Roula Galland

A quarter of patients do not receive any information on the modalities of renal remplacement therapy (RRT) before its initiation. In our facility, we provide therapeutic education workshops for all RRT except for home hemodialysis (HHD). The objectives of this study were to identify and describe the needs of CKD patients and caregivers for RRT with HHD and design therapeutic education workshops. Two sequential methods of qualitative data collection were conducted. Interviews with patients treated with HHD and doctors specialized in HHD were performed to define the interview guide followed by semi-structured interviews with the help of HHD patients from our center. Thematic analysis was conducted and were rooted in the principles of qualitative analysis for social scientists. Data were analyzed by two investigators. Transcribed interviews were entered into RQDA 3.6.1 software for data organization and coding purposes (Version 3.6.1). In total, five interviews were performed. We identified six themes related to the barriers, facilitators, and potential solutions to home dialysis therapy: (1) HHD allows autonomy and freedom with constraints, (2) safety of the care environment, (3) the caregiver and family environment, (4) patient’s experience and experiential knowledge, (5) self-care experience and impact on life, and (6) factors that impact the choice of treatment with HHD. We designed therapeutic education workshops in a group of patients and caregivers. Our study confirmed previous results obtained in literature on the major barriers, facilitators, and potential solutions to HHD including the impact of HHD on the caregiver, the experiences of patients already treated with HHD, and the role of nurses and nephrologists in informing and educating patients. A program to develop patient-to-patient peer mentorship allowing patients to discuss their dialysis experience may be relevant.

Introduction: Depuis quelques années sont apparus des appareils conçus spécialement pour la dialyse quotidienne en particulier à domicile. L’objectif est d’avoir des appareils simples, sûr et rapides à préparer. Certains ne sont pas des générateurs mais des cycleurs qui utilisent un dialysat prêt à l’emploi stérile avec un débit ≤ à 200 mL/min. Nous rapportons une étude multicentrique sur 11 patients, faite dans 6 centres avec le cycleur Physidia S3 (Aura-Paris, AURAL et Calydial-Lyon, CH Cherbourg, CHU Caen, Echo Angers). Matériels et méthodes Le cycleur S3 a les particularités suivantes : circuit bain entièrement disposable, constitué par une cassette qui comprend 4 poches souples, 2 débitmètres, des capteurs de pression et un réchauffeur ; dialysat circulant grâce à des pompes pneumatiques qui exercent des pressions/dépressions sur les poches ; débit du dialysat compris entre 150 et 200 mL/min ; tampon bicarbonate ; pas de temps de préparation du bain ni de désinfection après la séance. Pour augmenter les échanges convectifs, possibilité d’HDF interne par push/pull avec un volume d’infusion maîtrisé pouvant aller jusqu’à 2/3 du débit dialysat. L’étude s’est déroulée sur 2 semaines, à raison de 6 séances de 2 h/semaine ; dialyseur SmartfluxHFP190 (PES) ; débits sang entre 250 et 350 mL/min. Séances analysées : 114. Résultats: (Tableau 1). Discussion: La dose de dialyse mesurée par le Sdt Kt/V urée est ≥ à 2,2 pour 10 patients/11 ; il existe une relation inverse entre Sdt Kt/V et poids sec. La réduction du débit dialysat a peu d’influence sur les transferts convectifs. Le pourcentage de réduction (PR) moyen de la B2 m était à 47,7 % ; il n’a pas été constaté d’augmentation de l’épuration de la B2 m lors des séances faites avec HDF interne mais les volumes infusés étaient faibles (max 1/3 du débit dialysat) et l’étude de courte durée. Conclusion: L’HDQ courte à bas débit dialysat avec le cycleur S3 est efficace et bien tolérée. Le push/pull à haut débit d’infusion devrait pouvoir augmenter les transferts convectifs.

In order to rationalize the cost of care for dialysis patients in Centre, regulatory authorities urge establishments to favor the orientation of the patients in Medical Dialysis Unit where the medical presence is not permanent. This involves clinical skills for nurses in the conduct of the dialysis session. Faced with this changing work patterns, we present two security tools of the dialysis session. The first is a "check-list", simple, quick and easy to use, it enables secure connection phase of the patient. It was quickly integrated practice of all professionals. The second tool developed is a combination of indicators "DEAUP" for Pain, Purification, Blood access, Ultrafiltration and other Problems for assessing the quality of the course of the dialysis session. The aim is to reduce the occurrence of adverse events, the DEAUP rating certain criteria depending on the occurrence of incidents, from 0 to 2, 2 corresponding to the appearance of an incident having required the call of the doctor and constitute a precious tool of evaluation of the session for all the professionals. All nurses have joined the practice of evaluation, 98% of the realized sessions are informed and quoted; 8.4% of sessions required call nephrologists before or at the connection. The evaluation at the end of dialysis session found 15% of the sessions listed 2. Calls have resulted in an adjustment to the prescription of the sessions.

Background/Aims: In diabetics with end-stage renal disease (ESRD), risk of death has been reported to be non-constant after the first dialysis, and different outcomes have been observed between genders. We assessed the impact of type 2 diabetes (T2DM) on mortality in dialysis regarding its differential effect by gender using time-dependent analyses. Methods: All T2DM and non-diabetic (no-DM) patients who started dialysis in two renal units in Lyon, France, between January 1, 1995, and December 31, 2007, were included. In multivariate analyses, the Cox model and Shoenfeld residual approach were used to assess the effect of T2DM on dialysis mortality by gender. Results: We included 235 T2DM (males: 57.9%) and 480 no-DM (males: 65.6%) patients. In males, the adjusted hazard ratio (aHR) for death in T2DM versus no-DM was 0.83 (p = 0.20) and was constant over time after the first renal replacement therapy (RRT) (p = 0.88). In females, aHR for death in T2DM versus no-DM patients was not constant over time (p = 0.002). It was 0.64 (p = 0.13) within the first year after the first RRT and 2.10 (p = 0.002) after the first year. Evolutions with time of these aHR by gender were significantly different (p = 0.009). Conclusions: T2DM was associated with death only in females. This association was not constant over time after the first dialysis.