[Vulnerability of patients with intellectual disabilities in emergency].

People with intellectual disabilities should receive the same healthcare as those offered to the general population. However, they have weakened defense capabilities compared to the rest of the population and are therefore more vulnerable, with somatic, psychological, and psychosocial crises being more frequent and becoming complicated to manage. Usually, a primary assessment can reduce the need for transfer to emergency departments, but some situations may become complex and require hospital-based care.

Prevention of secondary hyperparathyroidism in hemodialysis patients: the key role of native vitamin D supplementation.

Secondary hyperparathyroidism (SHPT) is a frequent complication in chronic kidney disease, especially in hemodialysis (HD) patients. Treatments for SHPT include calcitriol analogues (CA), phosphate binders, cinacalcet (CC), and surgical parathyroidectomy (PTX). This study aimed to assess the incidence and prevalence of SHPT in a single center during the period when native vitamin D (N-VitD) supplementation and CC treatment became available.

[Calciphylaxis in dialysis patients: To recognize and treat it as soon as possible].

Calciphylaxis (CPX) or calcific uraemic arteriolopathy is a rare life-threatening complication, affecting mainly dialysis patients. The condition is characterized by calcifications and thrombosis of the small cutaneous vessels and small vessels in the fat tissue, resulting in the development of necrotizing and non-healing ulcers. The development of these lesions leads to poor outcomes owing to infectious complications and some frequently associated unfavourable medical conditions: obesity, diabetes, and peripheral vascular disease.

[Treatment of secondary hyperparathyroidism resistant to conventional therapy and tertiary hyperparathyroidism with Cinacalcet: an efficiency strategy].

Introduction: The treatment of secondary hyperparathyroidism (SHPT) in dialysis patients has changed with the introduction of cinacalcet (CC), which represents a medical alternative to surgical parathyroidectomy (PTX). The aim of our study is to prospectively assess the tolerance and efficacy of CC in patients, treated in one centre using long haemodialysis, with SHPT who do not respond to conventional therapy.

Patients And Methods: We prospectively observed all patients treated with CC between September 2004 and 2009.

Treating mineral metabolism disorders in patients undergoing long hemodialysis: a search for an optimal strategy.

In hemodialysis (HD) patients, mineral metabolism (MM) disorders have been associated with an increased mortality rate. We report the evolution of MM parameters in a stable HD population undergoing long hemodialysis by performing an annual cross-sectional analysis for every year from 1994 to 2008. The therapeutic strategy has changed: the dialysate calcium concentration has decreased from a mean of 1.

The plasma level of brain natriuretic peptide is increased in malnourished hemodialysis patients.

Background: In hemodialysis (HD) patients, the plasma brain natriuretic peptide (BNP) level is associated with left ventricular dysfunction and patients' survival. Malnutrition is common in HD patients, it is associated with inflammation and contributes to the high incidence of cardiovascular (CV) disease in this setting (malnutrition-inflammation-atherosclerosis syndrome). In a cross-sectional study, we assessed the relationship between predialysis plasma BNP level and nutritional markers in chronic HD patients.

Randomized equivalence study evaluating the possibility of switching hemodialysis patients receiving subcutaneous human erythropoietin directly to intravenous darbepoetin alfa.

Background: Darbepoetin alfa is an erythropoiesis-stimulating agent (ESA) used either intravenously or subcutaneously with no dose penalty; however, the direct switch from subcutaneous recombinant human erythropoietin (rHuEPO) to intravenous darbepoetin has barely been studied.

Objective: To establish the equivalence of a direct switch from subcutaneous rHuEPO to intravenous darbepoetin versus an indirect switch from subcutaneous rHuEPO to intravenous darbepoetin after 2 months of subcutaneous darbepoetin in patients undergoing hemodialysis.

Methods: In this open, randomized, 6-month, prospective study, patients with end-stage kidney disease who were on hemodialysis were randomized into 2 groups: direct switch from subcutaneous rHuEPO to intravenous darbepoetin (group 1) and indirect switch from subcutaneous rHuEPO to intravenous darbepoetin after 2 months of subcutaneous darbepoetin (group 2).

High levels of serum fibroblast growth factor (FGF)-23 are associated with increased mortality in long haemodialysis patients.

Background: Fibroblast growth factor (FGF)-23, a novel bone-derived phosphaturic factor involved in mineral metabolism, is increased in chronic kidney disease (CKD); in dialysis patients, it has been linked to increased mortality rates and vascular calcification (VC). The present investigation aimed to study the factors associated with elevated serum FGF-23 levels in patients treated with long haemodialysis (LHD) sessions and to determine whether a relationship exists between serum FGF-23 levels and patient survival.

Methods: All patients treated in one haemodialysis centre from September 2006 were included in the study.

[An efficient strategy to decrease the central venous catheter-related adverse events rate in haemodialysis patients].

Introduction: Catheter-related adverse events (CAE) remain a major cause of mortality and morbidity.

Aim: We aimed to compare the CAE prevalence and adverse events rate at 10 years interval in one centre using different devices, dressing procedures.

Methods: We compared two periods, from 1994 to 1997 (period 1) and from 2004 to 2007 (period 2).

Peripheral vascular calcification in long-haemodialysis patients: associated factors and survival consequences.

Background: Vascular calcifications (VCs) are frequently observed in chronic kidney disease (CKD) and haemodialysis (HD) patients. They have been associated with numerous factors, particularly hyperphosphataemia, excess calcium load, hypertension and increased mortality rate. The purpose of this study is to measure VCs in long-HD patients with good blood pressure and phosphate control, with the occasional use of sevelamer, using a plain radiological score to identify the associated factors and effects on the 1-year survival rate.

Evidence for persistent vitamin D 1-alpha-hydroxylation in hemodialysis patients: evolution of serum 1,25-dihydroxycholecalciferol after 6 months of 25-hydroxycholecalciferol treatment.

Background: End-stage renal disease (ESRD) patients are thought to have impaired 1-alpha-hydroxylase capacity, but an extrarenal source of 1,25(OH)(2)D has been recognized.

Objective: The aim of this study was to assess the evolution of serum 1,25(OH)(2)D in hemodialysis (HD) patients with vitamin D deficiency after 6 months of 25(OH)D(3) supplementation, and to identify the factors associated with persistent 1,25(OH)(2)D production.

Methods: HD patients in a HD center with vitamin D deficiency (i.

Daily oral 25-hydroxycholecalciferol supplementation for vitamin D deficiency in haemodialysis patients: effects on mineral metabolism and bone markers.

Background: Vitamin D deficiency is frequently observed in end-stage renal disease (ESRD) patients; however, the effects of vitamin D supplementation have rarely been reported. We aimed to assess the effects of daily 25(OH)D(3) supplementation on mineral metabolism, bone markers and Kidney Disease Outcomes Quality Initiative (KDOQI) targets in haemodialysis (HD) patients for a period of 6 months.

Methods: HD patients were included in this study if their serum 25(OH)D level was <75 mmol/L.

Stability of nutritional parameters during a 5-year follow-up in patients treated with sequential long-hour hemodialysis.

Progressive nutritional impairment has been recently reported during conventional hemodialysis (HD) treatment. We studied the nutritional parameters during a 5-year follow-up in HD patients. Thirty-three patients (15F/18M; 65 years old at the study start) filled out a 3-day food questionnaire once a year between 1995 and 1999 (study group).

Role of sodium in dialysis.

The total amount of sodium present in the body conditions the extracellular compartment volume. In advanced renal failure and in dialysis the sodium balance becomes positive and the extracellular volume inflates. This leads to hypertension and to direct cardiac and vascular changes that explain for a large part the excessive cardiovascular morbidity and mortality in dialysis patients.

Long 3 x 8 hr dialysis: a three-decade summary.

A long hemodialysis (HD), 3 x 8 hours/week, has been used without significant modification in Tassin for 35 years with excellent morbidity and mortality results. It can be performed during the day or overnight. The relatively good survival is mainly due to a lower cardiovascular mortality than usually reported in dialysis patients.

Intensive dialysis and blood pressure control: a review.

The prevalence of hypertension in hemodialysis (HD) patients has increased over the years. In the early days of maintenance HD blood pressure (BP) control was achieved in most patients. As sessions were shortened, the prevalence of hypertension increased.

Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias.

Infection, mainly related to vascular access, is one of the main causes of morbidity and a preventable cause of death in hemodialysis patients. From January 1994 to April 1998 we conducted a prospective study to assess the incidence and risk factors of catheter-related bacteremia. One hundred and twenty-nine tunneled dual-lumen hemodialysis catheters were inserted percutaneously into the internal jugular vein in 89 patients.

[Prevalence of stenosis and thrombosis of central veins in hemodialysis after a tunneled jugular catheter].

Central venous stenosis (ST) and thrombosis (TB) related to catheter (KT) had been reported mostly for the subclavian vein. We performed a systematic cavographic study to evaluate the prevalence of these complications in 51 hemodialysis patients with present or previous history of tunneled internal jugular catheter. Each of them had used one or several KT (1.

Long-term outcome of permanent hemodialysis catheters: a controlled study.

Aims: Hemodialysis tunneled catheters are widely used nowadays. However, their complications, infection and dysfunction, remain much too frequent. Different types of tunneled silicone hemodialysis catheters are available.

Malnutrition in long-term haemodialysis survivors.

Background: Long survival is now common in patients with end-stage renal disease owing to improvement in dialysis techniques and kidney transplantation. As malnutrition is commonly reported in dialysis patients, we evaluated the nutritional status of patients treated with haemodialysis (HD) for more than 20 years.

Methods: Ten patients (59.

Diabetes mellitus in Tassin, France: remarkable transformation in incidence and outcome of ESRD in diabetes.

The incidence and prevalence of diabetes mellitus (DM) in the dialysis population in Europe, and more especially in France, have been lagging behind the impressive United States and Japanese rates. For a decade, things have been changing, and the incidence of DM in hemodialysis (HD) reached almost 40 in Tassin, France in 1999. The prevalence has followed the same trend but increased more slowly.

Clinical Determination of Dry Body Weight.

While nephrologists wait for the ideal, non invasive, inexpensive, precise, and reproducible tool to evaluate extracellular volume (ECV), they need to exert their clinical acumen in the quest of that holy grail, dry weight (DW). Estimation of DW using a clinical approach based on blood pressure (BP) and ECV is feasible and reliable as shown by successful experiences in various dialysis modes over more than three decades. But a need still exists to resolve difficulties associated with accurate assessment of BP (methods and circumstances of measurement, and the confounding effects of antihypertensive drugs) and ECV (evaluation of weight changes unrelated to ECV, lack of specificity and sensitivity of clinical symptoms, lag time, confusion in terminology).