Introduction: Different techniques of guidewire exchange of tunneled catheters for hemodialysis (HD) have been reported. This study was carried out to assess the feasibility of a new procedure in chronic HD patients who needed catheter exchange because of mechanical dysfunction. Methods: The guidewire exchange method was based on the creation of a new exit site and a new subcutaneous tunnel while using the same venous insertion site. This was a retrospective study of exchanged tunneled catheters because of mechanical complications in patients on chronic HD between June 1, 2015, and December 31, 2019. The feasibility of the procedure was defined by successful exchange and catheter patency at 6 months. Catheter survival and immediate complications were reported. Results: A total of 49 procedures were performed in 34 HD patients. There was no catheter insertion failure. At 6 months, 6 catheters have lost their patency because of a mechanical complication. Thus, the success rate of the procedure was 43/49 (87.8%). Catheter survival censored on death, transplantation, or vascular access creation was 97.8% at 90 days, 86.2% at 180 days, and 74.5% at 1 year. The median catheter survival was 10.2 months. Among the 49 procedures, there were 9 hematomas at the insertion site that did not require surgical intervention. Discussion/Conlusion: Our study shows that guidewire exchange of a tunneled HD catheter by creating a new exit site and a new subcutaneous tunnel by using the same venous access is a newer method in chronic HD patients. This procedure should not be used in patients with coagulation issues. Additional studies are needed to compare the different methods of HD catheter exchange.

Dialysis is a restrictive treatment with a significant impact on the quality of life of patients. Home hemodialysis (HHD) allows to maintain quality of life while improving the conditions of purification, in particular with the daily or even nocturnal practice of hemodialysis. The arrival of systems with a cycler in the 2010s for home hemodialysis brings a new dynamism for this type of technique. The practice with dialysate low flow with the optimization of storage space, the simplification of the use of generators and the emmergence of telemonitoring tools increases the accessibility of this dialysis technique, so that we can hope in the coming years to be able to offer this dialysis modality to any patient with chronic renal failure requiring extra-renal purification. (c) 2022 Societe francophone de nephrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.

L’épuration extra-rénale est un traitement contraignant qui impacte fortement la qualité de vie des patients. L’hémodialyse à domicile (HDD) permet de maintenir un certain confort de vie tout en permettant d’améliorer les conditions d’épurations, notamment avec la pratique quotidienne ou encore nocturne de l’hémodialyse. La venue de systèmes avec cycleur dans les années 2010 pour l’ hémodialyse à domicile apporte un nouvel essor pour ce type de technique. La pratique à bas débit de dialysat avec l’optimisation de l’espace de stockage, la simplification de l’utilisation des générateurs et l’apparition d’outils de télésurveillance rendent plus accessible cette technique de dialyse, si bien que l’on peut espérer dans les prochaines années pouvoir proposer cette technique à n’importe quel patient atteint d’insuffisance rénale chronique requérant l’épuration extra-rénale.

INTRODUCTION:In low-flow home daily dialysis (HDD), the dialysis dose is evaluated from the total body water (TBW). TBW can be estimated by anthropometric methods or bioimpedance spectroscopy. METHODS:A multicentric cross-sectional study of patients in HDD for >3 months was conducted to assess the correlation and the difference between the anthropometric estimate of TBW (Watson-TBW) and the bioimpedance estimate (BIS-TBW) and to analyse the impact on the dialysate volume prescribed. RESULTS:Forty patients from 10 centres were included. The median BIS-TBW and Watson-TBW were 35.1 (29.1-41.4 L) and 36.9 (32-42.4 L), respectively. The 2 methods had a good correlation (r = 0.87, p < 0.05). However, Bland-Altman analysis showed an overestimation of TBW with Watson's formula, with a bias of 2.77 L. For 4, 5, or 6 sessions per week, the use of Watson-TBW increases the dialysate prescription per week by 100 L, 45 L, or 10 L, respectively, over our entire cohort. There is no increase in the volume of dialysate prescribed with the 7 sessions per week schedule. CONCLUSION:BIS-TBW and Watson-TBW estimation have a good correlation; however, Watson's equation overestimates TBW. This overestimation is negligible for a prescription frequency of >5 sessions per week.

La vascularite urticarienne hypocomplémentémique est une vascularite systémique caractérisée par une atteinte des vaisseaux de petit calibre, des lésions urticariennes, une hypocomplémentémie et une atteinte d’organe variable. L’atteinte rénale est principalement glomérulaire. Nous rapportons le cas d’une patiente âgée de 59 ans, consultant pour une découverte d’insuffisance rénale dans un contexte d’urticaire chronique et d’arthralgies. Les explorations initiales mettaient en évidence une hématurie et une protéinurie, une hypocomplémentémie touchant la voie classique, la présence d’anticorps anti-SSa. La ponction biopsie rénale objectivait des lésions de hyalinose segmentaire et focale, et de néphrite interstitielle aiguë. Le diagnostic de vascularite urticarienne hypocomplémentémique était retenu devant la mise en évidence d’immunoglobulines G anti-C1q. L’association à un syndrome de Gougerot–Sjögren était écartée devant l’absence de syndrome sec, la négativité du test de Schirmer et l’absence de sialadénite à la biopsie des glandes salivaires. L’évolution était favorable sous traitement par hydroxychloroquine et corticothérapie. Parmi les 82 cas de néphropathie associée à une vascularite urticarienne hypocomplémentémique rapportés dans la littérature, 72 (88 %) étaient des atteintes glomérulaires, principalement des lésions de glomérulonéphrite membrano-proliférative. Seulement 6 cas (7 %) de néphrite interstitielle associée à une vascularite urticarienne hypocomplémentémique ont été décrits, dont quatre coexistaient avec une atteinte glomérulaire. La population atteinte était majoritairement des femmes, dans leur troisième décennie. Le signe d’appel néphrologique le plus observé était une hématurie (60 %) et une protéinurie (52 %). L’insuffisance rénale était rare (22 %), avec un pronostic rénal rassurant. Chez 11 (13 %) patients, la vascularite urticarienne hypocomplémentémique était associée à une maladie de système. En l’absence de recommandations, la stratégie thérapeutique reste à définir.

Hypocomplementemic urticarial vasculitis is a rare systemic vasculitis, affecting small vessels, characterised by chronicle urticaria, hypocomplementemia, and systemic manifestations. Renal involvement, whose prevalence varies between 9% and 60%, is mainly glomerular. We here report the case of a 59 years old woman presenting kidney failure, associated with chronicle urticaria and arthralgias. Laboratory investigation showed haematuria, proteinuria, hypocomplementemia and anti-SSa antibody positivity. A percutaneous kidney biopsy revealed focal and segmental glomerulonephritis associated with an acute interstitial nephritis. Hypocomplementemic urticarial vasculitis diagnosis was established after identifying anti-C1q antibodies. The lack of a dry syndrome, the negativity of a Schirmer test and the lack of sialadenitis on a salivary gland biopsy excluded an associated Gougerot-Sjogren Syndrome. The patient was treated with hydroxychloroquine and low-dose steroids, enabling a clinical and biological recovery. Of the 82 cases in the literature describing hypocomplementemic urticarial vasculitis associated nephropathies, 72 (88%) were a glomerular impairment, most frequently secondary to membranoproliferative glomerulonephritis. Only 6 (7%) tubulo-interstitial nephritis have been reported, 4 of them being associated with a glomerulonephritis. Patients were more likely to be women, aged in their third decade. The most frequent renal manifestations were haematuria (60%), and proteinuria (52%). Kidney failure was rarely observed (22%), with a fairly good renal prognosis. Hypocomplementemic urticarial vasculitis was associated with a systemic disease in 11 (13%) patients. In the absence of recommendations, the treatment strategy remains to be defined. (C) 2019 Societe francophone de nephrologie,dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.