Introduction. End-stage kidney disease radically alters the patients’ lives. The aim of this study was to compare the levels of employment, financial assistance, global activities, quality of life, and energy expenditure in patients according to the autonomous dialysis modality: Long Nocturnal Hemodialysis (LNHD), Daily Home Hemodialysis (DHHD), Automated Peritoneal Dialysis (APD), and hemodialysis in a self-care unit. Methods. Voluntary patients (n = 182) treated with an autonomous dialysis modality completed an anonymous e-questionnaire that included items on type of paid employment, voluntary work and leisure activities, and three self-report questionnaires (SONG-Fatigue, Recent Physical Activity Questionnaire, and EuroQol EQ-5D-5L). Results. Overall, 33% of patients had a remunerated activity, 10% of patients were considered as sedentary and 39.6% reported an important physical activity. The SONG-Fatigue median score was 3 (IQR 2–5). Moreover, 54%, 89% and 56% of patients did not report any problem with mobility, self-care, and usual activities, respectively. In addition, 35% of patients did not complain about pain or discomfort and 59% had no anxiety or depression symptoms. Patients estimated their global health status at 60 (IQ 50–80). The LNHD group had more often a remunerated activity and the DHHD group reported fewer problems with usual activities. The APD and LNHD groups experienced pain more often. Conclusion. This study showed a significant overall impact of dialysis on the patients’ daily life with some differences according to the dialysis modality.

Abstract Background and Aims Fatigue and dialysis recovery time (DRT) are two important patient-reported outcomes that highly affect the well-being of patients on hemodialysis. The DOPPS working group showed that prolonged DRT increases mortality. Therefore, this study aims to assess all modifiable dialysis-related factors, associated with DRT and fatigue, that could be addressed in future clinical trials. Method This is a French multicenter observational study that included all patients ≥ 18 years, on chronic hemodialysis for >3 months, who consented to participate during December 2023. Patients with cognitive problems, active cancer and admitted to hospital were excluded. The study got the approval of the local ethics committee. DRT was assessed six times by asking at each session for two non-consecutive weeks: "How long did it take you to recover from your last dialysis session?" Fatigue was assessed by using the French validated SONG-HD fatigue scale that includes three questions: in the last week, "did you feel tired?", "did you lack energy?", "did fatigue limit your usual activities?". Logistic regression analysis assessed the association between DRT>12 hours and fatigue score ≥4 with all demographic and dialysis-related factors. A sub-analysis of DRT-related factors was performed for very elderly ≥ 85 years. Results A total of 536 patients and 2967 sessions were analyzed. Mean age was 68.1 ± 14.3 years with 10.4% above 85 years; 60.9% were males, median dialysis vintage was 41 (22.5, 80) months, 33.2% had diabetes, 46.3% had cardiovascular (CV) disease, 5.2% were on nocturnal hemodialysis, 14.4% had a catheter and 63.3% were on HDF. Median dialysate sodium was 138 (136, 140) with a minimum of 130 to a maximum of 142. Median DRT was 140 (45, 440) minutes with 42.7% of patients recovering in <2 hours, 16.2% in 120-360 minutes, 26.1% in 361-720 minutes and 14.9% >12 hours. The mean SONG-HD fatigue score was 3.1 ± 2.3 with 18% having no fatigue and 37.7% having a score ≥4. DRT and fatigue score were significantly associated (P < 0.001). Factors significantly associated with DRT>12 hours are summarized in Table 1: sex, diabetes, CV disease, BMI, ultrafiltration rate/Kg/hour, duration of session, blood flow, Kt/V, blood pressure, membrane type and all routine blood tests were not associated with DRT whereas intradialytic change in natremia was significantly associated with recovery time (Fig. 1). In multivariable regression analysis, factors associated with a fatigue score ≥4 included females (OR = 1.74; 95% CI: 1.21, 2.51; P = 0.003), and lower hemoglobin (OR = 0.83; 95% CI: 0.71, 0.99; P = 0.003). In the subgroup of patients ≥85 years, HDF was associated with prolonged DRT (OR = 4.2; 95% CI: 1.04, 17.03; P = 0.045) and lower hemoglobin was associated with fatigue (OR = 0.51; 95% CI :0.28, 0.93; P = 0.029). Conclusion DRT and fatigue are significantly associated however modifiable factors associated with prolonged DRT are not exactly similar to those associated with fatigue. A negative intra-dialytic change in natremia and low frequency of dialysis are two major factors associated with longer DRT, with HDF significantly associated with longer recovery in very elderly patients, whereas the modifiable independent factor associated with fatigue is the hemoglobin level.

Introduction: Methods: There is still a great deal of progress to be made in improving patients' quality of life and getting them involved in social and physical activities.

BACKGROUND:Dialysis recovery time (DRT) and fatigue are two important patient-reported outcomes that highly affect hemodialysis patients' well-being and survival. This study aimed to identify all modifiable dialysis-related factors, associated with DRT and fatigue, that could be addressed in future clinical trials. METHODS:This multicenter observational study included adult patients, undergoing chronic hemodialysis for > 3 months during December 2023. Patients admitted to hospital, with cognitive problems, or active cancer were excluded. DRT was determined by asking over six sessions: "How long did it take you to recover from your last dialysis session?" Fatigue was assessed using the French-validated SONG-HD fatigue scale. Logistic regression analysis assessed the association between DRT>12 hours and fatigue score ≥4 with all dialysis-related factors. A sub-analysis of DRT-related factors was performed for very elderly ≥ 85 years. RESULTS:A total of 536 patients and 2967 sessions were analyzed. Mean age was 68.1 ±14.3 years, 60.9% were males, 33.2% had diabetes, 63.3% were on hemodiafiltration. Median dialysate sodium was 138 (136, 140). Median DRT was 140 (45, 440) minutes and 14.9% of patients had DRT >12 hours. Fatigue score was 3.1 ±2.3, 18% had no fatigue and 37.7% had a score ≥4. DRT and fatigue score were significantly associated. In multivariable regression analysis, intradialytic reduction in serum sodium and frequency of dialysis were significantly associated with DRT. Factors associated with fatigue included female sex and lower hemoglobin. In patients ≥85 years, hemodiafiltration was associated with prolonged DRT. CONCLUSION:Modifiable factors associated with prolonged DRT are not exactly similar to those associated with fatigue. Intradialytic reduction in serum sodium and low frequency of dialysis are two independent factors associated with longer DRT, with hemodiafiltration associated with longer recovery in very elderly patients. The hemoglobin level is the modifiable independent factor associated with fatigue. These modifiable factors can be addressed in future interventional trials in order to improve patients' outcomes.

Abstract Background and Aims 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. The objective of this study was to compare the cost of four dialysis modalities that enable patients to play a substantial role in their own care and have social and professional lives. Method We identified all patients in the national French ESKD REIN registry aged 18–65 years who received any dialysis treatment in 2015-2019, used stepwise indirect linkage with the national health database to analyse exhaustive hospital stays and outpatient health-care utilisation. Four treatment groups were defined: non-assisted haemodialysis in self-care units (scHD), non-assisted automated peritoneal dialysis (naAPD), daily home HD (dhHD), and non-hospital-based nocturnal extended hours HD (neHD).Total costs by categories and subcategories were aggregated monthly and by patient. Costs are expressed as their medians and interquartile ranges (Q1-Q3). Results Our study included 1932 patients with 39 966 patient treatment-months. The median monthly cost for one patient was €6154 (IQR €5088 – €7566) and varied from €5700 for naAPD to €7903 € for dhHD. Analysis by cost subcategories showed that the main cost came from dialysis fee payments —60% of the monthly cost. Hospitalization costs came next (11%). The costs of the different subcategories varied between dialysis modalities. During the study period, the hospitalization rate was 33 per 100 months at risk: 14 for inpatient admissions and 19 for day hospitalization. Day hospitalization was more frequent for patients with home treatment. Various compensatory allowances were paid to 49% of the patients. Conclusion Most of the cost difference variability related to payment methods for the different dialysis techniques. Our study shows that different care strategies could be offered to French dialysis patients. Underused techniques such as neHD might usefully be promoted as they do not involve any excess costs, at least compared with dhHD. Real cost analyses are however needed because some reimbursements are not adapted and deserve to be revised upwards.

La dialyse longue nocturne réalisée trois fois 8heures par semaine est peu utilisée en France mais associée dans de nombreuses études à l’amélioration du contrôle-tensionnel, du remodelage cardiaque, de l’équilibre minéral, nutritionnel, de la qualité de vie et de la survie par rapport au traitement conventionnel.

In France, long nocturnal dialyses, eight hours three-times a week, are sparsely proposed. However, numerous studies reported that this specific type of dialysis is associated to better blood pressure control, better cardiac remodeling, better mineral and nutritional balance as well as better life quality and survival rate. Material and methods. - In this study, we aimed at quantifying the benefits, risks and obstacles of developing night dialysis and at describing the results of a program that took place in Rennes from 2002 to 2019. Data were collected between 2008 and 2014 for eighteen case-patients and were compared to thirty-six controls that underwent conventional dialysis. Patients were paired according sex, age and year of dialysis start. Results. - The median age for dialysis start was 47.5 years [27-60] with a male prevalence (5/1). After six months, a significant difference was reported for postdialytic, systolic and diastolic pressure (respectively 126 +/- 15 vs 139 +/- 21 [P = 0.04] and 72 +/- 9 vs 81 +/- 14 [P = 0.02]) despite an antihypertensive reduction ranging from 2.4 +/- 1.4 to 1.3 +/- 0.9 per day at six months and 0.7 +/- 0.9 at one year (P = 0.02). An increase of nPCR was evidenced at 6 and 9 months (P = 0.02). At the end of the study, the phosphate level was maintained for both cohorts at the expense of an increased consumption of phosphate binder for the long nocturnal dialysis group (P = 0.025). As a whole, 61% of the patients that pursued long night dialysis maintained a professional activity compared to only 30% for the controls (P = 0.04). This highlights the advantages of night dialysis for maintaining employment but also the bias that represents the employment status in observational study on this specific topic. (C) 2020 Societe francophone de nephrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.

BACKGROUND:Previous US studies have indicated that haemodialysis with ≥6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients. METHODS:We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association-European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5-4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders. RESULTS:From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62-0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71-0.90)]. CONCLUSIONS:EHD is associated with better survival in European patients treated with haemodialysis three times weekly.

Home hemodialysis therapy orientation is rising since 2011 in France due to technical progress in dialysis machines, with a simplified use, an ultrapure and sparing dialysate delivery. The most frequent therapy is short daily dialysis sessions with performing results in terms of water and salt balance, depuration and mainly on autonomy and flexibility. In this article, we describe the organization of an alternative therapy with long nocturnal low flow hemodialysis in a dialyzed patient since 2006 after a graft failure. We discuss the benefits of this therapy, first results, eventual barriers to this method specially the occurrence of an adverse event, security and benefit of a telemonitoring and teleassistance that we develop for this occasion.

BACKGROUND:Among the vitamin K antagonists (VKA), indanedione-derived VKA is suspected to induce an immunoallergic risk. One indanedione-derived VKA, fluindione, is still being used in France. The aim of this study was to evaluate the contribution of VKA to acute and chronic nephritis.METHODS:Twenty-four cases of biopsy proven acute interstitial nephritis (AIN) were retrospectively selected, based on a first intake of VKA within the previous 12 months as well as an increase of at least 50% of the basal level of serum creatinine. The 24 cases were all treated with fluindione VKA and not with coumarinic VKA.RESULTS:The subjects studied included 20 men and 4 women, with a mean age of 73.0±9.3 years (range: 44-84). The delay between fluindione introduction and the appearance of an AIN, proven by biopsy when available, was 11.9±6.9 weeks (range: 3-28). Creatinine increased from 123.0±56.4 μmol/L (range: 56-335) at fluindione introduction to 460.7±265.3 μmol/L (range: 109-1200) at the time of AIN discovery. The treatment then consisted of stopping the fluindione and introducing steroids for 21 patients. If a VKA was necessary, fluindione was replaced by a coumarinic VKA. After 6 months, 1 patient died and 15 patients presented severe chronic kidney disease (CKD Stages 4-5). Two patients still required chronic dialysis after 6 months and five patients after 3 years. Patients with pre-existing kidney disease were more prone to develop severe CKD with fluindione.CONCLUSION:In this large study, arguments are presented to incriminate fluindione in the induction of acute and chronic nephritis.

Background. - Chronic kidney failure (CRF) in addition to cardiovascular comorbidities and aging decrease physical activity capacity. An adapted rehabilitation program might be strongly recommended in this population. The aim of the study is to evaluate a 3 months exercise training program with ergocycle at the anaerobic threshold (AT) during dialysis sessions on effort tolerance, quality of life, blood pressure and lipidic disorders.Methods. - Six patients meanly aged 72 were evaluated before (t(0)) and after (t(3)) the rehabilitation program by: maximal cardiorespiratory ergotest, a 6-Minute Walk Test (6MWT) and 2 quality of life tests: Medical Outcome Survey Short Form 36-items and the Kidney Disease Quality of Life (SF 36, KDQol).Results. - Physical activity during dialysis is well tolerated. There was no undesirable event during rehabilitation sessions. The dyspnea and muscular weariness threshold linked to the AT increased meanly by 39% (8.83 +/- 0.87 vs. 12.25 +/- 1.23 mL/min per kg). Distances walked during 6 MWT increased for all patients (351.83 +/- 72.17 vs. 412.80 +/- 82 meters) Moreover, physical component scale improved (+ 4.7), mean systolic blood pressure (- 7 mmHg) and mean triglycerides concentration (- 19%) decreased.Conclusion. - An exercise training program during dialysis sessions with ergocycle and working intensity based on AT seems safe and an effective alternative to improve the effort functional capacity by hemodialysis patients. (C) 2011 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved.