they provide: screening, referral, follow-up, slowing down CKD progression and renal replacement therapy preparation. They often intervene simultaneously in a collaborative context. Several guidelines define this medical work and collaborative care models. However, evidence suggests that the implementation of such models is limited and suboptimal. For example, 18% of patients who started dialysis in 2018 in France did not see a nephrologist before.The objectives of this study were 1) to quantitatively describe the practices of both French nephrologists and GPs through drug and biology lab test prescriptions for patients with CKD and its evolution before and after dialysis start, 2) to qualitatively describe how they see each other’s role and from this 3) identify the factors interfering with optimal care trajectory Method All incident 2015 dialysis patients from France were identified using the national REIN registry. Healthcare consumption of those patients 2 years before and 1 year after dialysis start was retrieved from the French national health insurance database (SNDS) via indirect record linkage. The items of interest were drug and lab test prescriptions as well as the prescriber medical specialty. Prescription frequencies and percentages per months and per prescriber specialty were reported. Anatomical Therapeutic Chemical (ATC) classification level 2 was used for drugs. Semi-structured interviews with general practitioners and nephrologists exploring their practices surrounding CKD care were performed in a sample from the Bretagne region. Thematic analysis was performed on the transcripts. Results A total of 2 263 935 drug prescriptions were found for 8679 patients who started dialysis in 2015 in France in the span of 2 years before and 1 year after dialysis start. The place of each professional changed through time: drug prescribed by GPs decreased from 83.6% of the total during the 2 years before dialysis start to 62.6% during the year following dialysis start. Nephrologist’s place increased from 4.9% of the total prescriptions to 21%. Although GPs and nephrologists had differences between the drugs they prescribe (nephrologists prescribed more frequently vitamins and antianemic preparations whereas GPs prescribed more frequently analgesics and drugs used in diabetes), they also had similarities (frequencies of beta blocking agents, calcium channel blockers and lipid modifying agents). Similarly, the interviews highlighted that despite the unique technical nature of a large part of nephrologists’ practice (nephropathy aetiology, dialysis and kidney transplantation, nephrotoxicity) another part was similar to GPs’, including the long-term holistic care of patients with multiple comorbidities as well as diet and lifestyle advices. This appears to blur the perimeter of the role of each professionals regarding CKD care and favours an increased presence of nephrologists, as suggested by the quantitative prescription analysis. In turn, as interviews revealed, some GPs expressed a fear of losing their patients and regretted a decreased communication from specialists. Nephrologists’ description of the role of GPs ranged from a strict addressor to nephrologists, to an intermediary support to reduce uncertainties, to a constant partner with transfer of therapeutic objectives. Conclusion Combining the crossed point of view of GPs and nephrologists and robust prescription data, this study highlights an overlap in the roles and practices and suggests a competition in the control of therapeutic strategies that might hinder an optimal care trajectory for patients. Development of integrated renal care network could address these obstacles

Background Wolfram's syndrome (WFS) is a hereditary (autosomal recessive) neurodegenerative disorder. The clinical features are related to diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD) with other variable clinical manifestations. Pathogenic variants in the WFS1 gene, encoding wolframin, are known to be the main cause of Wolfram's syndrome. In this study, we present the clinical and genetic characteristics of two WFS patients from an Iranian family. Methods The mutation screening was performed by polymerase chain reaction (PCR) followed by direct Sanger sequencing of all exons from two affected WFS. Results The complete Sanger sequencing of the WFS1 gene detected a homozygous missense variant, c.2207G>A (p.Gly736Asp), in the eighth exon of the WFS1 gene. Both cases developed all the major symptoms of the disease, interestingly, except hearing loss. Conclusions Because of the rarity and clinical heterogeneity of WFS, the molecular genetic assay is essential to confirm the diagnosis and management of the WFS patients.

Background The risk of cancer is higher in patients with renal diseases and diabetes compared with the general population. The aim of this study was to assess in dialyzed patients, the association between diabetes and the risk to develop a cancer after dialysis start. Methods All patients who started dialysis in the French region of Poitou-Charentes between 2008 and 2015 were included. Their baseline characteristics were extracted from the French Renal Epidemiology and Information Network and were linked to data relative to cancer occurrence from the Poitou-Charentes General Cancer Registry using a procedure developed by the INSHARE platform. The association between diabetes and the risk of cancer was assessed using the Fine & Gray model that takes into account the competing risk of death. Results Among the 1634 patients included, 591 (36.2 %) had diabetes and 91 (5.6 %) patients developed a cancer (n = 24 before or at dialysis start, and n = 67 after dialysis start). The risk to develop a cancer after dialysis initiation was lower in dialyzed patients with diabetes than without diabetes (SHR = 0.54; 95 %CI: 0.32-0.91). Moreover, compared with the general population, the cancer risk was higher in dialyzed patients without diabetes, but not in those with diabetes. Conclusion The risk of developing a cancer in the region of Poitou-Charentes is higher in dialyzed patients without diabetes than with diabetes.