Nurse-assisted arterio-venous fistula cannulation during home hemodialysis: first results of the DIADIDEAL study / La ponction de fistule assistée par infirmier libéral en hémodialyse à domicile : premiers résultats de l'étude DIADIDEAL.

Introduction: We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients. The aim of the present study was to describe enrollment of the patients and their nurses. Materials: All prevalent HD patients on 30th November 2018 with no medical contraindication to HDD treatment and all incident patients on dialysis from the 30th November 2018 to the 21st April 2023 were eligible. Results: Among 155 prevalent HD patients, 4 patients were included. Among the 276 incident patients on dialysis during the study period, 6 were included. We have phoned 23 nurse centers during the recruitment period. Eight of them agreed to learn in our unit how to cannulate AVF; 27 private nurses were enrolled. Discussion: The results of the DIADIDEAL study will be available in 2024; we hope it will lead to a reimbursement of nurse-AVF cannulation at home in HDD.

Introduction: L'étude DIADIDEAL est une étude pilote sur la ponction de fistule artério-veineuse (FAV) assistée par infirmier libéral en hémodialyse à domicile (HDD). L'objectif de l'étude actuelle est de rapporter le recrutement des patients et de leurs infirmiers diplômés d'État libéraux (IDEL). Matériels et méthodes: Tous les patients prévalents en HD au 30 novembre 2018 n'ayant pas de contre-indication médicale à un traitement par HDD ainsi que tous les patients incidents en dialyse du 30 novembre 2018 au 21 avril 2023 étaient éligibles. Résultats: Parmi les 155 patients prévalents en hémodialyse, 4 ont été inclus. Parmi les 276 patients incidents en dialyse sur la période, 6 ont été inclus dans l'étude. Parmi les 23 cabinets IDEL contactés pour l'étude, 8 ont accepté et 27 IDEL ont été formés à la ponction de FAV. Discussion: Les résultats de l'étude DIADIDEAL seront disponibles en 2024 et viseront à obtenir une nomenclature pour l'acte de ponction de FAV par les IDEL.

Early diagnosis of chronic kidney disease in patients with diabetes in France: multidisciplinary expert opinion, prevention value and practical recommendations.

Diabetes is the leading cause of end-stage kidney disease (ESKD), accounting for approximately 50% of patients starting dialysis. However, the management of these patients at the stage of chronic kidney disease (CKD) remains poor, with fragmented care pathways among healthcare professionals (HCPs). Diagnosis of CKD and most of its complications is based on laboratory evidence. This article provides an overview of critical laboratory evidence of CKD and their limitations, such as estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), Kidney Failure Risk Equation (KFRE), and serum potassium. eGFR is estimated using the CKD-EPI 2009 formula, more relevant in Europe, from the calibrated dosage of plasma creatinine. The estimation formula and the diagnostic thresholds have been the subject of recent controversies. Recent guidelines emphasized the combined equation using both creatinine and cystatin for improved estimation of GFR. UACR on a spot urine sample is a simple method that replaces the collection of 24-hour urine. Albuminuria is the preferred test because of increased sensitivity but proteinuria may be appropriate in some settings as an alternative or in addition to albuminuria testing. KFRE is a new tool to estimate the risk of progression to ESKD. This score is now well validated and may improve the nephrology referral strategy. Plasma or serum potassium is an important parameter to monitor in patients with CKD, especially those on renin-angiotensin-aldosterone system (RAAS) inhibitors or diuretics. Pre-analytical conditions are essential to exclude factitious hyperkalemia. The current concept is to correct hyperkalemia using pharmacological approaches, resins or diuretics to be able to maintain RAAS blockers at the recommended dose and discontinue them at last resort. This paper also suggests expert recommendations to optimize the healthcare pathway and the roles and interactions of the HCPs involved in managing CKD in patients with diabetes.

[Towards real progress for advanced practice nurses thanks to Rider 9]. / Vers de réelles avancées pour les infirmiers en pratique avancée grâce à l'avenant 9.

The national agreement for nurses organizes the relationship between these professionals and the Health Insurance. An amendment was signed on July 27, 2022, leading to the implementation of a new billing system on March 23, 2023. Two types of pathways are now possible: "Patients followed" and "Occasional patients" with, for each, two types of billing. After a few months of implementation, the production and analysis of quantitative and qualitative data will be necessary for possible readjustment.

[The ANFIPA in practice: the example of the chronic kidney disease, dialysis, transplant college]. / L'Anfipa en pratique : exemple du collège Maladie rénale chronique, dialyse, transplantation.

The French association of advanced practice nurses (anfipa) is actively participating in setting up advanced practice across the country. Colleges are places of interaction and work for advanced practice nurses and students. Highlighting missions of this college enables us to create places of discussion and exchanges in the field, and to take part in the rollout of this new profession.

[The advanced practice nurse and chronic renal patients]. / L'infirmier en pratique avancée et les malades rénaux chroniques.

In the course of his life, a patient with chronic kidney disease will have to hear the announcement of a diagnosis, live with a pathology for which there is no hope of cure, undergo a multitude of tests and, finally, choose a mode of substitution (dialysis and/or transplantation). The advanced practice nurse has a role to play in bringing added value to these patients. In this function lies a constant questioning of his practices, a development of his intellectual curiosity in the service of patients.

[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.

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.

[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.