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.
♦ Background: Transfer to hemodialysis (HD) is a frequent cause of peritoneal dialysis (PD) cessation. In the present study, we set out to describe the transition period between PD and HD.
BackgroundIn the light of scientific data, the medical and pharmaceutical community (rheumatology, gastroenterology, internal medicine) decided to use Inflectra for any patient requiring initiation, and proposed substituting Remicade with Inflectra in patients requiring maintenance therapy. Infliximab represents the first drug cost in our hospital.PurposeThe mains objectives were to evaluate the therapeutic maintenance rate after the third infusion of Inflectra and the cost savings. A secondary objective was to analyse the reasons of stopping Inflectra or returning to Remicade.Material and methodsSince October 2015, Inflectra was prescribed to adult patients requiring initiation, and substitution of Remicade with Inflectra was proposed to adult patients needing maintenance therapy (at least three Remicade infusions). The number of refusals and return to Remicade after substitution was analysed. Costs savings during the 10 month study period were estimated. Disease activity between the beginning and end of the study, changes in infliximab biosimilar residual levels and tolerance were also studied.ResultsInflectra initiations involved 66 patients (41 in rheumatology, 23 in gastroenterology, 2 in internal medicine). Substitutions were carried out in 267 patients (178 in rheumatology, 63 in gastroenterology, 26 in internal medicine). 1 patient remained on Remicade for current in vitro fertilisation. The therapeutic maintenance rate at the third infusion was 85.4% (228 patients). Among the 39 patients who discontinued Inflectra after substitution, 31 returned to Remicade, 4 changed to a subcutaneous biotherapy, 2 stopped the anti-TNF therapy for medical reason and 2 were lost to follow-up. The main reason for returning to Remicade was loss of efficacy of Inflectra (30 patients). Tolerance was deemed satisfactory with the exception of an allergic reaction requiring discontinuation of treatment. Cost savings were estimated at €733 236 (29.7% savings): €133 596 for patients with Inflectra initiation and €599 540 regarding substitution. Analysis of other secondary clinical and biological criteria is ongoing.ConclusionThe therapeutic maintenance rate obtained (greater than 80%) is encouraging. The main reason for stopping Inflectra was loss of efficacy. Substitutions allowed 4.5 more savings than initiations alone to be made. Finally, analyses currently ongoing will provide additional information on the efficacy and safety of Inflectra and prediction of maintenance.No conflict of interest
It is well established that technique failure is one of the main reasons for peritoneal dialysis cessation. Early PD failures occur during the first 6 months of PD and are mainly related to catheter dysfunction and psychosocial problems. Catheter malfunction should be treated by a video-laparoscopic procedure as this prolongs the catheter survival. Assisted peritoneal dialysis could help patients to cope with peritoneal dialysis. Preservation of residual renal function is of importance in peritoneal dialysis patients as it affects both patients and technique survival. Failure to obtain a sufficient ultrafiltration volume to maintain a euvolemic state without using large amount of hypertonic glucose solution can cause peritoneal dialysis failure. New approaches in the use of icodextrin to increase ultrafiltration and sodium removal are under investigation. A novel modality of prescribing automated peritoneal dialysis would improve ultrafiltration in peritoneal dialysis patients.
BackgroundIn chronic inflammatory rheumatism (CIR), preventing joint damage and function loss is based on regularly taking medication. Patients’ involvements in their therapeutic management is essential and can be improved by information provided during pharmaceutical consultations.PurposeTo evaluate patients’ knowledge of synthetic conventional and biologic disease modifying antirheumatic drugs (DMARDs) and to assess patients’ satisfaction with the pharmaceutical consultation.Material and methodsA 3 month prospective study was carried out. Inclusion criteria: patients >18 years of age, diagnosed with CIR, attending rheumatology day hospitalisation, treated by biologic DMARDs and methotrexate (MTX). Two questionnaires were used to evaluate patients’ knowledge: biologic DMARD (10 questions) and MTX (20 questions). Patient satisfaction was assessed using a self-administered questionnaire (7 questions).Results40 patients were included (M/F=14/26; mean age=51.6 years, treated by biotherapy for 4.7 years and MTX for 6.8 years). 80.0% received infliximab, 12.5% tocilizumab and 7.5% abatacept. Average per cent of correct answers related to biologic DMARD was 53.5%±28.5%. The necessity of blood test monitoring (80.0%), treatment goal (67.5%) and recommended vaccines (65.0%) were the best known items. Conversely, vaccine contraindications (35.0%), regular consultation with physician specialists (40.8%) and strategy in case of surgery or tooth extraction (50.0%) were lesser known items and patients required information supplements. Regarding MTX (77.5% oral form and 22.5% subcutaneously), percentage of correct answers was 39.5%±17.6%. The best known items were: storage rules (93.5%), non-concomitant administration of folic acid and MTX (85.0%) and necessity of blood test monitoring (60.0%). The lesser known items were: reason for use of folic acid (10.0%), management of side effects (16.7%) and side effects (19.2%). 100% of patients were ‘very satisfied’ or ‘satisfied’ by drug information provided during pharmaceutical consultations and. 97.0% thought they had gained knowledge. Finally, all thought that pharmaceutical consultations should be generalised.ConclusionOur study design allowed us to evaluate patients’ knowledge about their treatments, to identify areas for improvement and to issue individualised information. Thus pharmacists should particularly insist on the lesser known items. In order to generalise these pharmaceutical consultations and confirm their relevance, the impact of this intervention on improving patient knowledge will be assessed.No conflict of interest
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