Frédéric Collart

Background: Global inequities in dialysis and kidney transplantation among immigrant populations remain poorly characterized. At the crossroads of European migration, Brussels’ Brugmann University Hospital provides an opportunity to examine outcomes in one of the most ethnically diverse dialysis cohorts in Western Europe, including a substantial proportion of undocumented immigrants. Methods: We conducted a retrospective 15-year analysis of 497 incident dialysis patients (2010–2024), categorized as Western European (WE, 32%), Eastern European (EE, 21%), North African (NA, 26%), or Sub-Saharan African (SSA, 21%). Kaplan–Meier and Cox models assessed survival, while Fine–Gray competing-risk analyses evaluated transplant access. Results: Despite language barriers, housing instability, and the frequent lack of legal residency, equitable dialysis delivery was achieved, with peritoneal dialysis implemented in 25%–30% of patients, including asylum seekers and undocumented immigrants. Median pre-dialysis nephrology follow-up was longer in WE (8 months) than in other groups (<1 month). Age (HR = 1.73) and comorbidity (HR = 1.62) independently predicted mortality, whereas ethnicity (HR = 0.77) reflected demographic rather than systemic disparities. Competing-risk analysis showed the highest transplant access among SSA patients (35%–40% at 10 years; sub-distribution hazard ratios) = 2.13, P = .004), confirming that allocation was driven by clinical suitability rather than origin. Conclusion: In this uniquely multicultural setting, equitable access to dialysis and transplantation can be achieved across all immigrant groups, even among undocumented patients, but only when a dedicated hospital, social, and administrative structure is deliberately built to make it possible. The success of peritoneal dialysis among asylum seekers and the high transplant rates in SSA patients reflect an integrated system where equity is actively implemented, not assumed. These findings demonstrate that outcomes depend on clinical and organizational excellence rather than geography or migration status, offering a model for inclusive nephrology care in increasingly diverse European societies.

Introduction: Endothelial dysfunction is a common feature of end-stage kidney disease, requiring hemodialysis (HD) and antiphospholipid antibody (aPL) persistent positivity. Endothelial dysfunction can be assessed with noninvasive tests such as flow-mediated dilation (FMD). In the HD population, it is not known whether aPL persistent positivity is associated with a more severe endothelial dysfunction. Methods: We performed a cross-sectional study in our HD patients. The FMD of the brachial artery was measured in 17 aPL-positive patients who fulfilled the inclusion criteria and were matched to 17 controls according to age, gender, diabetes mellitus, smoking status and markers of dialysis adequacy (Kt/V). Results: FMD was significantly lower in the aPL group with a mean of 6.9% and 11.8% in the aPL-positive and the control groups, respectively (mean difference (IC 95%): −4.9 (−8.3; −1.6), p = 0.006). aPL was associated with a higher c-reactive protein level, and longer HD vintage. There was no statistical difference between groups in terms of pre-dialysis urea and urinary output, dialysis adequacy (Kt/V), and history of cardiovascular disease or treatments. Conclusions: aPL persistent positivity in HD patients was associated with worse endothelial dysfunction, reflected by FMD measurements. These findings have to be confirmed in larger studies.

Key Points: A simplified lung ultrasound (LUS)–guided management approach safely reduced pulmonary congestion in patients undergoing hemodialysis. LUS may be performed by nurses and paramedics, making it even easier to integrate it into routine practice. LUS may contribute to better BP control in patients undergoing hemodialysis. Background: Pulmonary congestion (PC) is frequent in hemodialysis patients and is associated with deleterious prognosis. Lung ultrasound (LUS) accurately quantifies PC; however, many methods exist to evaluate PC using LUS. Here, we validate a simplified LUS-guided protocol for managing PC in patients undergoing hemodialysis and explore its impact on BP control. Methods: We enrolled 100 hemodialysis patients from six dialysis units in three countries in a multicenter randomized controlled trial. All patients had LUS after their mid-week session on days 1, 15, 30, 45, and 60. LUS was performed using the eight-zone method to obtain a global B-line score (BLS). Doctors and nurses performed LUS at the bedside. Dry weight was adjusted according to the standard of care in the control group, while it was reduced by 500 g if BLS was above five on day 1 and by 500 g further on day 15 if BLS was still above five in the active group. BP home monitoring was obtained weekly. Results: The mean BLS on day 1 (13±9) decreased to 8±5 on day 60 ( P < 0.001) in the active group. By contrast, the control group showed no significant changes in BLS on day 60 compared with baseline. Home blood pressure monitoring on day 60 was similar to the baseline in both groups. Applying this protocol did not increase the intradialytic hypotension frequency. Conclusions: This simplified LUS-guided protocol for managing PC was effective and safe in hemodialysis patients and could be considered for inclusion in standard care practices. Nurses and advanced caregivers may perform LUS in hemodialysis units. LUS-guided management may have a positive impact on BP control. Clinical Trial registry name and registration number: ClinicalTrials.gov, NCT06296160.

Background: Olmesartan-induced enteropathy is a rare complication of a widely used angiotensin II receptor blocker. Patients usually present with chronic diarrhea and weight loss. Histologically, villous atrophy and intraepithelial lymphocyte infiltrates within the duodenum confirm the diagnosis. The prognosis is usually good after withdrawal of the offending drug. Case presentation: Here, we report the case of a 76-year-old woman who developed a severe form of Olmesartan-induced enteropathy complicated by acute kidney injury and acute recurrence after drug rechallenge. After definite cessation of the drug, the patient did not experience any gastrointestinal (GI) symptom recurrence after 6 months of follow-up. However, she experienced chronic kidney disease stage G3b. Histological analysis did not show any villous atrophy or intraepithelial lymphocyte infiltrates within the duodenum or the colon biopsy. Discussion and conclusion: This case highlights the broad spectrum of clinical manifestations and histological findings in Olmesartan-induced enteropathy. It also highlights the importance of rapid diagnosis in order to limit organ damage such as chronic kidney disease.

Background: Arteriovenous fistula (AVF) is the preferred vascular access option for hemodialysis (HD). The latter requires a remodeling process called maturation that can take up to 3 months. Maturation failure is a frequent complication associated with significant morbidity. The prevalence of antiphospholipid antibody (aPL) positivity in HD patients is high and may result in thrombosis of the vascular access. Recently, aPL persistent positivity has been associated with AVF maturation failure in a retrospective study including 116 patients. Methods: We are conducting an observational prospective cohort study aiming to evaluate this association. Included patients are planned for AVF creation, aged over 18 years old, and have an interpretable aPL assay confirmed at 12 weeks and without any other innate or acquired thrombophilia or inflammatory disease. Primary endpoints will be the evaluation of AVF maturation clinically and by ultrasound. Secondary endpoints will focus on clinical outcomes other than AVF maturation (i.e., primary patency, thrombosis or stenosis, bleeding and hemodialysis adequacy parameters). Conclusions: This prospective observational cohort study aims to examine the possibly causative link between aPL persistent positivity and AVF maturation failure. This study was registered on ClinicalTrials.gov (ID number: NCT06112821).

Background and hypothesis: The prevalence of antiphospholipid antibody (aPL) is high among hemodialysis (HD) patients compared to the general population and is inconsistently associated with arteriovenous fistula (AVF) thrombosis or stenosis. The association with maturation failure has never been investigated. This study aims to evaluate native AVF complications (thrombosis, stenosis, and maturation failure) and primary patency in aPL positive HD patients. Methods: We retrospectively identified 116 HD patients with native AVF. We collected the aPL profiles, the clinical and biological data potentially involved in AVF maturation failure, thrombosis, and stenosis, and investigated the association of these complications and aPL positivity. Kaplan–Meier survival analysis was performed. Results: In our cohort, the prevalence of aPL persistent positivity was 32.7% and this was strongly associated with AVF maturation failure defined by ultrasound. aPL persistent positivity was a strong predictor in multivariate analysis and this association was independent of AVF stenosis or thrombosis during maturation process. There was no association with primary and functional primary patency, and stenosis. However, aPL persistent positivity according to ACR/EULAR classification criteria was associated with thrombosis when compared to strictly negative aPL patients. Conclusions: In our cohort, aPL persistent positivity was significantly associated with AVF maturation failure and thrombosis but not with AVF stenosis. To our knowledge, we report for the first time, a statistically significant association between aPL positivity and delay or absence of native AVF maturation.

Summary Little information is available on the seasonal ecology of germs responsible for peritoneal dialysis peritonitis. We performed a retrospective study based on RDPLF data covering the last 20 years and 20411 episodes of peritonitis. We show that the percentage of enteric peritonitis is highest in summer, lowest in winter and identical in spring and autumn. This higher proportion of organisms of enteric origin in summer has itself tended to increase in recent years. We postulate that a food contamination by enteric germs associated with an increased bacterial translocation at the level of the digestive tract itself favoured by constipation, as well as changes of the food nature could be responsible for this phenomenon. These seasonal variations may suggest that probabilistic initial antibiotic therapy should be adapted in cases of suspected peritonitis before the results of bacteriological analysis.

Background: The aim of this study was to describe the trends in the incidence, prevalence and survival of patients on kidney replacement therapy (KRT) for end-stage kidney disease (ESKD) across Europe from 2008 to 2017.Methods: Data from renal registries in 9 countries and 16 regions that provided individual patient data to the ERA Registry from 2008 to 2017 were included. These registries cover 34% of the general population in Europe. Crude and standardized incidence and prevalence per million population (pmp) were determined. Trends over time were studied using Joinpoint regression. Survival probabilities were estimated using Kaplan–Meier analysis and hazard ratios (HRs) using Cox regression analysis.Results: The standardized incidence of KRT was stable [annual percentage change (APC): −1.48 (−3.15; 0.21)] from 2008 (146.0 pmp) to 2011 (141.6 pmp), followed by a slight increase [APC: 1.01 (0.43; 1.60)] to 148.0 pmp in 2017, although trends in incidence varied across countries. This increase was primarily due to a rise in the incidence of KRT in men older than 65 years. Moreover, as a cause of kidney failure, diabetes mellitus is increasing. The standardized prevalence increased from 2008 (990.0 pmp) to 2017 (1166.8 pmp) [APC: 1.82 (1.75; 1.89)]. Patient survival on KRT improved in the time period 2011–13 compared with 2008–[adjusted HR: 0.94 (0.93; 0.95)].Conclusion: This study showed an overall increase in the incidence and prevalence of KRT for ESKD as well as an increase in the KRT patient survival over the last decade in Europe.