[Survival and mortality in ESRD patients]. / Survie et mortalité des patients en IRCT.

This chapter provides a set of indicators on survival, life expectancy and causes of death of patients in chronic renal failure treated by dialysis or transplantation beginning a first replacement therapy between 2002 and 2011. Age strongly influences survival on dialysis. Thus, one year survival of patients under age 65 is over 90%. After 5 years, among patients over 85 years, it is more than 15%. The presence of diabetes or one or more cardiovascular comorbidities also significantly worse patient survival. In terms of trend, we do not find significant improvement in the 2-year survival between patients in the cohort 2006-2007 and the 2008-2009 cohort. Cardiovascular diseases account for 27% of causes of death to infectious diseases (12%) and cancer (10%). Life expectancy of patients is highly dependent on their treatment. Thus, a transplant patient aged 30 has a life expectancy of 41 years versus 23 years for a dialysis patient. Transplant patients have a mortality rate much lower than those of dialysis patients. Thus, between 60 and 69 years, for 1000 patients in dialysis in 2011, 127 died within the year. For 1000 patients of the same age, who have a functioning kidney transplant, 24 died within the year.

[Access to the waiting list and renal transplantation]. / Accès à la liste d'attente et à la greffe rénale.

This chapter provides a set of indicators related to Renal Transplantation access in France. It describes patient outcomes and reports on cumulative incidence rates of wait-listing and renal transplantation according to main patient of characteristics and regions. The REIN registry integrates kidney transplant and dialysis data. It provides a comprehensive view on waiting list and renal transplantation access to the patients, nephrologists, and national or regional health authorities. Access to the waiting list is evaluated on a cohort of 51,845 new patients who started dialysis between 2002 and 2011 in 25 regions. The probability of first wait-listing was of 3.7% at the start of dialysis (pre-emptive registrations), 15% at 12, 22% at 36 and 24% to 60 months. The probability of being registered was strongly related to age, diabetes and region. Patient older than 60 had a very poor access to the waiting list, whatever their diabetes status was. Probability of first wait-listing was much lower (36.5% at 60 months) in type 2 diabetic-40 to 59 years old patients. Among 13,653 patients less than 60 years old, the probability of being registered was 11% at the start of dialysis, 43% to 12 months, 62% to 36 months and 66% to 60 months (median dialysis duration: 16 months). Seventeen regions with up to 5 years follow-up show an increase of 8 to 15% in pre-emptive registrations between 2007 and 2001, without change at 1 year. Access to kidney transplant is evaluated on a cohort of 53,301 new patients who started a renal replacement therapy (dialysis or pre-emptive renal transplant) between 2002 and 2011 in 25 regions. The probability of first kidney transplant was of 7% at 12, 17% at 36 and 21% at 60 months. 8,633 patients (16,2%) had received a first renal transplant within 14.7 month median time; 1,455 (2.7%) had received a pre-emptive graft [male: 58%, median age: 48.7y]. Among the 14,770 new patients less than 60 years old, the probability of being transplanted was of 21% at 12, 46% at 36 and 58% at 60 months (median dialysis duration: 42 months). When pre-emptive graft were excluded, the probability of being transplanted was of 5% at 12, 15% to 36 and 19% to 60 months Insofar as kidney transplant is regarded as the most efficient treatment, access to the waiting list and renal transplant are sensitive issues.

[Ambulatory blood pressure profile during 48 hours in patients treated with chronic hemodialysis]. / Profil tensionnel ambulatoire de 48 heures chez l'hémodialysé chronique.

Hypertension is one of the severest cardiovascular risk factor in subjects affected by end-stage renal disease in chronic hemodialysis. The behavior of blood pressure between the first hemodialysis (day 1) and the next one (day 2) was studied in 24 untreated normotensive hemodialysis patients. Patients were between 34 and 83 years (mean age: 60 +/- 12 yrs) and were hemodialysed 3 x 4 hours a week, between 7 and 12 a.m. ABP was recorded at 15 minutes intervals between 7 and 22 hours, and 30 minutes intervals during the night, during 48 hours with a Spacelabs 90202 or 90207 device. The following results were observed: ABP is greater at day 2 (122/74 mmHg) than at the first (117/70 mmHg, p less than 0.001); that increase is not correlated with gaining weight during interdialytic period; after hemodialysis, blood pressure continues to fall during 2 or 3 hours until a level of 119 mmHg; low values continue during postdialysis and during the first night; the following day, ABP increases progressively during the morning and during the evening; before the second hemodialysis, the increase is suddenly faster; circadian rhythm is lost in 9/24 patients; in 17/24 patients, nocturnal decrease of BP is lower than 5%; age and ancientness of hemodialysis are the most important factor; rest blood pressure measured by physician before HD is continually higher than diurnal ABP (138/74 vs 121/73 mmHg, p less than 0.001), even if ABP is only analysed during one hour before the second hemodialysis (129/77 mmHg).

[Obstructive renal lithiasis, hypercalcemia, parathyroid adenoma and term pregnancy. Report of a case]. / Lithiase rénale obstructive, hypercalcémie, adénome parathyroïdien et grossesse à terme. A propos d'un cas.

The authors report an observation of primitive hyperparathyroidism by adenoma diagnosed at the time of a bilateral urinary lithiase, obstructive on the left, with hypercalcemia in young pregnant woman near of the term.

[Use of salbutamol in the treatment of severe hyperkalemia in hemodialysed patients]. / Utilisation du salbutamol dans le traitement de l'hyperkaliémie grave chez l'hémodialysé.

The possibility of obtaining a rapid fall of kalaemia in patients with renal failure under haemodialysis by injecting salbutamol intravenously in doses of 0.5 mg over 15 minutes was tested in 11 subjects. Kalaemia fell by 1.08 +/- 0.30 mmol in 30 minutes, 75 per cent of the effect being obtained at the end of the infusion. Malaise with tachycardia was frequent but always transient. Thus, a rapid infusion of salbutamol seems to be well tolerated and effective against hyperkalaemia, provided two contra-indications are observed: coronary disease and treatment with beta-blockers.