ABSTRACT
Kidney transplantation from living donors is particularly under-developed in France in comparison with the US and most European countries. Among others, the lack of a proactive and evidence-based communication from French health providers is a potential cause that has been overlooked thus far. With this as a backdrop, the SFNDT Commission of transplantation has elaborated a 10 points-call for promoting living kidney transplantation in France in 2023 with the aims at (1) providing the entire nephrology community with a scientific rationale and (2) strenghtening the conviction of health providers, patients, and their relatives regarding the relevance of this modality of kidney transplantation.
La transplantation rénale à partir de donneur vivant est une activité qui reste insuffisamment développée en France. Ceci est particulièrement vrai en comparaison à la majorité des pays nord-américains et européens. Les raisons en sont multiples et incluent un défaut de communication proactive et argumentée par les acteurs de soins. La communication, l'information et finalement la promotion de la greffe à partir de donneurs vivants sont l'affaire de l'ensemble de la communauté néphrologique et, au premier rang, des néphrologues non spécifiquement impliqués en transplantation. C'est dans cet esprit que la Commission Transplantation de la Société francophone de néphrologie, dialyse et transplantation (SFNDT) a travaillé à l'élaboration d'un plaidoyer en tentant de répondre, en dix points, à la question « Pourquoi faut-il développer la transplantation rénale à partir de donneurs vivants en France en 2023 ? ¼. L'objectif est double : (1) fournir les principales bases d'une information scientifiquement argumentée et (2) renforcer la conviction de l'ensemble des acteurs de soins et des patients du bien-fondé de cette modalité de greffe.
Subject(s)
Kidney Transplantation , Kidney , Humans , Tissue and Organ Harvesting , France , Living DonorsABSTRACT
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.
Subject(s)
Anxiety/etiology , COVID-19 , Communicable Disease Control , Depression/etiology , Fear , Stress, Psychological/etiology , Age Factors , Aged , Caregivers/psychology , Epidemics , Female , France/epidemiology , Humans , Male , Middle Aged , Sex Factors , Surveys and QuestionnairesABSTRACT
The elderly are more often referred to nephrologists and questions about indications for renal biopsy are increasing. The vascular lesions that appear with aging make the diagnosis of additional nephropathy more difficult. The purpose of our study is to investigate the characteristics of renal biopsies in the elderly in order to evaluate the indications and their use in guiding specific therapeutic interventions. Patients over 70 years who underwent a renal biopsy between 2000 and 2007 in Rennes University Hospital were retrospectively analyzed for biopsy complications, clinical features, diagnosis, therapy and its complications, evolution and mortality. Among the 150 renal-biopsied patients, 60% had a glomerulopathy and 30% had nephrotic syndrome. Biopsy complications occurred in 3.3%. 64% of nephrotic patients received immunosuppressive treatment and 62% of them developed drug-associated complications. In the treated group, there was more remission and survival at day 1000 was improved. Renal biopsy may be indicated in the elderly, because it often gives a therapeutically useful diagnosis and complications are rare if contra-indications are respected. Kidney biopsy revealed histological diagnoses that were not usually suspected by the clinical presentation. In addition, immunosuppressive therapy did not alter the mortality rate, but did increase survival at 3 years.
