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.

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.

Background/Aims: In diabetics with end-stage renal disease (ESRD), risk of death has been reported to be non-constant after the first dialysis, and different outcomes have been observed between genders. We assessed the impact of type 2 diabetes (T2DM) on mortality in dialysis regarding its differential effect by gender using time-dependent analyses. Methods: All T2DM and non-diabetic (no-DM) patients who started dialysis in two renal units in Lyon, France, between January 1, 1995, and December 31, 2007, were included. In multivariate analyses, the Cox model and Shoenfeld residual approach were used to assess the effect of T2DM on dialysis mortality by gender. Results: We included 235 T2DM (males: 57.9%) and 480 no-DM (males: 65.6%) patients. In males, the adjusted hazard ratio (aHR) for death in T2DM versus no-DM was 0.83 (p = 0.20) and was constant over time after the first renal replacement therapy (RRT) (p = 0.88). In females, aHR for death in T2DM versus no-DM patients was not constant over time (p = 0.002). It was 0.64 (p = 0.13) within the first year after the first RRT and 2.10 (p = 0.002) after the first year. Evolutions with time of these aHR by gender were significantly different (p = 0.009). Conclusions: T2DM was associated with death only in females. This association was not constant over time after the first dialysis.

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Introduction Face à la progression rapide de la pandémie liée au COVID-19, les professionnels de santé sont en première ligne dans la prise en charge des patients et eux-mêmes exposés au risque de contamination et maintenant d’épuisement. « Un(e) infirmier(e) sur cinq pense avoir été contaminé et deux sur trois sont en souffrance au travail ! », selon un sondage de la MNH. Une réorganisation en urgence de l’offre de soins en hémodialyse a été nécessaire. Les infirmiers et aides-soignants de dialyse ont vu leurs pratiques bouleversées ( cohorting , port de masque pour les patients et soignants, suppression de la collation, distanciation…). Description L’objectif de ce travail : évaluer les répercussions psychologiques des soignants en dialyse pendant le confinement du COVID-19 (T1) et plusieurs mois après (T2) chez les infirmiers/aides-soignants. Seuls les résultats à T1 seront présentés. Méthodes Étude multicentrique, non interventionnelle. Plusieurs variables ont été recueillies à partir d’un questionnaire par voie électronique ou papier : – données sociodémographiques ; – perception protectrice ou pathogène des séances de dialyse en période de confinement (Échelle Numérique Simple) ; – niveau de stress (Échelles Numériques Simples de Stress) ; – symptomatologie anxieuse et dépressive (Hospital Anxiety and Depression Scale) ; – stratégies de coping (BRIEF-COPE). Résultats Treize structures de dialyse (6 associations, 4 CHU, 2 CHG, 1 centre privé) de différentes régions impactées différemment par le virus ont participé à l’étude. Plus de 800 personnes (patients/IDE/AS confondus) ont rempli le questionnaire. Les résultats (en cours) permettront une estimation des niveaux de stress, dépression et anxiété ressentis mais aussi d’observer s’il existe des différences selon la région. Nous évaluerons les stratégies d’adaptations utilisées. Conclusion Cette étude permettra de mieux comprendre l’impact de la crise sur l’état de santé mentale des soignants, et de proposer des solutions thérapeutiques en cas de confrontation à une nouvelle crise sanitaire.