[News in peritoneal dialysis]. / Actualités en dialyse péritonéale.

Peritoneal dialysis, like hemodialysis, is a first-line therapy for patients with end-stage renal disease. Progress in medical devices and materials has reduced infectious complications such as peritonitis and catheter exit-site infections and thus decreased morbidity. Peritoneal dialysis fluids are increasingly biocompatible, result in fewer glucose degradation products, protect the peritoneal membrane better and thus improve tolerance. The maintenance of residual renal function, together with better comfort and no pain, help control the fluid and sodium balance. Automated peritoneal dialysis can be performed each night, either autonomously or assisted by a visiting nurse twice a day (to prepare, connect, and disconnect the machine). This treatment can thus be provided to most patients, regardless of their age. Peritoneal dialysis is indicated principally for young people waiting for a kidney transplantation (to preserve their vascular network), elderly patients who wish to remain either at home or in an institution, and patients with cardiac insufficiency, because of the better hemodynamic tolerance. Numerous obstacles, mainly nonmedical, still impede the development of peritoneal dialysis. Patients seen in emergencies start hemodialysis without necessarily receiving any information about peritoneal dialysis. Indeed, neither physicians nor patients receive adequate information.

[Is clinical judgment a suitable method to select marginal allograft for transplantation? A single centre experience]. / Le seul jugement clinique peut-il être utilisé pour accepter un greffon marginal? Expérience d'un centre de transplantation.

In order to deal with the organ shortage, the use of organs from marginal donors has emerged as an obvious option. The decision to accept a kidney from an expanded criteria donor is left to the transplantation centre. This study was carried out to evaluate whether clinical judgment is a suitable method to decline a kidney from a marginal donor. This was a retrospective study of the outcome of marginal kidneys rejected by our centre between 1st January 2000 and 31st December 2006 but accepted by another centre. The decision to refuse a marginal kidney was based on the clinical judgment of the nephrologists on call. Kidney refusal was retrospectively considered as a "mistaken decision" when the kidney was transplanted in another centre and when the estimated GFR was above 60 mL/min/1.73 m(2) one year after transplantation. The DD score was calculated retrospectively for every rejected kidney. During the study period, 304 kidneys were not accepted for transplantation. Of these 304 kidneys, 55 marginal kidneys were not accepted by the nephrologists on call. Among these 55 marginal kidneys, 44 were accepted and transplanted in another centre. Early graft loss occurred in 2/44 recipients. Death censored allograft survival at one and two years was retrospectively 98 and 93%. Kidney refusal was considered as a "mistaken decision" for 12/44 rejected kidneys. Of these 12 rejected kidneys, only two could have been considered as marginal kidneys by the DD score, as compared with 27/30 of the remaining rejected kidneys. Our study shows that clinical judgment alone is not a suitable method for selecting marginal donors. Proven definitions of "marginal donor", available to physicians when the medical decision has to be made, may help nephrologists in their clinical practice.