Artificial intelligence can be of considerable help to those wishing to publish their work; however, using it without a critical eye can lead to completely false results. We felt it would be useful to ask a biostatistician and trainer to raise our readers’ awareness of the potential pitfalls of such software when analysing their data, using the example of a programme widely used in medical research.This article presents four best practices for the effective use of language models (LLMs) such as ChatGPT or Claude in an R programming context. The author begins by describing the three most common errors produced by LLMs: the invention of non-existent functions, the use of obsolete syntax and, even more seriously, the suggestion of inappropriate statistical methods. These errors can go unnoticed by beginners and lead to erroneous analyses. It is therefore essential to systematically check the suggested functions, pay attention to R’s warning messages, and understand the conditions under which the recommended statistical tests apply.The article then details a three-step method for obtaining more reliable results: providing a precise context regarding the data and the working environment, clearly describing the desired objective, and specifying the expected format of the output. The author places particular emphasis on data confidentiality.A third section explains how to verify that generated code actually works. Four checks are suggested: checking for the absence of errors and “warnings”, verifying the structure of the results, assessing the plausibility of the values obtained, and testing the code on a small set of known data.Finally, the article specifies when to prioritise an LLM, when to consult the official R documentation, and when to seek the advice of a competent human. The overall aim is to empower the user whilst using LLMs as support tools rather than as substitutes for critical thinking.
Introduction: Vascular access exhaustion is a critical situation in chronic hemodialysis patients and may compromise the continuation of renal replacement therapy. In this context, salvage peritoneal dialysis represents a valuable alternative. Methods: This retrospective, monocentric, descriptive, and analytical study was conducted at Ibn Sina University Hospital in Rabat between 2006 and 2025. Among 257 patients treated with peritoneal dialysis, 21 had vascular access exhaustion; 15 patients were finally analyzed after exclusion of incomplete files. Results: The mean age was 47.1 ± 15.4 years, and the median duration on hemodialysis before transfer was 49 months [36–168]. Urgent or early peritoneal dialysis initiation occurred in 60% of cases. Automated peritoneal dialysis was used in 66.7% of patients. Significant improvement was observed in hemoglobin, phosphatemia, and bicarbonate levels, with overall preservation of dialysis adequacy. Mechanical complications were frequent, especially catheter migration (53.3%) and pericatheter leaks (40%). Nevertheless, technique retention reached 80%, with a median technique survival of 24 months [16.5–34]. Overall mortality remained high (73.3%), mainly related to cardiovascular and infectious comorbidities. Conclusion: Salvage peritoneal dialysis is an effective and realistic strategy in patients with vascular access exhaustion, but earlier identification of at-risk patients could improve outcomes.
IntroductionPeritoneal dialysis (PD) represents a viable alternative to hemodialysis in resource-limited countries, but the data on its technical survival in sub-Saharan Africa remain scarce. This study aims to evaluate one-year technique survival in PD at a semi-urban center in northern Senegal.Methods A single-center retrospective cohort study, including all patients with stage 5D chronic kidney disease treated with PD between August 2021 and December 2024. Demographic, clinical, and event data (peritonitis, transfers) were collected via a standardized form. Technical survival, defined as continued peritoneal dialysis without a definitive transfer to hemodialysis, was estimated at 12 months using the Kaplan–Meier method (95% CI).Results Thirty-three patients were included (mean age: 46.8 ± 18.6 years; 57.6% women; rural origin: 60.6%). Hypertension was the leading cause of renal failure (33.3%), followed by glomerulonephritis (21.2%). The mean Charlson score was 3.5 ± 1.0. The predominant modality was CAPD (63.6%). The peritonitis rate was 0.59 episodes per patient-year (23 episodes over 38.8 patient-years). Seven patients (21.2%) experienced technical failure. One-year technical survival was estimated at 75.3% (95% CI: 60.7–93.5) using the Kaplan–Meier method. The median technical survival was not reached (median follow-up duration: 10.3 months). Technical failure was due to catheter malfunction (57.1%) or therapeutic failure of peritonitis (42.9%).ConclusionIn this semi-urban setting in Senegal, one-year technical survival with PD is very encouraging, despite an early failure rate linked to mechanical and infectious complications as well as logistical constraints. These results support the strengthening of PD programs in sub-Saharan Africa, with a focus on optimizing the prevention of complications.
For more than 40 years, the French Language Peritoneal Dialysis (and Home Hemodialysis) Registry (RDPLF) has been a major source of data on home dialysis treatment modalities. Since centers participate on a voluntary basis, the question of its completeness and national representativeness remains essential. This study evaluates these parameters by comparing RDPLF data with those from the 2026 report of the French national REIN registry, which is considered comprehensive for France.The comparison is based on data as of December 31, 2024; several common indicators were analyzed: number of prevalent and incident patients on peritoneal dialysis, regional distribution of patients, treatment modalities by age, level of autonomy, use of assistance, and parameters related to anemia. The results show that the RDPLF captures between 90% and 97% of prevalent patients recorded in REIN. The number of incident patients is slightly higher in the RDPLF, likely due to differences in the timing of data updates. Despite these discrepancies, the trends observed in the two registries are remarkably consistent.A comparison of patient characteristics and treatment practices reveals a very high degree of consistency. The distributions of peritoneal dialysis techniques by age, levels of autonomy, and dialysis modalities are virtually identical. These results confirm the RDPLF’s national representativeness for peritoneal dialysis in France and highlight the complementary nature of the two registries. While REIN provides comprehensive surveillance of chronic kidney disease, the RDPLF offers detailed, specialized clinical data on home-based treatments. This complementarity is a significant asset for evaluating practices and developing home dialysis strategies.
L’intelligence artificielle, peut apporter une aide considérable à celles et ceux qui souhaitent publier leurs travaux ; néanmoins son utilisation, sans esprit critique, peut aboutir à des résultats totalement faux. Il nous a paru utile de demander à une biostatisticienne et formatrice de sensibiliser nos lecteurs et lectrices aux pièges possibles de ces logiciels pour l’analyse de leurs données , en prenant l’exemple d’un logiciel très utilisés dans les travaux médicaux. Cet article présente quatre bonnes pratiques pour utiliser efficacement les modèles de langage (LLM) comme ChatGPT ou Claude dans un contexte de programmation en R. L’auteur commence par décrire les trois erreurs les plus fréquentes produites par les LLM : l’invention de fonctions inexistantes, l’utilisation de syntaxes obsolètes et, plus grave encore, la proposition de méthodes statistiques inadaptées. Ces erreurs peuvent passer inaperçues chez les débutants et conduire à des analyses erronées. Il est donc essentiel de vérifier systématiquement les fonctions proposées, de prêter attention aux messages d’avertissement de R et de comprendre les conditions d’application des tests statistiques recommandés. L’article détaille ensuite une méthode en trois étapes permettant d’obtenir des réponses plus fiables : fournir un contexte précis sur les données et l’environnement de travail, décrire clairement l’objectif recherché et préciser le format attendu de la réponse. L’auteure insiste particulièrement sur la confidentialité des données. Une troisième partie explique comment vérifier qu’un code généré fonctionne réellement. Quatre vérifications sont proposées : contrôler l’absence d’erreurs et de “warnings”, vérifier la structure des résultats, évaluer la plausibilité des valeurs obtenues et tester le code sur un petit jeu de données connues. Enfin, l’article précise quand privilégier un LLM, quand consulter la documentation officielle de R et quand demander l’avis d’un humain compétent. L’objectif global est de rendre l’utilisateur autonome tout en utilisant les LLM comme outils d’assistance et non comme substituts à la réflexion critique.
Peritoneal dialysis (PD) is an effective alternative to hemodialysis for patients with end-stage renal disease. However, its success depends on proper peritoneal catheter function, and mechanical complications remain a major cause of technique failure. We conducted a retrospective analysis of 38 patients who initiated PD between October 2022 and March 2025 in a newly established Tunisian center. All catheters were implanted by mini laparotomy. Mechanical complications occurring during a minimum follow-up of three months were recorded. Fourteen patients (37%) experienced at least one mechanical complication, mainly catheter dysfunction including migration, obstruction, and drainage failure. The incidence of catheter replacement or reinsertion was 2.16 per 100 patient-months. All complications were successfully managed with conservative measures or catheter reinsertion, and no patient required permanent transfer to hemodialysis. These findings suggest that, although mechanical complications are frequent in newly established PD programs, they can be effectively managed through close monitoring and standardized protocols.
Le Registre de Dialyse Péritonéale de Langue Française (RDPLF) constitue depuis plus de quarante ans une source majeure de données sur les modalités thérapeutiques de dialyse à domicile. Sa participation reposant sur le volontariat des centres, la question de son exhaustivité et de sa représentativité nationale reste essentielle. Cette étude évalue ces para-mètres en comparant les données du RDPLF à celles du rapport 2026 du Registre national français REIN, réputé exhaustif pour la France. La comparaison porte sur les données du 31 décembre 2024 ; plusieurs indicateurs communs ont été analysés : nombre de patients prévalents et incidents en dialyse péritonéale, répartition régionale des patients, modalités de traitement selon l’âge, niveau d’autonomie, recours à l’assistance et paramètres liés à l’anémie. Les résultats montrent que le RDPLF recense entre 90 % et 97 % des patients prévalents enregistrés dans REIN. Les effectifs de patients incidents sont légèrement supérieurs dans le RDPLF, probablement en raison de différences dans la temporalité de mise à jour des données. Malgré ces écarts, les tendances observées dans les deux registres sont remarquablement concordantes. La comparaison des caractéristiques des patients et des pratiques de prise en charge révèle une très forte cohérence. Les distributions des techniques de dialyse péritonéale selon l’âge, les niveaux d’autonomie et les modalités d’assistance sont quasiment identiques. Ces résultats confirment la représentativité nationale du RDPLF pour la dialyse péritonéale en France et soulignent la complémentarité des deux registres. Alors que REIN fournit une surveillance exhaustive de l’insuffisance rénale chronique, le RDPLF apporte des données cliniques continues détaillées et spécialisées sur les traitements à domicile. Cette complémentarité constitue un atout important pour l’évaluation des pratiques et le développement des stratégies de dialyse à domicile.
Introduction: L’épuisement du capital vasculaire constitue une situation critique chez les patients en hémodialyse chronique, compromettant la poursuite de la suppléance rénale par voie extracorporelle. Dans ce contexte, la dialyse péritonéale de sauvetage représente une alternative thérapeutique permettant d’assurer la continuité du traitement. Matériel et méthodes: Il s’agit d’une étude monocentrique, rétrospective, descriptive et analytique, menée au CHU Ibn Sina de Rabat sur la période 2006–2025. Parmi 257 patients pris en charge en dialyse péritonéale, 21 présentaient une impasse vasculaire; après exclusion de 6 dossiers inexploitables, 15 patients ont été analysés. Résultats: L’âge moyen était de 47,1 ± 15,4 ans, avec une durée médiane préalable en hémodialyse de 49 mois [36–168]. L’initiation de la dialyse péritonéale était urgente ou précoce dans 60 % des cas. La dialyse péritonéale automatisée représentait 66,7 % des modalités. Une amélioration significative de l’hémoglobine, de la phosphorémie et des bicarbonates a été observée, avec une adéquation dialytique globalement maintenue. Les complications mécaniques étaient fréquentes, notamment la migration du cathéter (53,3 %) et les fuites péricathétériques (40 %). Malgré cela, le maintien en technique atteignait 80 %, avec une survie médiane de la technique de 24 mois [16,5–34]. La mortalité globale restait élevée (73,3 %), principalement en lien avec les comorbidités cardiovasculaires et infectieuses. Conclusion: La dialyse péritonéale de sauvetage apparaît comme une stratégie efficace et réaliste chez les patients en impasse vasculaire, mais son recours gagnerait à être anticipé afin d’en améliorer les résultats.
Introduction La dialyse péritonéale (DP) représente une alternative viable à l’hémodialyse dans les pays à faibles ressources, mais les données sur sa survie technique en Afrique subsaharienne restent rares. Cette étude vise à évaluer la survie technique à un an en DP dans un centre semi-urbain au nord du Sénégal. Méthodes Étude de cohorte rétrospective monocentrique incluant tous les patients atteints de maladie rénale chronique stade 5D traités par DP entre août 2021 et décembre 2024. Les données démographiques, cliniques et événements (péritonites, transferts) ont été recueillis via un formulaire standardisé. La survie technique définie par le maintien en dialyse péritonéale sans transfert définitif en hémodialyse, a été estimée à 12 mois par Kaplan-Meier (IC95%). Résultats Trente-trois patients ont été inclus (âge moyen : 46,8 ± 18,6 ans ; 57,6 % de femmes ; origine rurale : 60,6 %). L’hypertension artérielle était la cause principale d’insuffisance rénale (33,3 %), suivie des glomérulonéphrites (21,2 %). Le score de Charlson moyen était de 3,5 ± 1,0. La modalité dominante était la DPCA (63,6 %). Le taux de péritonite était de 0,59 épisode par année-patient (23 épisodes sur 38,8 années-patient). Sept patients (21,2 %) ont présenté un échec technique. La survie technique à un an était estimée à 75,3 % (IC 95 % : 60,7–93,5) selon la méthode de Kaplan-Meier. La médiane de survie technique n’a pas été atteinte (durée médiane de suivi : 10,3 mois). L’échec technique faisait suite à un dysfonctionnement du cathéter (57,1 %) ou à un échec thérapeutique d’une péritonite (42,9 %). Conclusion Dans ce contexte semi-urbain sénégalais, la survie technique en DP à un an est très encourageante, malgré un taux d’échec précoce lié aux complications mécaniques et infectieuses ainsi qu’aux contraintes logistiques. Ces résultats plaident pour un renforcement des programmes de DP en Afrique subsaharienne, avec une optimisation de la prévention des complications.
Background: Brown tumors (BTs) are rare skeletal manifestations of osteitis fibrosa cystica caused by prolonged hyperparathyroidism. They are most commonly reported in patients with advanced secondary hyperparathyroidism undergoing hemodialysis. Conversely, early presentation in peritoneal dialysis (PD) remains uncommon, and craniofacial involvement is especially rare. Case Presentation: We report a case of a 27-year-old woman with end-stage renal disease on PD who developed a craniofacial BT shortly after dialysis initiation. A biochemical evaluation revealed markedly elevated parathyroid hormone (PTH) levels (3032 pg/mL). Despite initial partial regression, the BT rapidly progressed to multifocal skeletal lesions, including on the clavicle, humeral head, ribs, and ischiopubic ramus, associated with fractures and tumoral calcinosis. Medical management was initiated, and parathyroidectomy was planned. Conclusion: This case emphasizes the potential for early craniofacial BT development and rapid multifocal skeletal progression in PD patients with uncontrolled hyperparathyroidism. It further demonstrates that early detection and prompt surgical referral may be vital in preventing severe skeletal complications in PD patients with uncontrolled hyperparathyroidism.
Calciphylaxis is a rare and potentially fatal disease manifested by progressive skin ulcerations due to calcification and obstruction of small-caliber arteries and arterioles. It mainly affects patients with chronic kidney disease treated by dialysis or renal transplantation but also individuals with normal kidney function, in which case it is often associated with chronic inflammatory diseases, neoplasia, primary hyperparathyroidism, and post-bariatric surgery. Necrotized ulcerations can become infected, leading to septic syndrome and a mortality rate of up to 80%. Its incidence varies from one case per 1,000 to one case per 1,500 hemodialysis patients per year, although this is probably underestimated. Clinical manifestations include very painful nodular or plaque-like indurations occurring in the extremities and central to the body. Lesions can also affect the fingers, penis, breasts, and visceral organs such as the lungs, intestines, and eyes. Its management is complex and requires a multimodal, individualized approach, involving close cooperation between nephrologists, dermatologists, surgeons, and other specialists. The aim of this review is to revise old and new aspects of this management while including the control of parameters of mineral and bone metabolism disorders, the replacement of vitamin K antagonists by alternative anticoagulants, the optimization of dialysis prescription, and the use of sodium thiosulfate, as well as new experimental therapies under development. We hope this review will help avoid common pitfalls and provide the highest quality care for patients with calciphylaxis.
We report the case of a 7-month-old infant presenting with severe acute kidney injury in the context of respiratory infection and dehydration who was managed in French Guiana, an isolated territory with limited medical resources. Automated peritoneal dialysis was initiated early, leading to rapid clinical improvement. Due to the necessity of medical evacuation to a referral center, continuity of treatment was maintained aboard a commercial flight from Cayenne to Paris (duration 8 hours 30 minutes) through the performance of three manual exchanges of ambulatory continuous peritoneal dialysis. These exchanges were conducted by a multidisciplinary team (pediatrician, adult nephrologist, nurse) with the assistance of the infant’s mother using an improvised setup that adhered strictly to aseptic protocols. This case highlights the feasibility, safety, and strategic importance of peritoneal dialysis in extreme pediatric settings and constrained environments.
Infectious peritonitis remains a frequent complication of peritoneal dialysis. Over the years, numerous technical advancements have been introduced, aimed at both reducing the incidence of these infections and enhancing their microbiological characterization. In this study, we analyzed 26,235 peritonitis episodes recorded in the French-Language Peritoneal Dialysis Registry (RDPLF) database to describe the evolution of infectious epidemiology from the 1980s to the present day. Our findings reveal a marked decrease in the proportion of staphylococcal infections between 1978 and 2010. Conversely, infections caused by Enterobacteriaceae, enterococci, and streptococci have progressively increased over the same period. The modality of peritoneal dialysis appears to be associated with specific bacterial profiles: infections involving skin flora are more prevalent in continuous ambulatory peritoneal dialysis, whereas those of environmental or mixed (oral/gastrointestinal) origin are more frequently observed with automated peritoneal dialysis.The advent of advanced diagnostic techniques, particularly molecular biology methods, has significantly improved the microbiological documentation of peritonitis, especially for organisms that are non-cultivable or difficult to culture by conventional laboratory methods.In summary, this study presents the microbiological trends observed in peritoneal dialysis-associated peritonitis in France from the 1980s to the present, based on data from over 20,000 patients included in the RDPLF database. It highlights the impact of evolving technological approaches on the detection and understanding of these infections.
Peritonitis is a frequent complication of peritoneal dialysis. Its diagnosis is based on clinical signs (pain, cloudy effluent), intraperitoneal hyperleukocytosis (> 0.1×109/L with more than 50% polynuclears), or a positive culture. Although the majority of peritonitis cases are of infectious origin, there are also cases due to non infectious origin, which can lead to the inappropriate use of antibiotics and delayed diagnosis. We report the case of a 78-year-old male patient with a complex haemopathy that combined paroxysmal nocturnal haemoglobinuria, despite treatment with ravulizumab, and essential thrombocythemia, which transformed into myelofibrosis. After the initiation of peritoneal dialysis treatment, he presented with occasionally cloudy dialysis fluid rich in leukocytes (up to 0.442 ×109/L), with no evidence of infection (negative cultures and DNA16S PCR, moderate CRP, and an absence of atypical cells). The origin of the intraperitoneal hyperleukocytosis was attributed to myelofibrosis-related blood hyperleukocytosis. The clinical course was unfavorable, leading to palliative management. This case illustrates the difficulty of managing this complication in peritoneal dialysis patients. Although infectious peritonitis is the most common first-line diagnosis, it is important to consider various differential diagnoses in cases of culture-negative peritonitis, particularly hematological causes (leukemia, lymphoma, myelofibrosis). However, forms with a predominance of neutrophils in the dialysate may simulate an infection. The absence of fever, elevated CRP, and a correlation between blood and peritoneal hyperleukocytosis should help in making a differential diagnosis. Immunophenotyping or molecular biology in the dialysate could refine the diagnosis. This case highlights a possible cause of sterile peritonitis due to myelofibrosis with hyperleukocytosis, and calls for recommendations to be adapted to increasingly complex clinical situations.
France has been a pioneer in the implementation of assisted peritoneal dialysis (PD), with its first institutional programs launched in the late 1970s. According to data from the French-language Peritoneal Dialysis Registry (RDPLF), approximately a third of patients treated by PD receive assistance, placing France among the european and OECD countries with the highest proportion of assisted peritoneal dialysis. Assisted PD is recommended by european and international guidelines, which are based on the french model. A recent incident at the Bouchard Clinic in Marseille highlights the current administrative challenges associated with peritoneal dialysis assisted by private nurses. It also underscores the potential risks of a restrictive interpretation of administrative policies by certain primary health insurance funds. It is vital that the medical and cultural achievement of assisted peritoneal dialysis be defended. On October 6, 2025, the events in Marseille led stakeholders from the nephrology community, the nursing world, patient associations and hospital federations to write a joint letter of alert to the Director of Healthcare Provision at the French Ministry of Health on this issue.
Malnutrition is a common complication in patients with chronic renal failure treated by peritoneal dialysis (PD), which can compromise prognosis. To control this malnutrition, feeding via a nasogastric tube may be necessary. However, in cases of insufficiency or intolerance, the placement of a gastrostomy may be an alternative. Its use in PD raises concerns about infection risk. We report the observation of a 67-year-old patient treated with continuous ambulatory peritoneal dialysis in whom a gastrostomy was performed in the context of severe malnutrition.After starting PD in January 2020, the patient experienced several episodes of deterioration in his general condition and progressive malnutrition despite the introduction of oral nutritional supplements. Faced with worsening malnutrition (albumin 18.2 g/L), nasogastric feeding was attempted in October 2020 but withdrawn due to repeated disinsertions.A gastrostomy was finally performed in March 2021 under antibiotic prophylaxis with cefazolin. PD was temporarily suspended in favor of hemodialysis and resumed without complications after healing. Reoperation was necessary after accidental removal of the tube, also without peritoneal complications. Tube feeding consisted of 1 L of high-calorie, high-protein solution (Mégaréal®) at night.The patient’s nutritional status improved, with albumin rising from 25.8 g/L to 33 g/L.The patient died suddenly in September 2021, unrelated to the gastrostomy or PD.This observation illustrates the feasibility of gastrostomy in an adult on PD. Pediatric data show an acceptable risk of infection when a rigorous protocol is followed, including antibiotic prophylaxis, sometimes antifungal prophylaxis, and temporary PD adaptation. In our case, no peritonitis or leakage was observed after two gastrostomy placements.This case illustrates the benefits of gastrostomy for the nutritional management of malnourished peritoneal dialysis patients, as well as the practical difficulties encountered.
Obesity is a major public health issue that affects a significant proportion of patients with end-stage renal disease (ESRD). In patients undergoing peritoneal dialysis (PD), obesity complicates treatment by increasing the risk of mechanical complications and infections and reducing the effectiveness of peritoneal exchanges. Furthermore, obesity limits access to kidney transplantation, making weight loss a crucial goal. Bariatric surgery is emerging as an effective strategy for improving metabolic condition and promoting placement on a transplant waiting list.Sleeve gastrectomy (SG) is now the preferred technique for helping obese patients on ESRD lose weight, particularly due to its favorable safety profile, reduced operating time, and absence of intestinal bypass, thus limiting the risk of deficiencies. The available data, although limited to case series and isolated reports, suggest that SG can be performed in PD patients either with early resumption of PD or after a temporary transition to hemodialysis depending on clinical status. Optimized protocols include a gradual resumption of PD at low volumes, minimizing the risk of leakage or infection.Bariatric surgery therefore appears feasible and generally safe in PD patients, provided that a rigorous multidisciplinary assessment and close nutritional monitoring are carried out to prevent malnutrition and sarcopenia. It is a relevant therapeutic option for improving access to kidney transplantation and optimizing the prognosis of obese patients with ESRD. This article was written following a presentation at the Société Francophone de Néphrologie, Dialyse et Transplantation 2025 on the feasibility of bariatric surgery in PD.
Chronic kidney disease (CKD) represents a major global public health challenge, affecting nearly 850 million people and ranking among the fastest-growing causes of premature mortality. In the French West Indies and Guiana region, end-stage renal disease (ESRD) places a disproportionate burden on healthcare systems, exacerbated by low medical density, geographic dispersion, and cultural diversity. Home dialysis, including peritoneal dialysis and hemodialysis, is an essential tool that improves quality of life, autonomy, and continuity of care. However, its adoption remains limited due to human, organizational, and medical barriers. Artificial intelligence (AI) emerges as a strategic lever to overcome these limitations, enabling the prediction of complications, personalized treatment optimization, and proactive telemonitoring. Its implementation requires careful attention to ethical issues, data protection, professional training, and adaptation to local cultural contexts. International experiences demonstrate that such approaches improve safety, adherence, and technical survival. In overseas territories, AI can transform home dialysis into a scalable, equitable, and sustainable solution, addressing both healthcare challenges and organizational constraints, while placing the patient and their cultural context at the heart of care management.
La dénutrition est une complication fréquente chez les patients insuffisants rénaux chroniques traités par dialyse péritonéale (DP), pouvant compromettre le pronostic. Pour controler cette malnutrition, l’utilisation d’une alimentation par sonde nasogastrique (SNG) peut s’avérer nécessaire. Néanmoins, en cas d’insuffisance ou intolérance, la mise en place d’une gastrostomie peut représenter une alternative. Son utilisation en DP soulève des inquiétudes liées au risque infectieux. Nous rapportons l’observation d’un patient de 67 ans traité par DPCA chez qui une gastrostomie a été mise en place dans un contexte de dénutrition sévère. Après l’initiation de la DP en janvier 2020, le patient a présenté plusieurs épisodes d’altération de l’état général, et une dénutrition progressive malgré l’introduction de compléments nutritionnels oraux. Devant l’aggravation de la dénutrition (albumine 18,2 g/L), une SNG a été tentée en octobre 2020 mais retirée du fait de désinsertions répétées. Une gastrostomie a finalement été posée en mars 2021 sous antibioprophylaxie par céfazoline. La DP a été suspendue temporairement au profit d’une hémodialyse et reprise sans complication après cicatrisation. Une réintervention a été nécessaire après arrachement accidentel de la sonde, également sans complication péritonéale. L’alimentation par la sonde comprenant un litre de solution hypercalorique hyperprotéiné (Mégaréal®) nocturne. L’état nutritionnel s’est amélioré (albumine 25,8 g/L puis 33 g/L). Le patient est décédé subitement en septembre 2021, sans lien avec la gastrostomie ni la DP. Cette observation illustre la faisabilité de la gastrostomie chez un adulte en DP. Les données pédiatriques montrent un risque infectieux acceptable sous couvert d’un protocole rigoureux incluant antibioprophylaxie, parfois prophylaxie antifongique, et adaptation temporaire de la DP. Dans notre cas, aucune péritonite ni fuite n’a été observée après deux poses de gastrostomie. Ce cas illustre l’intérêt de la gastrostomie pour la prise en charge nutritionnelle des patients dialysés péritonéaux dénutris, ainsi que les difficultés pratiques rencontrées.
L’obésité constitue un enjeu majeur de santé publique et touche une proportion significative de patients atteints d’insuffisance rénale chronique terminale (IRCT). Chez les patients en dialyse péritonéale (DP), elle complique la prise en charge en augmentant le risque de complications mécaniques, d’infections, et en réduisant l’efficacité des échanges péritonéaux. Par ailleurs, l’obésité limite l’accès à la transplantation rénale, faisant de la perte pondérale un objectif crucial. La chirurgie bariatrique émerge comme une stratégie efficace pour améliorer la condition métabolique et favoriser l’inscription sur liste d’attente de greffe. La sleeve gastrectomy (SG) est désormais la technique privilégiée chez les patients obèses en IRCT, notamment en raison d’un profil de sécurité favorable, d’un temps opératoire réduit et de l’absence de dérivation intestinale, limitant ainsi le risque de carences. Les données disponibles, bien que limitées à des séries de cas et rapports isolés, suggèrent que la SG peut être réalisée chez des patients en DP, soit avec reprise précoce de la DP, soit après une transition temporaire vers l’hémodialyse selon le statut clinique. Les protocoles optimisés incluent une reprise progressive de la DP à faibles volumes, permettant de minimiser les risques de fuite ou d’infection. La chirurgie bariatrique apparaît ainsi faisable et globalement sûre chez les patients en DP, à condition d’une évaluation multidisciplinaire rigoureuse et d’un suivi nutritionnel étroit pour prévenir la dénutrition et la sarcopénie. Elle constitue une option thérapeutique pertinente pour améliorer l’accès à la transplantation rénale et optimiser le pronostic des patients obèses en insuffisance rénale terminale. Cet article a été rédigé suite à une présentation à la SFNDT (Société Francophone de Néphrologie, Dialyse et Transplantation) 2025 sur la question de la faisabilité de la chirurgie bariatrique en DP.
