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Néphrologie & Thérapeutique

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Effects of acoustic treatment of a dialysis room on the quality of life of patients Volume 15, issue 1, Mars 2019

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Authors

Subcellular organelles consist of smaller substructures called supramolecular assemblies and these in turn consist of macromolecules. Various subcellular organelles have critical functions that consist of genetic disorders of organelle biogenesis and several metabolic disturbances that occur during non-genetic diseases e.g. infection, intoxication and drug treatments. Mitochondrial damage can cause renal dysfunction as ischemic acute renal injury, chronic kidney disease progression. Moreover, mitochondrial dysfunction is an early event in aldosterone-induced podocyte injury and cardiovascular disease due to oxidative stress in chronic kidney disease. Elevated production of reactive oxygen species could be able to activate NLRP3 inflammasome representing new deregulated biological machinery and a novel therapeutic target in hemodialysis patients. Peroxisomes are actively involved in apoptosis and inflammation, innate immunity, aging and in the pathogenesis of age related diseases, such as diabetes mellitus and cancer. Peroxisomal catalase causes alterations of mitochondrial membrane proteins and stimulates generation of mitochondrial reactive oxygen species. High concentrations of hydrogen peroxide exacerbate organelles and cellular aging. The importance of proper peroxisomal function for the biosynthesis of bile acids has been firmly established. Endoplasmic reticulum stress-induced pathological diseases in kidney cause glomerular injury and tubulointerstitial injury. Furthermore, there is a link between oxidative stress and inflammations in pathological states are associated with endoplasmic reticulum stress. Proteinuria and hyperglycemia in diabetic nephropathy may induce endoplasmic reticulum stress in tubular cells of the kidney. Due to the accumulation in the proximal tubule lysosomes, impaired function of these organelles may be an important mechanism leading to proximal tubular toxicity.

Cytomegalovirus is common in adult recipients (prevalence of 40–90%). Children are typically seronegative but immunosuppression may prone to primary-infection or viral reactivation, with potentially severe consequences. CMV infection incidence in pediatric kidney transplant recipients has seldom been investigated. The aim of our study was to evaluate the incidence and timing of CMV infection during the first year after renal transplantation. We assembled a retrospective cohort of 136 children who had received a kidney transplant between 2003 and 2014 with a year follow-up. The patients were classified regarding CMV infection as high risk (D+/R−), intermediate risk (R+) or low risk (D−/R−). CMV infection was defined by the viral replication remaining asymptomatic whereas CMV disease concerned viral replication with clinical and/or biological symptoms. Oral valganciclovir was used as prophylaxis for high-risk recipients. A total of 38 patients (27.9%) developed CMV infection, 13 (40.6%) of the 32 D+/R−, 24 (45.3%) of the 53 R+ and 1 (2.0%) of the 51 D−/R−. Of these 38 infected patients, 10 developed tissue-invasive disease. During the first year after kidney transplantation, 27.9% of recipients developed CMV infection. This study confirms the influence of donor and recipient CMV status on infection propensity and highlights the importance of adequate follow-up for intermediate risk patients.

L’altération de la qualité de vie perçue par les patients traités en hémodialyse chronique résulte de nombreux facteurs, parmi lesquels l’environnement de soins. La réglementation en vigueur a sensiblement amélioré les conditions d’accueil et de traitement des patients, mais une attention, peut-être insuffisante, a été apportée aux nuisances sonores liées aux équipements de dialyse. Il nous est donc apparu utile de conduire une étude sur les paramètres acoustiques en salle de dialyse, et d’évaluer les effets sur la qualité de vie perçue d’un traitement acoustique destiné à réduire le niveau de bruit ambiant. Après des mesures réalisées en conditions standard, des dispositifs adaptés d’absorption du bruit (panneaux et claustras) ont été installés dans une salle de traitement de 8 postes, accueillant 32 patients volontaires, et leurs effets évalués par un questionnaire de qualité de vie administré à 3 reprises (avant l’installation, au terme d’une semaine, et après le retrait des dispositifs), chaque patient étant son propre témoin. Les mesures du bruit ambiant pendant les périodes de dialyse et une modélisation numérique de la salle ont été effectuées en parallèle afin de rechercher des corrélations entre les modifications subjectives exprimées par les patients et les critères quantitatifs du bruit. Les résultats montrent que de tels dispositifs permettent de réduire significativement la gêne acoustique perçue et leurs conséquences (céphalées), et suggèrent que ces améliorations sont dues à l’homogénéisation fréquentielle du temps de réverbération dans la salle et à la réduction des composantes basses fréquences induites par les différentes sources de bruit identifiées.

The impairment of quality of life experienced by patients treated with chronic hemodialysis results from many factors, including the care environment. Current regulations have significantly improved reception and treatment conditions for patients, but perhaps insufficient attention has been paid to the noise nuisance associated with dialysis equipment. We therefore found it useful to conduct a study on acoustic parameters in the dialysis room, and to evaluate the effects on perceived quality of life of an acoustic treatment intended to reduce the level of ambient noise. After measurements carried out under standard conditions, adapted noise absorption (devices panels and trellis) were installed in a treatment room of 8 posts hosting 32 volunteer patients, and their effects evaluated by a quality of life questionnaire administered 3 times (before, at the end of one week, and after the removal of the devices), each patient being his own witness. Measurements of ambient noise during dialysis periods and numerical modeling of the room were performed in parallel in order to search for correlations between the subjective changes expressed by the patients and the quantitative noise criteria. The results show that such devices can significantly reduce the perceived acoustic discomfort and their consequences (headaches), and suggest that these improvements are due to the frequential homogenization of the reverberation time in the room and the reduction of the low frequency components induced by the different sources of noise identified.