[Impact of comorbidities on hemoglobin stability in patients with chronic kidney insufficiency on hemodialysis, treated with CERA in current practice: The MIRIADE study]. / Impact des comorbidités sur la stabilité de l'hémoglobine chez des patients insuffisants rénaux chroniques en hémodialyse, traités par CERA en pratique courante : l'étude MIRIADE.

This national, prospective and multicenter study aimed to describe the real-life impact of comorbidities on hemoglobin stability in patients with chronic kidney disease on hemodialysis, treated with CERA in relay of an erythropoietin stimulating agent. Comorbidities were defined by the Charlson Index (adjusted on age) and hemoglobin stability as a variation of ±1g/dL after the 6-month treatment period. The 585 analyzed patients were distributed as follows according to the adjusted Charlson index: score≤3 (12% of patients), 4≤score≤5 (17%), 6≤score≤7 (31%) and score≥8 (40%). At CERA start, its median monthly dose was of 100µg for the overall population, with no changes during the treatment period and with little variation according to the comorbidity score. Patients with stable hemoglobin (56%, 67% if score≤3) were more numerous to reach the therapeutic target range between 10 and 12g/dL after 6 months (85% versus 43% if not stable hemoglobin). Patients with low C-reactive protein value (≤5mg/L ; P=0.04), no red blood cell transfusion (P=0.03), or no/low dose of intravenous iron (≤200mg ; P=0.03) were more likely to reach stable hemoglobin under CERA after 6 months. Among the 644 CERA-treated patients, 4 patients (<1%) had one serious adverse event related to treatment. A stable hemoglobin within the therapeutic target was reached in the majority of the patients after 6 months in current practice with a lower CERA dose, regardless of the comorbidities scores of patients on hemodialysis.

[Recurring peritonitis due to Streptococcus from the upper respiratory tract in a saxophone player under peritoneal dialysis]. / Péritonites récidivantes à streptocoques oraux chez un joueur de saxophone en dialyse péritonéale.

This is a nephrectomized patient of 77 years, musician (saxophonist), in peritoneal dialysis, with diabetes, hypertension, and coronary disease. He presented a few months apart two successive episodes of peritonitis due to Streptococcus mitis/oralis and Streptococcus parasanguis. Before each episode he played the saxophone he played twice and each time he has peritonitis. Colonoscopy objectifying a sigmoid polyp. The assumption of self-contamination of the patient was supported by the fact that S. mitis/oralis and S. parasanguis are oral streptococci, and the intraperitoneal pressure (IPP) from 8 to 32 cm of water when the patient plays the saxophone. In this measurement of IPP we have also seen how the saliva is spread on all sides when playing the saxophone. Our patient is now cured and did not include the saxophone.