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.

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.

Introduction (NDLR) Un groupe de néphrologues issus du Club des jeunes Néphrologues sélectionne chaque trimestre à tour de rôle un article de la littérature internationale en rapport avec la dialyse à domicile, Dialyse Péritonéale ou Hémodialyse à Domicile, et en propose un résumé en français et son analyse. Ces résumés sont librement téléchargeables sur le site du RDPLF à l’adresse : https://www.rdplf.org/biblio.html. Depuis décembre 2018 ceux sélectionnés au cours du trimestre par ces néphrologues sont publiés sous leur nom dans la présente rubrique du Bulletin de la Dialyse à Domicile.

NDLR : Un groupe de néphrologues issus du Club des jeunes Néphrologues sélectionne chaque mois à tour de rôle un article de la littérature internationale en rapport avec la dialyse à domicile, Dialyse Péritonéale ou Hémodialyse à Domicile, et en propose un résumé en français et son analyse. Ces résumés sont librement téléchargeables sur le site du RDPLF à l’adresse :https://www.rdplf.org/biblio.html. Depuis décembre 2018 ceux sélectionnés au cours du trimestre par ces néphrologues sont publiés sous leur nom dans la présente rubrique du Bulletin de la Dialyse à Domicile.

INTRODUCTION: The health crisis linked to the COVID-19 epidemic has required lockdown measures in France and changes in practices in dialysis centers. The objective was to assess the depressive and anxiety symptoms during lockdown in hemodialysis patients and their caregivers. METHODS: We sent, during lockdown period, between April and May 2020, self-questionnaires to voluntary subjects (patients and caregivers), treated by hemodialysis or who worked in hemodialysis in one of the 14 participating centers in France. We analyzed their perception of dialysis sessions (beneficial or worrying), their stress level (VAS rated from 0 to 10), their anxiety and depressive symptoms (Hospital anxiety and depression scale). Factors associated with stress, anxiety and depression were analyzed with multiple linear regression models. RESULTS: 669 patients and 325 caregivers agreed to participate. 70 % of participants found it beneficial to come to dialysis during confinement. The proportions of subjects with a stress level ≥ 6 linked to the epidemic, confinement, fear of contracting COVID-19 and fear of infecting a loved one were respectively 23.9%, 26.2%, 33.4% and 42%. 39.2% presented with certain (13.7%) or doubtful (19.2%) anxious symptoms. 21.2% presented a certain (7.9%) or doubtful (13.3%) depressive symptomatology. Age, gender, history of psychological disorders and perception of dialysis sessions were associated with levels of stress, anxiety and depression. CONCLUSION: During the lockdown period, in France, the majority of hemodialysis patients and caregivers found it beneficial to come to dialysis. One in three subjects had anxiety symptoms and one in five subjects had depressive symptoms.

Introduction. - The health crisis linked to the COVID-19 epidemic has required lockdown measures in France and changes in practices in dialysis centers. The objective was to assess the depressive and anxiety symptoms during lockdown in hemodialysis patients and their caregivers. Methods. - We sent, during lockdown period, between April and May 2020, self-questionnaires to voluntary subjects (patients and caregivers), treated by hemodialysis or who worked in hemodialysis in one of the 14 participating centers in France. We analyzed their perception of dialysis sessions (beneficial or worrying), their stress level (VAS rated from 0 to 10), their anxiety and depressive symptoms (Hospital anxiety and depression scale). Factors associated with stress, anxiety and depression were analyzed with multiple linear regression models. Results. - 669 patients and 325 caregivers agreed to participate. 70 % of participants found it beneficial to come to dialysis during confinement. The proportions of subjects with a stress level >= 6 linked to the epidemic, confinement, fear of contracting COVID-19 and fear of infecting a loved one were respectively 23.9%, 26.2%, 33.4% and 42%. 39.2% presented with certain (13.7%) or doubtful (19.2%) anxious symptoms. 21.2% presented a certain (7.9%) or doubtful (13.3%) depressive symptomatology. Age, gender, history of psychological disorders and perception of dialysis sessions were associated with levels of stress, anxiety and depression. Conclusion. - During the lockdown period, in France, the majority of hemodialysis patients and caregivers found it beneficial to come to dialysis. One in three subjects had anxiety symptoms and one in five subjects had depressive symptoms. (C) 2021 Published by Elsevier Masson SAS on behalf of Societe francophone de nephrologie, dialyse et transplantation.

Introduction (NDLR) Un groupe de néphrologues issus du Club des jeunes Néphrologues sélectionne chaque mois à tour de rôle un article de la littérature internationale en rapport avec la dialyse à domicile, Dialyse Péritonéale ou Hémodialyse à Domicile, et en propose un résumé en français et son analyse. Ces résumés sont librement téléchargeables sur le site du RDPLF à l’adresse : https://www.rdplf.org/biblio.html. Depuis décembre 2018 ceux sélectionnés au cours du trimestre par ces néphrologues sont publiés sous leur nom dans la présente rubrique du Bulletin de la Dialyse à Domicile.

Introduction (NDLR) Un groupe de néphrologues issus du Club des jeunes Néphrologues sélectionne chaque mois à tour de rôle un article de la littérature internationale en rapport avec la dialyse à domicile, Dialyse Péritonéale ou Hémodialyse à Domicile, et en propose un résumé en français et son analyse. Ces résumés sont librement téléchargeables sur le site du RDPLF à l’adresse : https://www.rdplf.org/biblio.html. A partir de décembre 2018 ceux sélectionnés au cours du trimestre par ces néphrologues sont publiés sous leur nom dans la présente rubrique du Bulletin de la Dialyse à Domicile.

Un groupe de néphrologues issus du Club des jeunes Néphrologues sélectionne chaque mois à tour de rôle un article de la littérature internationale en rapport avec la dialyse à domicile, Dialyse Péritonéale ou Hémodialyse à Domicile, et en propose un résumé en Français et son analyse. Ces résumés sont librement téléchargeables sur le site du RDPLF à l’adresse : https://www.rdplf.org/biblio.html. A partir de décembre 2018 ceux sélectionnés au cours du trimestre par ces néphrologues sont publiés sous leur nom dans la présente rubrique du Bulletin de la Dialyse à Domicile. Cette revue est mise à disposition selon les termes de la Licence Creative Commons Attribution 4.0 International.

Alkali therapy is frequently used during chronic kidney disease and nephrolithiasis: nephrologists and urologists are the key operators. Very few is known about the underlying conditions of such a prescription: the aim of this study was to delineate those determinants. We conducted a prospective survey where French nephrologists and urologists were involved. Responders were without gender distinction and principally nephrologists. Prescription frequency was associated with gender (women), specialty (nephrologists), indications and perceived efficiency. Urologists prescribe more often during nephrolithiasis and nephrologists during chronic kidney disease. Urologists were more expert (by scoring on mineral-based alkaline waters compositions knowledge). By multivariate analysis, prescription frequency is associated with gender (women), indications and perceived efficiency by prescribers, which is itself influenced by feedback from patients. These results could have been influenced by a huge representation of nephrologists but foster physicians to go on listening to feedback from patients, due to a lack of clinical trials on the efficiency of mineral-based alkaline waters in such a field. Finally, physicians' education (especially young nephrologists) on mineral-based alkaline waters should be intensified. (C) 2015 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved.

Le bicarbonate est utilisé notamment dans l’insuffisance rénale chronique et certaines maladies lithiasiques rénales : néphrologues et urologues en sont les premiers acteurs. Peu d’informations sont disponibles sur les déterminants de la prescription des eaux riches en bicarbonate en France. L’objectif de cette étude est de les évaluer : une enquête prospective a été réalisée auprès des néphrologues et des urologues. Les répondants étaient, sans distinction de genre, principalement des néphrologues. La majorité indique prescrire le traitement pour de longues périodes (>1 mois). Les répondants prescrivant fréquemment du bicarbonate (>50 % de leurs patients) étaient plus souvent des femmes et des néphrologues. La fréquence de prescription était, par ailleurs, associée au type de pathologies rencontrées et à l’efficacité perçue (par les médecins) du traitement. Les urologues indiquaient le prescrire majoritairement au cours de la maladie lithiasique rénale et les néphrologues au cours de la maladie rénale chronique. Les urologues avaient un meilleur score d’expertise sur la composition des eaux riches en bicarbonate. En analyse multivariée, les déterminants de la fréquence de prescription étaient le genre féminin, l’indication et l’efficacité perçue par les médecins, qui était elle-même influencée par le retour qu’ils avaient de la part des patients. Ces résultats peuvent avoir été influencés par la participation importante des néphrologues, mais ils encouragent les praticiens à poursuivre leur écoute des malades, en l’absence d’études cliniques sur l’efficacité des eaux riches en bicarbonate. Enfin, la formation des médecins (particulièrement les jeunes néphrologues) sur les eaux riches en bicarbonate devrait être intensifiée.

BACKGROUND: Vemurafenib is a BRAF inhibitor that has become the cornerstone of metastatic or inoperable melanoma therapy since its approval in 2011 in the United States and 2012 in Europe. This targeted therapy has shown impressive results in terms of increased progression-free and overall survival as compared to dacarbazine. The safety profile did not include any renal manifestations at that time. METHODS: This report is the first case series of 8 patients who experienced significant to severe renal insufficiency under vemurafenib treatment. RESULTS: This case series shows that vemurafenib may induce potentially severe acute renal failure, including renal sequelae and persistent kidney disease in some cases. CONCLUSIONS: Further studies are needed to investigate the effects of vemurafenib on the kidneys. Meanwhile, renal function should be closely monitored in treated patients for early detection of any renal dysfunction occurrence. (C) 2014 American Cancer Society.

Sir, Renal sinus lipomatosis (RSL) is a rare disease, described by replacement of parenchyma by sinus and/or perirenal fat. We report here an exceptional case of RSL on kidney graft after corticosteroid treatment was stopped, leading to functional graft transplantectomy. A 74-year-old man received a first renal allograft in 2004. He was maintained on tacrolimus and mycophenolate mofetil with no rejection. Corticosteroid was stopped at the sixth month. The lowest serum creatinine level was 100 μmol/L. On February 2007, renal ultrasonography, performed for acute renal failure, showed dilatation of renal cavities. Contrast-enhanced computed tomography (CT) showed an enlarged kidney (14.3 cm) with an increased amount of fatty-like tissue in renal sinus and perirenal area (Figure 1). For 6 months, he experienced several obstructive renal failures and infections, leading to permanent nephrostomy. Biopsy of the sinus mass revealed an extensive fatty tissue with fibrosis. Finally, because of bilateral pulmonary embolism secondary to vena cava compression, persistent obstruction and continuous graft enlargement without conclusive histology, and despite good renal function, he underwent transplantectomy. Histological examination showed RSL (immunophenotypical labelling and biomolecular investigations negative for sarcoma) and atrophic chronic pyelonephritis graft. Fig. 1 Filling defects secondary to thrombosis in the right RV and VCI (white arrows) after contrast administration from vena cava superior. RSL is essentially described on native kidneys [1,2]. Possible risk factors for RSL include ageing, obesity and pathologic states that cause renal inflammation such as intense corticotherapy and/or early rejection for transplants. Often, chronic or repeat urinary tract infections have been found, and one hypothesis is that RSL may be secondary to periodic leakages of urine into the peripelvic tissues [2]. RSL can also be part of replacement of destroyed or atrophic renal tissue [3]. It has also been suggested that high-dose steroid treatment by itself, Cushing's syndrome or obesity may have contributed to the development of fibrolipomatosis [4]. Intriguingly, a very few cases of RSL have been reported in the renal transplant population [5]. This case is intriguing for several reasons: The time between transplantation and the first symptoms was quite long (3 years). The recipient of the contralateral kidney did not develop any RSL. The patient experienced his first urinary tract infection at the same time as the first acute obstructive renal failure. No history of earlier acute rejection episodes has been found. He did not have a long-term steroid treatment and was not obese. Finally, our case is also exceptional because it led to transplantectomy. Transplantectomy was decided in view of the rapidly increasing graft mass, responsible of vena cava compression and suspicion of malignity. In conclusion, our case underlines that diagnosis of RSL, although exceedingly rare, should be considered when imaging exams demonstrate a fat-containing renal sinus mass. In transplant recipients, immunosuppressive regimen and malignancy risk underline the importance to establish differential diagnosis between fibrolipomatosis and fibrosarcoma, renal tumour or post-transplant lymphoproliferative disorder. Conflict of interest statement. None declared.