Paternity in male kidney transplant recipients: a French national survey, the PATeRNAL study.

BACKGROUND: There is concern about the impact of immunosuppressive agents taken by male kidney transplant (KT) recipients on the risk of foetal malformations. The aim of our survey was to estimate the paternity rate and the outcomes of pregnancies fathered by kidney transplanted males. METHODS: This survey analysed 1332 male KT recipients older than 18 years, followed in 13 centres in France. A self-reported questionnaire was used to collect data on the patients, treatments at the time of conception and the pregnancy outcomes. RESULTS: The study included data on 349 children from 404 pregnancies fathered by 232 male KT recipients. The paternity rate was 17% (95% CI [15-20]). There were 37 (9%, 95% CI [7-12]) spontaneous abortions, 12 (3%, 95% CI [2-5]) therapeutic abortions, 2 (0.5%, 95% CI [0.1-1]) still births, and 13 (4%, 95% CI [2-6]) malformations reported. Compared to the general population, there was no difference in the proportion of congenital malformations nor unwanted outcomes whether the father was exposed or not to immunosuppressive agents. CONCLUSIONS: This survey does not provide any warning signal that pregnancies fathered by male patients exposed to immunosuppressive agents, notably the debated MMF/MPA, have more complications than pregnancies in the general population.

Mycobacterium genavense Infections in Immunocompromised Patients Without HIV: Case Series of Solid Organ Transplant Patients and Literature Review.

Background: Mycobacterium genavense infection is rare and can occur in immunocompromised patients without human immunodeficiency virus (HIV). Methods: We describe 2 cases of M genavense infection in solid organ transplant (SOT) recipients, and we performed a literature review of immunocompromised patients without HIV. Results: Fifty-two cases are reported. Predisposing factors were receipt of SOT (40.4%) and autoimmune disease (36.5%). Infection was disseminated in 86.5% of cases. Organs involved were lymph nodes (72.3%), gastrointestinal tract (56.5%), lung (35.5%), and bone marrow (28.8%). Most patients were treated with at least 3 antimycobacterial agents (98%), with a clinical cure achieved in 54.9%. In multivariate analysis, lack for cure was associated with age of the time infection (odds ratio [OR], 15.81 [95% confidence interval {CI}, 2.92-152.93]; P = .011) and positive bone marrow culture (OR, 1.05 [95% CI, 1.01-1.12]; P = .042). Conclusions: Mycobacterium genavense infection is a rare and generally disseminated disease with a poor prognosis. Optimal treatment regimen and its duration remain to be defined.

[Ericksonian hypnosis and mindfulness meditation: Towards a behavioral medicine in nephrology]. / L'hypnose Ericksonienne et la méditation pleine conscience : vers une médecine comportementale en néphrologie.

The utilization of behavioral medicine, like Ericksonian hypnosis and mindfulness meditation, in the patient care is increasing. Psychological disorders associated with chronic renal failure are similar to the post-traumatic stress disorder and need a continuous personnel adjustment. Preventing depression, managing stress, pain and emotions, like anger, guiltiness and shame, is of importance in individual who suffer of chronic kidney disease, but also in their family caregivers and in health-care workers. The objective of this report is to describe how Ericksonian hypnosis, mindfulness meditation and compassion meditation could support chronic kidney disease patients, their caregivers and the health-care professional.

[Descriptive study of practices with patients in conservative care practices in a French district, the Normandy]. / Étude descriptive des pratiques normandes dans la prise en charge des patients en traitement conservateur.

INTRODUCTION: Renal replacement therapy and renal transplantation can't be considered as the only way to treat old end-stage renal disease patients. Nowadays conservative management has to be considered and proposed as a treatment option to patients with a chronic kidney disease. The aim of this study was to describe nephrologists' practices concerning conservative management care in a French department. MATERIAL AND METHOD: A cross-sectional practices survey has been conducted in 2015. A survey was sent to 66 nephrologists in 14 treatment centers in the Normandy region. RESULTS: 49 of the 66 nephrologists responded to the questionnaire. Among the 48 nephrologists who responded to the questionnaire, 38 out of 48 (79.2%) did not use decision support tools to implement conservative treatment. In all, 42/48 (87.5%) nephrologists did not discuss with their colleagues before providing conservative treatment. Meeting dedicated to the decision of conservative treatment did not exist in any center surveyed in this study. When conservative management was chosen, 34/48 nephrologists (70.8%) discussed end-of-life. And 31/48 nephrologists (64.6%) used the term "death". CONCLUSION: The results of this study show that the course of the patients in conservative treatment is heterogeneous and is not formalized. Improvements are needed to integrate conservative treatment for patients with chronic kidney disease.

Improved Detection and Evaluation of Depression in Patients with Chronic Kidney Disease: Validity and Reliability of Screening (PHQ-2) and Diagnostic (BDI-FS-Fr) Tests of Depression in Chronic Kidney Disease.

OBJECTIVE: Depression is underdiagnosed and thus undertreated. This study aimed to validate the French version of the PHQ-2 (Patient Health Questionnaire-2) and BDF-FS-Fr (Beck Depression Inventory-Fast Screen-France) on patients with chronic kidney disease (CKD) living in France. METHOD: A cross-sectional study was conducted on 109 patients of the Centre universitaire de maladies rénales, Centre Hospi-talier Universitaire (CHU) de Caen (37 patients with CKD on pre-dialysis and grafting stage, 36 grafted patients, and 36 dialyzed patients). STATISTICAL APPROACH: Test parameters and statistical aspects of assessing diagnostic and screening tests were used, including knowledge of and ability to calculate, sensitivity, specificity, positive and negative predictive values, diagnostic odds ratios, and the use of ROC (receiver operating characteristic) curves. RESULTS: PHQ-2 and BDI-FS-Fr statistical parameters for depression tested very positively and had a satisfactory AUC (area under the curve). The PHQ-2 had a satisfactory AUC > 0.70, sensitivity > 0.60, and specificity > 0.80. The BDI-FS-Fr had a satisfactory area under the curve (0.859) with sensitivity (83%) and specificity (0.859); and internal consistency (α = 0.668). The PHQ-2 and BDI-FS-Fr showed good internal and external validity of structure, construct validity, criterion validity, discriminant validity, internal consistency, and factorial validity. CONCLUSION: The French versions of the PHQ-2 and BDI-FS have highly favorable psychometric properties. These instruments are valid self-assessment tools for screening and evaluating depression, its intensity, and its evolution. The PHQ-2 and BDI-FS-Fr thus have very good psychometric properties and are useful tools for researchers and practitioners. Regarding clinical practice in the hospital, clinicians and nurses can use the PHQ-2 to screen quickly for depression during routine consultations, during hospitalization, and in dialysis centers. The 7 items of the BDI-FS-Fr enable us to assess the depressive state, thereby avoiding a false diagnosis of depression among CKD patients in a clinical setting.