[Psychological impact of lockdown and the COVID-19 epidemic on haemodialysis patients and carers in France]

Introduction

La crise sanitaire liée à l’épidémie de COVID-19 a nécessité des mesures de confinement en France et des changements de pratiques dans les centres de dialyse. L’objectif était d’évaluer les symptômes d’anxiété, de dépression et de stress pendant le confinement chez les patients hémodialysés et leurs soignants.

Méthodes

Nous avons adressé, pendant le confinement, entre avril et mai 2020, des autoquestionnaires à des sujets volontaires qui étaient traités par hémodialyse (patients) ou qui travaillaient en hémodialyse (soignants) dans l’un des 14 centres de France participants. Nous avons analysé leur perception des séances de dialyse (bénéfique ou inquiétante), leur niveau de stress (échelle visuelle analogique cotée de 0 à 10), et leur symptomatologie anxieuse et dépressive (échelle Hospital anxiety and depression scale). Les facteurs associés au stress, à l’anxiété et à la dépression ont été analysés avec des modèles de régression linéaire multiple.

Résultats

Parmi les 669 patients et 325 soignants ayant répondu, 70 % trouvaient bénéfique de venir en dialyse pendant le confinement. Les proportions de sujets présentant un niveau de stress ≥ 6 lié à l’épidémie, au confinement, à la peur de contracter la COVID-19 et à la peur de contaminer un proche étaient respectivement de 23,9, 26,2, 33,4 et 42 %. De plus, 39,2 % présentaient une symptomatologie anxieuse certaine (13,7 %) ou douteuse (19,2 %), et 21,2 % présentaient une symptomatologie dépressive certaine (7,9 %) ou douteuse (13,3 %). L’âge, le sexe, les antécédents de troubles psychologiques et la perception des séances de dialyse étaient les facteurs principaux associés aux niveaux de stress, d’anxiété et de dépression.

Conclusion

Pendant le confinement, en France, la majorité des patients et des soignants en hémodialyse ont trouvé bénéfique de venir en séance de dialyse. Un sujet sur trois présentait une symptomatologie anxieuse et un sujet sur cinq présentait une symptomatologie dépressive.

[e-Health in nephrology: 1st French survey on telenephrology]

The number of new patients with chronic kidney diseases strongly increases while the one of nephrologists does not: this is developing new challenges, in which e-health will take a special part. This field is poorly investigated: so, we developed a dedicated survey. Telenephrology is a new approach that includes all what nephrologists can do in their routine practice: especially, telehealth with teleconsulting, telesurvey, and helpline. We also studied their relationship with m-health. The questionnaire was developed and validated by members from the Club des Jeunes Néphrologues and the Société Francophone de Néphrologie, Dialyse et Transplantation: it was then broadcast to all french nephrologists, thru web media. From June to July, 2017, we collected 175 answers: they represented all kinds of practices of the profession. Results show that French nephrologists are connected: most of them are present on social network(s) and/or uses connected objects, mostly for personal reasons. They communicate a lot, between them and/or with patients, mainly via email. Computerized medical records are mostly used in the follow-up of patients on renal dialysis or with chronic kidney diseases. Most of French nephrologists are satisfied by telenephrology but there are still obstacles to its deployment: mainly, technical, administrative, and/or billing difficulties. All should be taken into account to help telenephrology developing. In conclusion, French nephrologists are yet connected but they really need more help again to face new challenges raised by e-health.

[Access to kidney transplantation's waiting list: Setting up a clinical pathway]

Early information about the kidney transplant is recommended to begin quickly the process of registration on the kidney transplantation waiting list, even for the patients not dialyzed at stage V of the renal insufficiency. It is a strategic choice for the patient care. From the arrival of all the patients in our center of dialysis, a systematic evaluation of the access to the kidney transplant waiting list is organized thanks to a clinical pathway. The impact of this new organization was estimated at 18 months with regard to the information about the kidney transplant transmitted to the patient, of the time required for the assessment of pre-kidney transplant evaluation, and of putting in contraindication. On 78 incident patients, 64 received the information concerning the kidney transplant. After 18 months, 50 clinical pathways are finalized at the time of the analysis among which 25 with a period lower than 6 days and 25 with a median of 169 days. A significant difference of age exists between both groups. The main causes of definitive medical contraindications were estimated. Twenty-two percent of the clinical pathway finalized is awaiting lifting of temporary contraindication. The management of the patient is improved, due to motivation of all the medical teams and a considerable work of coordination between the secretarial department and the department of transplantation in teaching hospital.

[Evaluation of information for renal insufficiency patients before dialysis]

The aim of this audit was to assess the quality of information given to patients before dialysis and to improve the use of this information on the acceptability of the treatment. Methods were those used in medical audit: retrospective data collection in a sample of patients, comparison to a set of standards given by professionals and recommendations disseminated in the group of professionals. Results showed that patients received a partial information on the various techniques used in dialysis. More complete information is needed. Recommendations consisted in a specialised team giving a detailed information on the disease and the techniques used in dialysis, with a psychological assistance. After implementation of this team, re-assessment showed a consistent benefit of structured information and entailed the necessity to improve the process of information delivery by general practitioners and specialists.