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.
Our observational study illustrates the high burden of cardiovascular diseases contrasting with sub-optimal cardiovascular therapeutic interventions in type II diabetes patients entering dialysis. Factors aggravating renal failure were mainly iatrogenic, and therefore largely avoidable. Late referral generally implied a poor clinical condition at the start of dialysis.
Eutrophication generally favours the growth of cyanobacteria over eukaryotic green algae in freshwater lakes. Cyanobacteria constitute a poor food source for the waterflea Daphnia, an important primary consumer of phytoplankton in lakes. While it is known that some Daphnia species are adapted to eutrophic conditions and can cope with cyanobacteria in their diet, it is less known whether cyanobacterial community composition can influence Daphnia population structure in lakes. We studied the variation in genetic diversity of Daphnia resting eggs and cyanobacterial DNA preserved in sediment cores from three European lakes impacted by eutrophication. Our retrospective analysis confirms that D. galeata invaded the two pre-alpine lakes around the middle of the twentieth century, hybridized with and became dominant over D. longispina. This coincides with the presence in all lakes and the increase in the proportion of colonial and filamentous cyanobacteria in the pre-alpine lakes. The recent reoligotrophication of the lakes did not reverse the cyanobacterial and Daphnia assemblages to their pre-eutrophication composition and genetic structure, suggesting that both changed irreversibly due to anthropogenic influence on the ecosystems. Genetic analyses applied to lake sedimentary archives have the potential to unveil how different compartments of the food-web co-vary in a changing environment.
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