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.

Introduction and aims: Vascular calcification is common in patients suffering from advanced chronic kidney disease (CKD), yet little is known about vascular calcification and arterial stiffness in the early stages of renal dysfunction. We evaluated, in patients suffering from CKD 3, the arterial vascular damage by means of the measurement of arterial stiffness and the coronary calcium score. Methods: Eleven patients (7 M, 4 f, aged 64±7 years) with mild to moderate renal failure were enrolled. We deliberately excluded patients with diabetes and previous history of heart disease from this study; we did this in order to exclude the interference of other pathologies apart from functional kidney insufficiency in the genesis of vascular alterations. the causes of renal failure were nephroangiosclerosis (73%), membranous glomerulonephritis (18%), and interstitial nephritis (9%). all the patients underwent the assessment of coronary calcification by means of multi-detector Ct (expressed as calcium score [Cs] according to agatston score), arterial stiffness by pulse wave velocity (pWV) measurement, common carotid intima-media thickness (iMt) by B-mode Us scan, and left ventricular mass index by echocardiography. renal function (Gfr) was evaluated using the Cockroft and Gault formula. Blood samples were drawn for the measurement of serum creatinine, lipid profile, glycidic profile, electrolytes, hOMa index, etc. Results: the main results are summarized in the table. Whilst the calcium score (Cs) was abnormal in only one patient (the remaining patients had a Cs <50 hU), the pWV and iMt were high in all of them. No substantial alterations in the lipid profile and hOMa index were present. Conclusions: Our data, albeit obtained in a small number of patients, show that in the early stages of chronic renal failure, in the absence of diabetes and cardiac involvement, vascular calcification is only rarely present. On the contrary, arterial stiffening, as shown by pWV and iMt, starts very early, even in the presence of a normal lipid profile and insulin resistance. further studies in larger groups are needed to confirm this results, as well as to understand at which moment or which factors lead to the development of the extensive vascular calci-fication observable in the advanced stages of CKD. Table. Results Variable Mean±SD GFR, mL/min 40.6±10 Total cholesterol, mg/dL 198±35 LDL cholesterol, mg/dL 111±29 HDL cholesterol, mg/dL 53±16 Triglycerides, mg/dL 183±93 HOMA index, % 1.9±1.5 PWV, m/sec 10.5±1.6 ccIMT, mm 0.8± 1.2 LVM index, g/m 2 110±41 CS (HU)* 0-1074 *Expressed as range. increased pulse wave velocity (pWV), a marker of arterial stiffness, is considered a strong predictor of cardiovascular mortality both in general and in the renal-disease population. however, it is unknown whether it may be affected by the rapid variations in the fluid status induced by treatment in dialysis (hD) patients. We studied 13 patients (6 M, 7 f, 65±12 years) on thrice-weekly chronic hD treatment in a study session after the longest interdial...

Dialysis patients exhibit an inverse, L- or U-shaped association between blood pressure and mortality risk, in contrast to the linear association in the general population. We prospectively studied 9333 hemodialysis patients in France, aiming to analyze associations between predialysis systolic, diastolic, and pulse pressure with all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular endpoints for a median follow-up of 548 days. Blood pressure components were tested against outcomes in time-varying covariate linear and fractional polynomial Cox models. Changes throughout follow-up were analyzed with a joint model including both the time-varying covariate of sequential blood pressure and its slope over time. A U-shaped association of systolic blood pressure was found with all-cause mortality and of both systolic and diastolic blood pressure with cardiovascular mortality. There was an L-shaped association of diastolic blood pressure with all-cause mortality. The lowest hazard ratio of all-cause mortality was observed for a systolic blood pressure of 165 mm Hg, and of cardiovascular mortality for systolic/diastolic pressures of 157/90 mm Hg, substantially higher than currently recommended values for the general population. The 95% lower confidence interval was approximately 135/70 mm Hg. We found no significant correlation for either systolic, diastolic, or pulse pressure with myocardial infarction or nontraumatic amputations, but there were significant positive associations between systolic and pulse pressure with stroke (per 10-mm Hg increase: hazard ratios 1.15, 95% confidence interval 1.07 and 1.23; and 1.20, 1.11 and 1.31, respectively). Thus, whereas high pre-dialysis blood pressure is associated with stroke risk, low pre-dialysis blood pressure may be both harmful and a proxy for comorbid conditions leading to premature death.

The 2003 guidelines for the management of hyperparathyroidism in chronic kidney disease compiled by the Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation (NKF-K/DOQI) were formulated on the basis of work published up until 2001. Since then, new drugs (e.g. calcimimetics and lanthanum carbonate) have become available, and others (e.g. sevelamer, nicotinamide and paricalcitol) have been more stringently clinically evaluated. Because of these advancements, a reappraisal of the 2003 guidelines is justified. In this article we critically review the following recommendations of the NKF-K/DOQI: (i) routine use of 1.25 mmol/l (5.0 mg/dl) dialysate calcium and 1 alphaOH-vitamin D derivatives; (ii) limitation of the maximal daily dose of calcium-based oral phosphate binders to 1.5 g of elemental calcium; and (iii) not correcting vitamin D insufficiency in dialysis patients.

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