No abstract

La survenue d'une grossesse en hémodialyse chronique (HDC) est rare, mais depuis la description du premier cas par Confortini en 1971, plusieurs observations ont été rapportées. L'hémodialyse a considérablement amélioré la fertilité de ces patientes. Nous rapportons l'expérience de douze grossesses survenues entre 1999 et 2014, chez douze patientes d’âge médian 34 ans (22-44), en hémodialyse (HD) depuis 40 mois (3-72), l’âge gestationnel moyen de diagnostic est de 16 semaines d'aménorrhée, la grossesse était compliquée dans 50% des cas par un hydramnios. Le terme moyen est de 35 semaine d'aménorrhée (SA) et l'accouchement a été réalisé dans 90% des grossesses par voie basse. Le poids moyen des nouveau-nés est de 1800g. De telles grossesses sont à haut risque du fait de la fréquence des complications. Elles devraient être contrôlées par les équipes multidisciplinaires, et la consultation prénatal ne devrait pas être négligée. L'objectif de ce travail est de rapporter notre expérience concernant la survenue d'une grossesse chez les patientes dialysées et de la confronter aux données de la littérature.

Background and aim: Dermatological manifestations are frequent and varied among chronic hemodialysis patients. The aim of this study is to determine the prevalence and characteristics of cutaneous abnormalities observed in hemodialysis patients. Methods:We led a transversal study, conducted at the Nephrology Department of the 5 th Military Hospital in Guelmim, from March to May 2017, including 44 hemodialysis patients. Results:The mean duration of hemodialysis was 61.81 months. Causes of end stage renal failure were diabetes (45.45%), high blood pressure (13.63%), lithiasis (4.54%), gout (4.54%), reflux nephropathy (4.54%), glomerulonephritis (4.54%), and indeterminate (22.72%). All our patients had dermatological abnormalities. Pruritus (63.63% of patients), Cutaneous xerosis (40.9%), hair loss (36.36%), and hyperpigmentation (22.72%) were the most common skin manifestations. 68.16% of our patients had nail disorders. Conclusions:The knowledge of these manifestations allows a proper care, so to improve the quality of life of the hemodialysis patient.

The inadequacy of dialysis and hyperphosphatemia are both associated with morbidity and mortality in chronic hemodialysis (HD) patients. Blood flow rate (BFR) during HD is one of the important determinants of increasing dialysis dose. The aim of this study was to determine the effect of increasing BFR on dialysis dose and phosphate removal. Forty-four patients were included in a cross-sectional study. Each patient received six consecutive dialysis sessions as follows: three consecutive sessions with a BFR of 250 mL/min, followed by three others with BFR of 350 mL/min without changing the other dialysis parameters. Patients' body weight was recorded, and blood samples (serum urea and phosphate) were collected before and after each dialysis session. For assessing the efficacy of dialysis, urea reduction ratio (URR), Kt/VDiascan (Kt by Diascan and V by Watson), Kt/V Daugirdas (Daugirdas 2 generation), equilibrated Kt/V, and phosphate reduction rate (PRR) were used. The increase of BFR by 100 mL/min resulted in a significant increase of URR, Kt/V , Kt/V, equilibrated Kt/V, and PRR: URR; 75.41 ± 5.60; 83.51 ± 6.12; P <0.001), (Kt/V; 1.28 ± 0.25; 1.55 ± 0.15; P <0.001), (Kt/V; 1.55 ± 0.26; 2.10 ± 0.61; P = 0.001), equilibrated Kt/V; 1.40 ± 0.19; 1.91 ± 0.52; P = 0.001), and (PRR; 50.32 ± 12.22; 63.66 ± 13.10; P = 0.010). Adequate dialysis, defined by single-pool Kt/V ≥1.4, was achieved using two different BFRs: 250 and 350 mL/min, respectively, in 73% and 100% of the cases. Increasing the BFR by 40% is effective in increasing dialysis dose and phosphate reduction rate during high-flux HD. The future prospective studies are needed to evaluate the impact of increasing BFR on phosphate removal using the total amount of phosphate removed, and also evaluate the cardiovascular outcome of phosphate reduction and dialysis improvement.