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Abstract Background and Aims : Dialysis patients faced a high risk of COVID-19 during the pandemic, but data on health-related quality of life (HR-QoL) were limited to early pandemic phases and inconclusive. These insights, however, are needed to evaluate the impact of public health interventions on vulnerable patient populations. We therefore studied the HR-QoL and symptom burden of dialysis patients in both early and later phases of the COVID-19 pandemic, and explored effects of lockdowns, COVID-19 infections and vaccinations. Method The Dutch Dialysis Registry routinely collects the HR-QoL and symptom burden of dialysis patients. The SF-12 health survey measures the HR-QoL by calculating physical (PCS) and mental (MCS) component summary scores (0–100, higher scores indicate better HR-QoL). The Dialysis Symptom Index captures 30 symptoms in a sum of symptom burden (0–120, higher scores indicate higher burden). The HR-QoL and symptom burden from pandemic periods were compared with a pre-pandemic period (Fig. 1), using mixed models and negative binomial regression. We explored mediation by adjusting for COVID-19 infections and vaccinations, evaluating percentual changes of effect estimates. Results 22,355 questionnaires from 5,495 patients were analyzed. In the pre-pandemic period, mean PCS and MCS scores were 36 ± 10 and 48 ± 10 and the median symptom burden was 17 [IQR: 9–28]. PCS scores improved during the first lockdown (+1.12 [95% CI: 0.47, 1.77]) but worsened in the Omicron period (−0.59 [−1.05, −0.14]) (Fig. 2). MCS scores worsened during Delta (−1.25 [−1.77, −0.73]) and Omicron periods (−1.46 [−1.97, −0.96]). The symptom burden improved during the first (−11.7% [−18.2, −4.7]) and the second (−6.9% [−12.0, −1.5]) lockdown. COVID-19 infections and vaccinations explained most of the lower PCS scores observed during Delta (77%) and Omicron periods (56%). Conclusion The HR-QoL and symptom burden of the Dutch dialysis population fluctuated throughout the COVID-19 pandemic. Outcomes improved during lockdowns but worsened with the emergence of new COVID-19 variants and relaxation of protective measures. In future pandemics, vulnerable populations may benefit from the sustained implementation and promotion of mitigating interventions, such as vaccination, personal protective measures, and rehabilitation, particularly when nationwide regulations are released.

This article investigates the written representation of orality in Faïza Guène's novel Kiffe kiffe demain. The novel gives an insight into the lives of residents in the Parisian banlieue suburbs, whose everyday lives are plagued by poverty and social anxiety. What is striking here is the frequent use of spoken language elements, which are not limited to discourse passages; they also continuously appear in the frame narrative, presented from the point of view of Doria, a fifteen-year-old Franco-Moroccan girl. After a short introduction, the article seeks to give a definition of the language under analysis, which will be defined as parler (jeune) des cités. This definition is largely based on Marchessou's (2018, 267) term contemporary urban vernacular. Subsequently, the article will delve into more detail about the linguistic peculiarities of this variety, the author, the corpus, and the methodology, before analyzing the results of the evaluation and the distribution of the linguistic phenomena in the narrative and discourse. It will be shown that the author integrates elements of spoken language into her novel using various linguistic and stylistic techniques in order to portray the world of the fifteen-year-old protagonist's thoughts and her environment in an authentic way. This integration is achieved on a lexical, syntactic, morphological, and pragmatic level, including the orthographic adaption of certain French lexemes to mimic Arabic accents in French. Special attention is also given to the cultural context of the novel's characters, exemplified by the use of eye dialect.

Abstract Background and Aims Access to individualized, evidence-based prognostics is needed to facilitate shared decision making about the clinical implications of whether to opt for kidney transplantation or long-term dialysis. We aim to implement a data-driven support tool (Nierkeuze.nl) that incorporates basic patient characteristics and treatment options. Method Consecutive patients (N = 14.275) above 18 years of age with end-stage-renal-disease (ESRD) who were eligible candidates for their first kidney transplantation and started renal replacement therapy between 2000 and 2019 were included from the national registries RENINE and NOTR. SF-12 quality of life data was obtained from RENINE and a local transplant database. Several algorithms were developed to predict waiting time, short- and long-term patient survival, graft survival, and quality of life according to factors that are known at ESRD. Probabilities of 3- and 5-year mortality were calculated using two-stage distinct Cox regression: 1) waitlist-mortality according to median time on the waiting list, 2) mortality after transplantation in remaining follow-up. Product and complement rules defined the final probabilities. No mortality on the waiting list was assumed for living donor transplants. Missing data were imputed. Model performance was evaluated by internally validated C-statistics and calibration plots. Results We included 4.889 deceased donor transplants, of which 990 were within the Eurotransplant Senior allocation Program (ESP), and 6.251 living donor transplants. Discrimination varied for patient survival models (C-stats: 0.68 deceased-ETKAS-TX; 0.58 for deceased-ESP-TX; 0.74 for living-TX; 0.64 for waitlisted-candidates). Survival models achieved good calibration by visual inspection across the range of predicted probabilities. Figure 1 illustrates a clear 5-year survival benefit of transplantation (living and deceased donor groups) compared with wait-listed candidates for a 65-year-old male with glomerulonephritis. Other developed algorithms of the support tool will be presented with an overview of the first experiences in the kidney failure clinic. Conclusion Nierkeuze.nl depicts the influence of anticipated waiting time, patient characteristics, kidney allocation program, and donor type on survival outcome of the different treatment options. Incorporating this individualized quantitative outcome information may provide valuable support for an informed choice by patients and potential living donors.

Abstract Background and Aims A growing number of patients suffers from End Stage Kidney Disease(ESKD), causing a logistical and economic burden to the healthcare system. Utilization of home dialysis is low in many countries worldwide, although home dialysis has several advantages including higher quality of life and possibly lower costs. The aim of this study is to explore time trends in the use of home dialysis in the Netherlands. Method Anonymized registry data from the Dutch Renal Registry (RENINE) were used for this study. All dialysis episodes of adult patients who started dialysis treatment between 1997 through 2016 in the Netherlands were included, including those who previously underwent kidney transplantation. Dialysis episodes shorter than 90 days were excluded. The probability of starting home dialysis between 1997 through 2016 was evaluated in time periods of 5 years, using logistic regression analysis. Home dialysis was defined as start with peritoneal dialysis or home haemodialysis, or transfer to either within 2 years after dialysis start. A logistic multilevel model was used to adjust for clustering at patient level. The cumulative incidence function of start of home dialysis in incident patients was estimated with a competing risk model with recovery of kidney function, kidney transplantations, and all-cause mortality as competing events. All analyses were stratified for age categories at dialysis start: 20-44 years, 45-64 years, 65-74 years and ≥75 years. Results A total of 33,340 dialysis episodes in 31,569 patients were evaluated. Between 1997 and 2016, mean age at start of dialysis treatment increased from 62.5±14.0 to 65.5±14.5 years in in-centre haemodialysis patients, whereas it increased from 51.9±15.1 to 62.5±14.6 years in home dialysis patients. In patients < 65 years, the probability of starting home dialysis was significantly lower during each 5-year period compared to the previous period, and kidney transplantation occurred more often. In patients ≥ 65 years, incidence of home dialysis remained constant, whereas mortality decreased. Conclusion In patients < 65 years, the overall probability of starting home dialysis declined consistently over the past 20 years. The age of home dialysis patients increased more rapidly than that of in-centre dialysis patients, implying that pre-dialysis education and organization of home dialysis must be adapted to the needs of the elderly patient. These developments have a significant impact on the organisation of home dialysis for patients with ESKD.

A funnel plot is a graphical method to evaluate health‐care quality by comparing hospital performances on certain outcomes. So far, in nephrology, this method has been applied to clinical outcomes like mortality and complications. However, patient‐reported outcomes (PROs; eg, health‐related quality of life [HRQOL]) are becoming increasingly important and should be incorporated into this quality assessment. Using funnel plots has several advantages, including clearly visualized precision, detection of volume‐effects, discouragement of ranking hospitals and easy interpretation of results. However, without sufficient knowledge of underlying methods, it is easy to stumble into pitfalls, such as overinterpretation of standardized scores, incorrect direct comparisons of hospitals and assuming a hospital to be in‐control (ie, to perform as expected) based on underpowered comparisons. Furthermore, application of funnel plots to PROs is accompanied by additional challenges related to the multidimensional nature of PROs and difficulties with measuring PROs. Before using funnel plots for PROs, high and consistent response rates, adequate case mix correction and high‐quality PRO measures are required. In this article, we aim to provide insight into the use and interpretation of funnel plots by presenting an overview of the basic principles, pitfalls and considerations when applied to PROs, using examples from Dutch routine dialysis care.

BackgroundPatient-reported outcome measures (PROMs) are becoming increasingly important in healthcare. In nephrology, there is no agreement on which chronic kidney disease (CKD) symptom questionnaire to use. Therefore, the aim of this study is to select a valid symptom questionnaire for routine assessment in patients with advanced CKD.MethodsA four-phase mixed methods approach, using qualitative and quantitative research methods, was applied. First, a systematic literature search was conducted to retrieve existing symptom questionnaires. Second, a symptom list was created including all symptoms in existing questionnaires and symptoms mentioned in interviews with patients with CKD, from which symptom clusters were identified. Next, questionnaires were selected based on predefined criteria regarding content validity. Last, two online feedback panels of patients with CKD (n = 151) and experts (n = 6) reviewed the most promising questionnaires.ResultsThe literature search identified 121 questionnaires, of which 28 were potentially suitable for symptom assessment in patients with advanced CKD. 101 unique symptoms and 10 symptom clusters were distinguished. Based on predefined criteria, the Dialysis Symptom Index (DSI) and Palliative Care Outcome Scale-Renal Version (IPOS-Renal) were selected and reviewed by feedback panels. Patients needed 5.4 and 7.5 min to complete the DSI and IPOS-Renal, respectively (p < 0.001). Patients experienced the DSI as more specific, complete and straightforward compared to the IPOS-Renal.ConclusionsThe DSI was found to be valid and reliable, the most relevant, complete, and comprehensible symptom questionnaire available for routine assessment in patients with advanced CKD. Routine PROMs collection could be of great value to healthcare, both at individual patient and national level. Feedback on scores and involvement of healthcare providers may promote adaptation and implementation in healthcare.

To examine international time trends in the incidence of renal replacement therapy (RRT) for end-stage renal disease (ESRD) by primary renal disease (PRD). Renal registries reporting on patients starting RRT per million population for ESRD by PRD from 2005 to 2014, were identified by internet search and literature review. The average annual percentage change (AAPC) with a 95% confidence interval (CI) of the time trends was computed using Joinpoint regression. There was a significant decrease in the incidence of RRT for ESRD due to diabetes mellitus (DM) in Europe (AAPC = -0.9; 95%CI -1.3; -0.5) and to hypertension/renal vascular disease (HT/RVD) in Australia (AAPC = -1.8; 95%CI -3.3; -0.3), Canada (AAPC = -2.9; 95%CI -4.4; -1.5) and Europe (AAPC = -1.1; 95%CI -2.1; -0.0). A decrease or stabilization was observed for glomerulonephritis in all regions and for autosomal dominant polycystic kidney disease (ADPKD) in all regions except for Malaysia and the Republic of Korea. An increase of 5.2-16.3% was observed for DM, HT/RVD and ADPKD in Malaysia and the Republic of Korea. Large international differences exist in the trends in incidence of RRT by primary renal disease. Mapping of these international trends is the first step in defining the causes and successful preventative measures of CKD.

Survival of expanded criteria donor (ECD) kidneys and their recipients has not been thoroughly evaluated in Europe. Therefore, we compared the outcome of ECD and non-ECD kidney transplantations in a Dutch cohort, stratifying by age and diabetes. In all first Dutch kidney transplants in recipients ≥18years between 1995 and 2005, both relative risks (hazard ratios, HR) and adjusted absolute risk differences (RD) for ECD kidney transplantation were analysed. In 3062 transplantations [recipient age 49.0 (12.8)years; 20% ECD], ECD kidney transplantation was associated with graft failure including death [HR 1.62 (1.44-1.82)]. The adjusted HR was lower in recipients ≥60years of age [1.32 (1.07-1.63)] than in recipients 40-59years [1.71 (1.44-2.02) P=0.12 for comparison with ≥60years] and recipients 18-39years [1.92 (1.42-2.62) P=0.03 for comparison with ≥60years]. RDs showed a similar pattern. In diabetics, the risks for graft failure and death were higher than in the nondiabetics. ECD kidney grafts have a poorer prognosis than non-ECD grafts, especially in younger recipients (<60years), and diabetic recipients. Further studies and ethical discussions should reveal whether ECD kidneys should preferentially be allocated to specific subgroups, such as elderly and nondiabetic individuals.

It is a well-known fact that chronic dialysis patients have a markedly increased mortality compared to the general population. In a recently published analysis of the European Renal Association–European Dialysis and Transplant Association Registry, the mortality rate in incident dialysis patients was 192 per 1000 person-years, while it was only 12.05 in the general population [1]. Despite the emphasis on the importance of accelerated atherosclerosis and cardiovascular death in dialysis patients [2], the excess mortality in them was due to both cardiovascular (39%) and noncardiovascular (51%) causes. The distribution of the causes of death was not different from that in the general population. The standardized mortality ratio for cardiovascular death was 42.9 in dialysis patients compared to 4.9 in the general population. For non-cardiovascular death, these figures were 57.1 and 7.0. This ‘normal’ distribution of mortality causes may lead to a different view on risk factors for mortality in dialysis patients. Also, factors that have been linked to cardiovascular death are often associated with non-cardiovascular mortality. This has been found for C-reactive protein [3], fetuin A [4] and possibly troponin T [5], making it likely that death from various causes is often associated with the presence of an acute-phase reaction.