The aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed.

OBJECTIVE -The Cockcroft-Gault formula is recommended for the evaluation of renal function in diabetic patients. The more recent Modification of Diet in Renal Disease (MDRD) study equation seems more accurate, but it has not been validated in diabetic patients. This study compares the two methods.RESEARCH DESIGN AND METHODS -In 160 diabetic patients, we compared the Cockcroft-Gault formula and MDRD equation estimations to glomerular filtration rates (GFRs) measured by an isotopic method ( 51 Cr-EDTA) by correlation studies and a Bland-Altman procedure. Their accuracy for the diagnosis of moderately (GFR Ͻ60 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2 ) or severely (GFR Ͻ30 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2 ) impaired renal function were compared with receiver operating characteristic (ROC) curves.RESULTS -Both the Cockcroft-Gault formula (r ϭ 0.74; P Ͻ 0.0001) and MDRD equation (r ϭ 0.81; P Ͻ 0.0001) were well correlated with isotopic GFR. The Bland-Altman procedure revealed a bias for the MDRD equation, which was not the case for the Cockcroft-Gault formula. Analysis of ROC curves showed that the MDRD equation had a better maximal accuracy for the diagnosis of moderate (areas under the curve [AUCs] 0.868 for the Cockcroft-Gault formula and 0.927 for the MDRD equation; P ϭ 0.012) and severe renal failure (AUC 0.883 for the CockcroftGault formula and 0.962 for the MDRD equation; P ϭ 0.0001). In the 87 patients with renal insufficiency, the MDRD equation estimation was better correlated with isotopic GFR (Cockcroft-Gault formula r ϭ 0.57; the MDRD equation r ϭ 0.78; P Ͻ 0.01), and it was not biased as evaluated by the Bland-Altman procedure.CONCLUSIONS -Although both equations have imperfections, the MDRD equation is more accurate for the diagnosis and stratification of renal failure in diabetic patients. Diabetes Care 28:838 -843, 2005D iabetic nephropathy affects 25-40% of diabetic patients (1), and diabetes is the leading cause of endstage renal disease (ESRD) in developed countries (2). Mainly because of the high prevalence and increased life expectancy of type 2 diabetic patients (3), the proportion of patients with both diabetes and ESRD is dramatically growing in developed countries (4). Survival rates are low in such patients because of high cardiovascular risk (5), and medical costs are high (6).The evaluation of renal function is therefore of critical importance in diabetic subjects. Glomerular filtration rate (GFR) is the best measure of overall kidney function in health and disease (7). Serum creatinine concentration is widely used as an indirect marker of GFR, but it is influenced by muscle mass and diet (8). GFR can be directly measured by infusion of external substances such as inulin or 51 Cr-EDTA (9), but these methods are expensive and time consuming. The use of prediction equations to estimate GFR from serum creatinine and other variables (age, sex, race, and body size) is therefore recommended by the National Kidney Foundation for the diagnosis and stratification of chronic kidney diseases (10). According to these guideline...

OBJECTIVE -About 20% of diabetic patients with chronic kidney disease (CKD) detected from the new American Diabetes Association recommendations (albumin excretion rate Ͼ30 mg/24 h or estimated glomerular filtration rate [GFR] Ͻ60 ml/min per 1.73 m 2 ) may be normoalbuminuric. Do the characteristics and outcome differ for subjects with and without albuminuria?RESEARCH DESIGN AND METHODS -A total of 89 patients with diabetes and a modification of diet in renal disease (MDRD) estimated GFR (e-GFR) Ͻ60 ml/min per 1.73 m 2 underwent a 51Cr-EDTA B-isotopic GFR determination and were followed up for 38 Ϯ 11 months.RESULTS -The mean MDRD e-GFR (41.3 Ϯ 13.1 ml/min per 1.73 m 2 ) did not significantly differ from the i-GFR (45.6 Ϯ 29.7). Of the subjects, 15 (17%) were normoalbuminuric. Their i-GFR did not differ from the albuminuric rate and from their MDRD e-GFR, although their serum creatinine was lower (122 Ϯ 27 vs. 160 Ϯ 71 mol/l, P Ͻ 0.05): 71% would not have been detected by measuring serum creatinine (sCr) alone. They were less affected by diabetic retinopathy, and their HDL cholesterol and hemoglobin were higher (P Ͻ 0.05 vs. albuminuric). None of the CKD normoalbuminuric subjects started dialysis (microalbuminuric: 2/36, macroalbuminuric: 10/38) or died (microalbuminuric: 3/36, macroalbuminuric: 7/38) during the follow-up period (log-rank test: P Ͻ 0.005 for death or dialysis), and their albumin excretion rate and sCr values were stable after 38 months, whereas the AER increased in the microalbuminuric patients (P Ͻ 0.05), and the sCr increased in the macroalbuminuric patients (P Ͻ 0.01).CONCLUSIONS -Although their sCr is usually normal, most of the normoalbuminuric diabetic subjects with CKD according to an MDRD e-GFR below 60 ml/min per 1.73 m 2 do really have a GFR below 60 ml/min per 1.73 m 2 . However, as expected, because of normoalbuminuria and other favorable characteristics, their risk for CKD progression or death is lower. Diabetes Care 30:2034-2039, 2007T wenty-five to forty percent of patients with diabetes have kidney damage (1), and diabetes is the first cause of end-stage renal disease in most countries (2). The early detection of chronic kidney disease (CKD) in diabetic patients is therefore of critical importance. The conventional approach for screening is the determination of the albumin excretion rate (AER). However, a substantial proportion of normoalbuminuric diabetic patients may present with a reduced glomerular filtration rate (GFR): their rates have been reported to be ϳ20% based on GFR Ͻ60 ml/min per 1.73 m 2 in type 2 diabetes (3) and in type 1 diabetes based on GFR Ͻ90 ml/min per 1.73 m 2 with more advanced glomerular lesions (4). In accordance with the National Kidney Foundation guidelines (5), this has led the American Diabetes Association to recommend the screening of CKD in diabetic patients based both on the AER (threshold: 30 mg/24 h) and the Cockcroft and Gault equation or modification of diet in renal disease (MDRD) equation estimated GFR (threshold: 60 ml/min per 1.73 m 2 ) (6...

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OBJECTIVE -The Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) equations poorly predict glomerular filtration rate (GFR) decline in diabetic patients. We sought to discover whether new equations based on serum creatinine (the Mayo Clinic Quadratic [MCQ] or reexpressed MDRD equations) or four cystatin C-based equations (glomerular filtration rate estimated via cystatin formula [Cys-eGFR]) were less biased and better predicted GFR changes.RESEARCH DESIGN AND METHODS -In 124 diabetic patients with a large range of isotopic GFR (iGFR) (56.1 Ϯ 35.3 ml/min per 1.73 m 2 [range 5-164]), we compared the performances of the equations before and after categorization in GFR tertiles. A total of 20 patients had a second determination 2 years later.RESULTS -The Cockcroft-Gault equation was the least precise. The MDRD equation was the most precise but the most biased according to the Bland-Altman procedure. By contrast with the MDRD and, to a lesser extent, the MCQ, three of the four Cys-eGFRs were not biased. All equations overestimated the low GFRs, whereas only the MDRD and Rule's Cys-eGFR equations underestimated the high GFRs. For the subjects studied twice, iGFR changed by Ϫ8.5 Ϯ 17.9 ml/min per 1.73 m 2 . GFR changes estimated by the Cockcroft-Gault (Ϫ4.5 Ϯ 6.8) and MDRD (Ϫ5.7 Ϯ 6.2) equations did not correlate with the isotopic changes, whereas new equationpredicted changes did: MCQ: Ϫ8.7 Ϯ 9.4 (r ϭ 0.44, P Ͻ 0.05) and all four Cys-eGFRs: Ϫ6.2 Ϯ 7.4 to Ϫ7.3 Ϯ 8.4 (r ϭ 0.60 to 0.62, all P Ͻ 0.005), such as 100/cystatin-C (r ϭ 0.61, P Ͻ 0.005). CONCLUSIONS -The new predictive equations better estimate GFR than the CockcroftGault equation. Although the MDRD equation remains the most accurate, it poorly predicts GFR decline, as it overestimates low and underestimates high GFRs. This bias is lesser with the MCQ and Cys-eGFR equations, so they better predict GFR changes. 30:1988-1994, 2007 C hronic kidney disease (CKD) is a major health problem worldwide, with dramatically rising incidence and prevalence. Patients with diabetes are particularly affected by this negative development. It is necessary to stratify CKD and estimate its progression because diabetes is the leading cause of end-stage renal disease (1). The National Kidney Foundation guidelines recommend estimating glomerular filtration rate (GFR) in subjects with CKD (2). According to the National Kidney Foundation and the American Diabetes Association, GFR can be estimated in adults by using the Cockcroft-Gault or the Modification of Diet in Renal Disease (MDRD) equations (1,3). Neither of these equations, based on serum creatinine, is highly predictive of GFR. The Cockcroft-Gault equation is less accurate (4), biased by body weight (5), and less robust in patients with poor glycemic control (6). The simplified MDRD equation allows renal function to be classified with acceptable precision and requires only usual information about the patient. However, adjustment may be required to avoid error due to creatinine assays and calibrators (7). Moreov...

The purpose of this study was to evaluate the detection and characterization of macrophage infiltration in native and transplanted kidneys using ultrasmall superparamagnetic iron oxide particles (USPIO). Among 21 patients initially enrolled, 12 scheduled for renal biopsy for acute or rapidly progressive renal failure (n = 7) or renal graft rejection (n = 5) completed the study. Three magnetic resonance (MR) sessions were performed with a 1.5-T system, before, immediately after and 72 h after i.v. injection of USPIO at doses of 1.7-2.6 mg of iron/kg. Signal intensity change was evaluated visually and calculated based on a region of interest (ROI) positioned on the kidney compartments. Histological examination showed cortical macrophage infiltration in four patients (>5 macrophages/mm(2)), two in native kidneys (proliferative extracapillary glomerulonephritis) and two in transplants (acute rejection). These patients showed a 33 +/- 18% mean cortical signal loss on T2*-weighted images. In the remaining eight patients, with <5 macrophages/mm(2), there was no cortical signal loss. However, in three of these, presenting with ischemic acute tubular necrosis, a strong (42 +/- 18%) signal drop was found in the medulla exclusively. USPIO-enhanced MR imaging can demonstrate infiltration of the kidneys by macrophages both in native and transplanted kidneys and may help to differentiate between kidney diseases.

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