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: 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: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.

♦ Introduction: This study was carried out to examine whether or not elderly patients on peritoneal dialysis (PD) had an increased risk of peritonitis. ♦ Methods: This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 8,396 incident patients starting PD between January 2003 and December 2010. The end of the observation period was 31 December 2012. Patients were separated into 2 age groups: up to 75 and over of 75 years old. ♦ Results: Among 8,396 patients starting dialysis there were 3,173 patients older than 75. When using a Cox model, no association was found between age greater than 75 years and increased risk of peritonitis (hazard ratio [HR]: 0.97 [0.88 – 1.07]). Diabetes (HR: 1.14 [1.01 – 1.28] and continuous ambulatory PD (HR: 1.13 [1.04 – 1.23]) were significantly associated with a higher risk of peritoneal infection whereas nurse-assisted PD was associated with a lower risk of peritonitis (HR: 0.85 [0.78 – 0.94]. In the analysis restricted to the 3,840 self-care PD patients, there was no association between age older than 75 years and risk of peritonitis. ♦ Conclusion: The risk of peritonitis is not increased in elderly patients on PD in a country where assisted PD is available.