High prevalence of chronic kidney disease in La Réunion island and its association with the metabolic syndrome in the non-diabetic population: La Réunion Diabetes (REDIA) Study.

AIM: To estimate the prevalence of chronic kidney disease (CKD) in La Réunion island and to investigate the link with the metabolic syndrome in the non-diabetic population. METHODS: The Réunion Diabetes (REDIA) Study included a random sample of 3600 adults aged 30-69 years. Clinical proteinuria (>200 mg/g creatinine), albuminuria (>or=30 mg/g) and estimated glomerular filtration rate (eGFR) were studied in 920 subjects, 411 of whom had diabetes and 509 who did not. Their relations with the metabolic syndrome (as defined by the US National Cholesterol Education Program Adult Treatment Panel III guidelines) were analyzed among those without diabetes. RESULTS: Age-, gender- and diabetes-standardized prevalence of CKD stage 1 or 2 (proteinuria or albuminuria with eGFR>or=60 mL/min/1.73 m2) was 13.8% and, for CKD stage 3 or more (eGFR<60 ml/min/1.73 m2), 10.7%. The adjusted odds ratios (OR) for proteinuria increased with the number of metabolic syndrome traits: 1.5 (95% confidence interval, 0.4-5.2) in non-diabetic participants with one trait compared with those with no trait, 2.0 (CI 0.6-6.6) for two traits and 4.1 (CI 1.3-12.8) for three or more; corresponding ORs for eGFR<60 ml/min/1.73 m2 were 1.9 (CI 0.8-4.5), 0.9 (CI 0.4-2.4) and 2.2 (CI 0.9-5.1), respectively. Clustering of either high blood pressure and triglyceride levels, or high triglycerides and plasma glucose, or all three, conferred the strongest associations with both clinical proteinuria and low eGFR. CONCLUSIONS: CKD prevalence is high in La Réunion island population, and the metabolic syndrome may help to target early diagnosis of CKD in non-diabetic individuals.

[Terminal chronic renal insufficiency in the south of Réunion. Epidemiology, survival on dialysis]. / Insuffisance rénale chronique terminale dans le sud de la Réunion. Epidémiologie, survie en dialyse.

In Reunion Island, as in the other French Overseas Territories, end-stage renal failure prevalence is more than twice that France as a whole. In the past 12 years, 407 patients were enrolled in the South-Island dialysis program, allowing for local epidemiologic and survival figures analysis. Non insulindependent diabetes mellitus and chronic systemic hypertension, both being silent maturity diseases with close physiopathology, are accountable for 60% of the incidence from beginning of the 90's. Female predominance among diabetic and dialysed patients could be a tropical specificity. In spite of lack of patient selection, dialysis survival seems satisfactory when compared to European Dialysis Registry. Overall survival median, starting 30 days after beginning of treatment in the South, is 6 years with a 35% 10 years survival rate. Diabetic patients have a lower survival rate at 1 (85.8%), 3 (58.4%) and 5 years (33.4%), the age-corrected relative mortality risk being 1.75. A local non insulin dependent diabetes epidemiologic survey is needed to identify predisposed populations, and prevent or delay degenerating complications, notably end-stage renal failure palliative treatment whose high-cost palliative treatment is further increased by ultraperipheral geographical location.

[Pregnancy in chronic hemodialysis]. / Grossesse en hémodialyse chronique.

Two successful pregnancies in our dialysis center bring us an opportunity to update the related treatment. The success rate of this rare event is more than 30% at the moment. Maternal morbidity is reduced through close follow up. From the second semester, it is necessary to adapt and intensify dialysis, which becomes daily. At the third quarter, full-time hospitalization, extended to a high risk pregnancy unit at first incident, must be provided. Delivery may be normal. The infant is not particularly at risk for malformation, but is 30 to 35 weeks premature; at short time, its psychomotor development seems normal. To our sense, to influence systematically on women a "voluntary" therapeutic pregnancy interruption might be qualified if, when duly informed, women wish to try and keep their child.