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3. Répercussions psychologiques du confinement et de l’épidémie à COVID-19 chez les patients et soignants en hémodialyse en France

Author

Guerraoui, Abdallah, Idier, Laetitia, Hallonet, Patrick, Dolley-Hitze, Thibault, Gosselin, Morgane, Duneau, Gabrielle, Vendrely, Benoît, Hirigoyen, Marie-Dorothée, Azzouz, Lynda, Bouillier, Marc, Pelletier, Solenne, Fouque, Denis, Fessi, Hafedh, De-Precigout, Valérie, Vigneau, Cécile, Kolko, Anne, Pinçon, Émilie, Duquennoy, Simon, Delezire, Arnaud, Chantrel, François, Combe, Christian, Chauveau, Philippe, Caillette-Beaudoin, Agnès, Lasseur, Catherine, and Prézelin-Reydit, Mathilde

Published
2021
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24. Wasting in chronic kidney disease: Refeeding techniques and artificial nutrition practices

Author

Pasian, Céline, Azar, Raymond, Fouque, Denis, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)

Subjects
[SDV]Life Sciences [q-bio]
Abstract

International audience; Protein energy wasting (PEW) is an independent factor associated with morbi-mortality in chronic kidney disease. Wasting is particularly common in chronic diseases of organs such as kidney disease with a major impact at the stage of dialysis. It covers 20 to 70% of patients diagnosed with chronic kidney disease according to the degree of evolution of the disease and the diagnostic method used patients. Mechanisms of PEW are based mainly on anorexia and metabolic abnormalities caused by kidney disease. Nutritional treatment differs depending on the stage of the kidney disease acute or chronic treated whether or not by dialysis. Nutritional monitoring should be regular, individualized and collaborative to detect a risk of PEW or treat installed PEW. Refeeding techniques should allow all the nutritional needs. Their indications depend on the clinic, biochemical assessment and nutrient intake.; La dénutrition protéino-énergétique (DPE) est un facteur indépendant aggravant la mortalité et la morbidité dans les pathologies rénales chroniques. La dénutrition est particulièrement fréquente lors de pathologies chroniques d’organes telles que l’insuffisance rénale, avec une incidence majeure au stade de la dialyse. Elle concerne 20 à 70 % des patients porteurs d’une maladie rénale chronique selon le degré d’évolution de la maladie et la méthode de diagnostic utilisée. Les mécanismes de la DPE reposent principalement sur l’anorexie et les anomalies métaboliques provoquées par l’insuffisance rénale. Les thérapeutiques nutritionnelles diffèrent suivant le stade de l’insuffisance rénale chronique ou aiguë, traitée ou non par épuration extrarénale. Le suivi nutritionnel doit être régulier, individualisé et collaboratif afin de diagnostiquer un risque de DPE ou de traiter une DPE installée. Les techniques de renutrition doivent permettre la couverture de l’ensemble des besoins nutritionnels. Leurs indications dépendent de la clinique, de la biologie plasmatique et des apports nutritionnels spontanés.

Published
2016

25. Indications du dosage de la 25-hydroxyvitamine D [Recommendations for the measurement of blood 25-OH vitamin D]

Author

Souberbielle, Jean-Claude, Deschênes, Georges, Fouque, Denis, Groussin, Lionel, Guggenbuhl, Pascal, Jean, Guillaume, Linglart, Agnès, Thomas, Thierry, Jonchère, Laurent, Explorations fonctionnelles, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Néphrologie Pédiatrique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre de Rein Artificiel, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Robert Debré, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), CHU Cochin [AP-HP], Service de rhumatologie, Hôpital Sud, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)

Subjects
clinical biology, [SDV] Life Sciences [q-bio], 25-hydroxyvitamin D assay, [SDV]Life Sciences [q-bio], Haute autorité de santé, Vitamin D
Abstract

National audience; The 25-hydroxyvitamin D (25OHD) serum concentration should not be measured to everybody but recommendations for this measurement in several clinical situations are available from numerous guidelines and expert positions. It can be proposed to measure 25OHD in diseases where a target range of 25OHD concentrations associated with better outcomes is defined with a sufficient level of evidence, and when this target concentration is difficult to reach without previous measurement (or may be exceeded in case of too large doses are provided). Many National and International Medical Societies recommend to measure 25OHD at least in any situation of « bone fragility » (defined by a low bone mineral density and/or a low energy fracture), in malabsorptions, in chronic kidney disease, in any « phosphocalcic pathology, in patients with clinical signs of profound vitamin D deficiency or excess, and, more generally in any biological exploration of calcium/phosphorus metabolism that includes the measurement of PTH. Although these recommandations may seem discordant with the recent French restriction in the reimbursment of 25OHD measurement, they may still be reimbursed.

Published
2016

27. Ostéopathies fragilisantes, maladie rénale chronique, malabsorptions, anomalies biologiques du métabolisme phosphocalcique : les bonnes indications pour un remboursement raisonné du dosage de vitamine D [Weakening osteopathies, chronic kidney disease, malabsorption, biological anomalies of calium/phosphorus metabolism: appropriate indications for a reasoned reimbursment of serum vitamin D measurement]

Author

Souberbielle, Jean-Claude, Benhamou, Claude-Laurent, Cortet, Bernard, Rousière, Mickael, Roux, Christian, Abitbol, Vered, Annweiler, Cédric, Audran, Maurice, Bacchetta, Justine, Bataille, Pierre, Beauchet, Olivier, Bardet, Rémi, Benachi, Alexandra, Berenbaum, Francis, Blain, Hubert, Borson-Chazot, Françoise, Breuil, Véronique, Briot, Karine, Brunet, Philippe, Carel, Jean-Claude, Caron, Philippe, Chabre, Olivier, Chanson, Philippe, Chapurlat, Roland, Cochat, Pierre, Coutant, Régis, Christin-Maitre, Sophie, Cohen-Solal, Martine, Combe, Christian, Cormier, Catherine, Courbebaisse, Marie, Debrus, Grégory, Delemer, Brigitte, Deschênes, Georges, Duquenne, Marc, Fardellone, Patrice, Fouque, Denis, Friedlander, Gérard, Gauvain, Jean-Bernard, Groussin, Lionel, Guggenbuhl, Pascal, Houillier, Pascal, Hannedouche, Thierry, Jacot, William, Javier, Rose-Marie, Jean, Guillaume, Jeandel, Claude, Joly, Dominique, Kamenicky, Peter, Knebelmann, Bertrand, Lafage-Proust, Marie-Hélène, Lebouc, Yves, Legrand, Erick, Levy-Weil, Florence, Linglart, Agnès, Machet, Laurent, Maheu, Emmanuel, Mallet, Eric, Marcelli, Christian, Mares, Pierre, Mariat, Christophe, Maruani, Gérard, Maugars, Yves, Montagnon, France, Moulin, Bruno, Orcel, Philippe, Partouche, Henri, Personne, Virginie, Pierrot-Deseilligny, Charles, Polak, Michel, Pouteil-Noble, Claire, Prié, Dominique, Raynaud-Simon, Agathe, Rolland, Yves, Sadoul, Jean-Louis, Salle, Bernard, Sault, Corinne, Schott, Anne-Marie, Sermet-Gaudelus, Isabelle, Soubrier, Martin, Tack, Ivan, Thervet, Eric, Tostivint, Isabelle, Touraine, Philippe, Trémollières, Florence, Urena-Torres, Pablo, Viard, Jean-Paul, Wemeau, Jean-Louis, Weryha, Georges, Winer, Norbert, Young, Jacques, Thomas, Thierry, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de rhumatologie[Lille], Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Cochin [AP-HP], Département de gastroentérologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de médecine interne et gérontologie clinique [Angers], Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Groupe d'Études Remodelage Osseux et bioMatériaux (GEROM), Université d'Angers (UA), COREVIH Nord Pas-de-Calais, Centre Hospitalier de Tourcoing, Néphrologie Hémodialyse, Centre hospitalier de Boulogne sur mer, Département de Médecine Interne et Gérontologie clinique, Centre Hospitalier Universitaire d'Angers (CHU Angers), Service de gynécologie-obstétrique, médecine de la reproduction [Béclère], Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Euromov (EuroMov), Université de Montpellier (UM), Eq 4, Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Groupement Hospitalier Lyon-Est (GHE), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL)-Centre de médecine nucléaire, Fédération d'endocrinologie-Groupement hospitalier Lyon-Est-Fédération d'endocrinologie-Groupement hospitalier Lyon-Est, Service de rhumatologie, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Caractérisation du Tissu Osseux par Imagerie : techniques et applications, Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Neuroprotection du Cerveau en Développement / Promoting Research Oriented Towards Early Cns Therapies (PROTECT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7), Service d'Endocrinologie Diabétologie Pédiatrique et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Hôpital Robert Debré, Service d'Endocrinologie (TOULOUSE - Endocrino), CHU Toulouse [Toulouse], Biologie du Cancer et de l'Infection (BCI ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Récepteurs stéroïdiens : physiopathologie endocrinienne et métabolique, Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR93-Université Paris-Sud - Paris 11 (UP11), Physiopathologie, diagnostic et traitements des maladies osseuses / Pathophysiology, Diagnosis & Treatments of Bone Diseases (LYOS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Pédiatrie, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Endocrinologie pédiatrique[CHU Angers], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Physiopathologie des maladies génétiques d'expression pédiatrique, Os et articulations, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fibrose hépatique et cancer du foie, Université Bordeaux Segalen - Bordeaux 2-IFR66-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Néphrologie-transplantation-dialyse [Bordeaux], CHU Bordeaux [Bordeaux], Centre de recherche Croissance et signalisation (UMR_S 845), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5), Néphrologie, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service d'Endocrinologie - Diabète - Nutrition [Reims], Université de Reims Champagne-Ardenne (URCA)-Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Unité de Néphrologie Pédiatrique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré, Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de médecine gériatrique, Centre Hospitalier Régional d'Orléans (CHRO), Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Service de Physiologie [Georges-Pompidou], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5), Institut de recherche en cancérologie de Montpellier (IRCM - U896 Inserm - UM1), Université Montpellier 1 (UM1)-CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université Montpellier 1 (UM1), Centre de Lutte contre le Cancer, Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER-UNICANCER-CHU Clermont-Ferrand, Service d'Endocrinologie et Maladies de la reproduction, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Tissu Osseux et Contraintes Mecaniques (LBTO), Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Immunologie et génétique du diabète de type 1, génétique multifactorielle en endocrinologie pédiatrique (U986), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de référence des maladies rares du calcium et du phosphore, CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Service de Rhumatologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de gynécologie obstétrique, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de Rhumatologie, Hôtel-Dieu, Service de Néphrologie et Transplantation, CHU Strasbourg, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Service de neurologie 1 [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de néphrologie et transplantation, Gérontopôle, Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse], Service d'Endocrinologie (NICE - Endocrino), Centre Hospitalier Universitaire de Nice (CHU Nice), Département d'information médicale, Hospices Civils de Lyon (HCL)-Université de Lyon, CHU Clermont-Ferrand, CHU Gabriel Montpied [Clermont-Ferrand], Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Service des explorations physiologiques, CHU Toulouse [Toulouse]-Hôpital de Rangueil, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-CHU Necker - Enfants Malades [AP-HP], CHU Pitié-Salpêtrière [AP-HP], Université Pierre et Marie Curie - Paris 6 (UPMC), Centre de ménopause, Hôpital Paule de Viguier, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Centre de Diagnost ic et de Thérapeutique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôtel-Dieu, Service d'Endocrinologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Gynécologie Obstétrique (NANTES - Gynéco Obstétrique), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Gustave Roussy (IGR), Service d'endocrinologie, PRES Université Nantes Angers Le Mans (UNAM), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Centre Hospitalier Boulogne-sur-mer, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service Endocrinologie, maladies métaboliques et nutrition [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Paris-Sud - Paris 11 (UP11)-IFR93-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Nutrition [Cergy] (N - cabinet libéral ), Centre Hospitalier Le Mans (CH Le Mans), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre de Rein Artificiel [Tassin la demi-lune] (CRA), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Trousseau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Victor Dupouy, Normandie Université (NU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Cabinet de Rhumatologie [Saint-Etienne] (CdR), Hôpital Lariboisière-Fernand-Widal [APHP], Département de Médecine Générale, Université Paris Cité (UPCité), CIC Hôpital Bichat, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine, Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Académie nationale de médecine, Eurofins Biomnis, Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Obstétrique [CHU Toulouse], Pôle Femme-Mère-Couple [CHU Toulouse], Clinique du Landy [Saint-Ouen] (CL), Hôpital Hôtel-Dieu [Paris], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupement Hospitalier Lyon-Est (GHE), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Picardie Jules Verne (UPJV), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Roger Salengro-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), CHU Cochin [AP-HP], Université d'Angers ( UA ) -CHU Angers, Remodelage osseux et biomatériaux, Université d'Angers ( UA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU Angers, Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Antoine Béclère, Centre de Recherche Saint-Antoine ( CR Saint-Antoine ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ), Department of Geriatrics - Efficiency and Deficiency Laboratory, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Centre de Recherche en Cancérologie de Lyon ( CRCL ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Groupement Hospitalier Lyon-Est ( GHE ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ) -Centre de médecine nucléaire, CHU Nice-Hôpital l'Archet, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Hôpital de la Conception [CHU - APHM] ( LA CONCEPTION ), Promoting Research Oriented Towards Early Cns Therapies ( PROTECT ), Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Paris Diderot - Paris 7 ( UPD7 ), Service d'Endocrinologie ( TOULOUSE - Endocrino ), Biologie du Cancer et de l'Infection ( BCI - UMR S1036 ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Grenoble Alpes ( UGA ), Université Paris-Sud - Paris 11 ( UP11 ) -IFR93-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Physiopathologie, diagnostic et traitements des maladies osseuses / Pathophysiology, Diagnosis & Treatments of Bone Diseases ( LYOS ), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Diabétologie et Endocrinologie de la Reproduction, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Bordeaux Segalen - Bordeaux 2-IFR66-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de recherche Croissance et signalisation ( UMR_S 845 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Université de Reims Champagne-Ardenne ( URCA ) -Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims ( CHU Reims ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Robert Debré, Université de Picardie Jules Verne ( UPJV ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Cardiovasculaire, métabolisme, diabétologie et nutrition ( CarMeN ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hospices Civils de Lyon ( HCL ) -Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Institut National de la Recherche Agronomique ( INRA ), Centre Hospitalier Régional d'Orléans ( CHR ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Sud, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ) -Université Paris Descartes - Paris 5 ( UPD5 ), Institut de recherche en cancérologie de Montpellier ( IRCM - U896 Inserm - UM1 ), Université Montpellier 1 ( UM1 ) -CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM ), Centre de gérontologie clinique, Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), CHU Clermont-Ferrand-Centre Jean Perrin, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, Tissu Osseux et Contraintes Mecaniques ( LBTO ), Université Jean Monnet [Saint-Étienne] ( UJM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Immunologie et génétique du diabète de type 1, génétique multifactorielle en endocrinologie pédiatrique ( U986 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), AP-HP, Service de Rhumatologie, CHU Saint-Antoine [APHP], CHU Caen, Hôpital Universitaire Carémeau [Nîmes], Service de néphrologie et tranplantation, CHU Saint-Etienne-Hôpital nord, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université de Lyon-Université de Lyon-Hospices Civils de Lyon ( HCL ) -Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ), Gérontopôle de Toulouse, Service d'Endocrinologie ( NICE - Endocrino ), CHU Nice, Hospices Civils de Lyon ( HCL ) -Université de Lyon, CHU Gabriel Montpied ( CHU ), Institut des Maladies Métaboliques et Cardiovasculaires ( I2MC ), Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ) -CHU Necker - Enfants Malades [AP-HP], Department of Endocrinology and Reproductive Medicine, CHU Pitié-Salpêtrière [APHP]-Centre de Référence des Maladies Endocriniennes rares de la croissance et des maladies gynécologiques rares, Université Pierre et Marie Curie - Paris 6 ( UPMC ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôtel-Dieu, Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Service de Gynécologie Obstétrique ( NANTES - Gynéco Obstétrique ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), Institut Gustave Roussy ( IGR ), Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, Hôpital Roger Salengro-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Antoine Béclère, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Centre de Recherche en Cancérologie de Lyon (CRCL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Groupement Hospitalier Lyon-Est (GHE), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION ), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA)-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Robert Debré, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Centre Hospitalier Régional d'Orléans (CHR), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5), CRLCC Val d'Aurelle - Paul Lamarque-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 1 (UM1), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], CHU Gabriel Montpied (CHU), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Descartes - Paris 5 (UPD5)-CHU Necker - Enfants Malades [AP-HP], CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôtel-Dieu, and Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre

Subjects
MESH: Bone Diseases / blood, Calcium Metabolism Disorders / blood, Humans, Malabsorption Syndromes / blood, Phosphorus Metabolism Disorders / blood, Renal Insufficiency, Chronic / blood, Vitamin D / blood, [ SDV ] Life Sciences [q-bio], [SDV]Life Sciences [q-bio], MathematicsofComputing_GENERAL, Phosphorus Metabolism Disorders, [SDV.CAN]Life Sciences [q-bio]/Cancer, GeneralLiterature_MISCELLANEOUS, InformationSystems_GENERAL, Malabsorption Syndromes, Calcium Metabolism Disorders, Renal Insufficiency, Chronic, Vitamin D, Bone Diseases, ComputingMilieux_MISCELLANEOUS
Abstract

National audience; No abstract available

Published
2014

28. Carences nutritionnelles : étiologies et dépistage

Author

Beaufrere, Bernard, Birgé, Jacques, Burlet, Claude, Campillo, Bernard, Couet, Charles, Fouque, Denis, Guéant, Jean-Louis, Hankard, Régis, Jeammet, Philippe, Lairon, Denis, Leverve, Xavier, Méjean, Luc, Moulias, Robert, ORANGE, Colette, Laboratoire de Nutrition Humaine (UMPE), Institut National de la Recherche Agronomique (INRA), Neurobiologie et physiologie de la prise alimentaire (U308), Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Albert Calmette, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CIC - Tours, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Pathologie cellulaire et moléculaire en nutrition (EP616), Centre National de la Recherche Scientifique (CNRS), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Hopital Robert Debre, Institut Mutualiste de Montsouris (IMM), Nutrition humaine et lipides : Biodisponibilité, métabolisme et régulation, Université de la Méditerranée - Aix-Marseille 2-Institut National de la Recherche Agronomique (INRA)-Université de Provence - Aix-Marseille 1-IFR125-Institut National de la Santé et de la Recherche Médicale (INSERM), Bioénergétique fondamentale et appliquée, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Charles Foix - Jean Rostand, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Charles Foix - Jean Rostand, Institut national de la santé et de la recherche médicale(INSERM), CHU Charles Foix [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Apport alimentaire, Vitamines, [SDV.AEN] Life Sciences [q-bio]/Food and Nutrition, Acides gras, Besoins énergétiques, Dénutrition, Anorexie, Nutriment, Oligo éléments, Carence, Jeûne, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, Nutrition
Abstract

Les carences nutritionnelles témoignent d'un déséquilibre entre les apportsalimentaires et les besoins en macronutriments (protéines, lipides, glucides) etmicronutriments (vitamines et oligo-éléments). Elles peuvent concerner tout sujet(enfant, adulte, personne âgée) présentant une pathologie ou un trouble ducomportement alimentaire. Indépendamment d'une baisse globale d'apport, on peutobserver des carences en micronutriments à différents âges de la vie (nouveau-nés,enfants en période de croissance, femmes non ménopausées, personnes âgées).Il existe des signes d'alerte de la dénutrition relativement simples à mettre enévidence: une diminution du poids corporel de 5 % à 10 % sur une période de 6mois (en l'absence de toute restriction alimentaire de la part du sujet), un index demasse corporelle (rapport entre le poids et la taille au carré) inférieur à 18,5 kg/m2(à l'exception des maigreurs constitutionnelles) ou un taux d'albumine Criqueinférieur à 35 g/1. Chez l'enfant, un rapport poids/taille inférieur à 85 % ou unindex de masse corporelle inférieur au troisième percentile doivent alerter lesoignant. De même, une dénutrition doit être suspectée chez tout enfant quittantson couloir de croissance pondérale présenté sur la courbe de croissance du carnetde santé.Les personnes âgées sont les plus exposées à la dénutrition, essentiellement pourdes raisons socio-économiques. Il est important de prendre en compte la dimensionmultifactorielle d'une dénutrition (socio-économique, culturelle, psychologique etrelationnelle. ). Dans le cadre d'une dénutrition liée à une pathologie, si le premiergeste à effectuer est de traiter la pathologie elle même, il est également nécessaired'envisager de façon précoce une prise en charge nutritionnelle adaptée.Choisis selon le contexte clinique, différents marqueurs permettentde reconnaître la dénutrition,d'apprécier sa gravité et d'en suivre l'évolutionLes marqueurs de la dénutrition protéino-énergétique ont pour but d'aider à lareconnaissance d'un état clinique ou infraclinique de dénutrition, à l'appréciation desa gravité, à la compréhension de sa physiopathologie et à l'évaluation del'efficacité de son traitement.Compte tenu de l'extrême diversité et complexité des facteurs étiologiques encause, aucun marqueur ne dispose d'une sensibilité et d'une spécificité telles275qu'il pourrait être considéré isolément. De plus, l'intérêt clinique réel de la mesure d'unmarqueur de la dénutrition passe par la comparaison à des valeurs de référence et par la définition de seuils pathologiques. De telles valeurs et de tels seuils restent à établir pour denombreux marqueurs aujourd'hui disponibles.L'association de marqueurs anthropométriques (poids, index de corpulence, circonférencebrachiale. ), biologiques (créatininurie des 24 heures, albumine plasmatique. ) et/ouimmunologiques (comptage Lymphocytaire, sensibilité cutanée retardée. ) est proposéedans un grand nombre de situations. Le choix des associations dépend de l'objectif(dépistage, évaluation du risque de morbidité/mortalité, décision d'une thérapeutiquenutritionnelle adaptée), du contexte clinique et technique dans lequel se déroule l'évaluationde l'état nutritionnel (domicile, cabinet médical, hôpital. ), du degré d'urgence thérapeutiqueet de l'expérience de l'évaluateur qu'il soit praticien ou diététicien. Des grilles d'évaluationmultifactorielle ont été élaborées et parfois validées. L'étude de la composition corporellenécessite également l'association de marqueurs. C'est dans ce cadre que l'impédancemétriepourrait occuper demain une place de choix dans le diagnostic et le suivi thérapeutique desdénutritions. Des marqueurs fonctionnels restent à développer pour l'évaluation du statutnutritionnel, en association avec d'autres marqueurs...

Published
1999

32. Chronic kidney disease and nephrological practices in France: lessons from the CKD-REIN cohort, 2013-2023

Author

Alencar de Pinho N, Metzger M, Hamroun A, Laville S, Prezelin-Reydit M, Combe C, Fouque D, Laville M, Massy Z, Herpe YÉ, Untas A, Jacquelinet C, Liabeuf S, Frimat L, and Stengel B

Subjects
Humans, Male, Female, Prospective Studies, France epidemiology, Information Services, Nephrology, Renal Insufficiency, Chronic epidemiology, Renal Insufficiency, Chronic therapy
Abstract

Launched in 2013 supported by the Program “Cohorts – Investments for the Future”, the CKD-REIN (Chronic Kidney Disease – Renal Epidemiology and Information Network) study is a prospective cohort that included and followed for 5 years more than 3000 patients with moderate or advanced chronic kidney disease (CKD), from 40 nationally representative nephrology clinics. A large amount of data was collected on CKD and its treatments, patient social characteristics and reported outcomes, and nephrology practices and services. A total of 170,000 blood and urine samples were collected and stored in a central biobank. Coordinated with the CKD outcomes and practice pattern study (CKDopps) and collaborating with the international Network of CKD cohorts (iNETCKD), CKD-REIN contributes to the understanding of CKD and the positioning of France with respect to CKD epidemiology and care in the world. This review highlights major findings from the cohort, and their potential implications for clinical practices and the health system, grouped into the following themes: (1) the complexity of patients with CKD; (2) adherence to clinical guidelines; (3) treatment practices and drug risk; (4) acute on chronic kidney disease; (5) CKD metabolic complications; (6) prediction of kidney failure; (7) sex differences in CKD; (8) patient perspective on CKD; (9) transition to kidney failure and replacement therapy; (10) conservative care.

Published
2023
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34. [CKD care in French nephrology practices].

Author

Alencar de Pinho N, Capgras JB, Speyer É, Combe C, Fouque D, Frimat L, Massy Z, Ayav C, Liabeuf S, Lange C, Jacquelinet C, Stengel B, Pascal C, and Laville M

Subjects
Aged, Cohort Studies, Female, Humans, Male, Nephrology, Renal Insufficiency, Chronic epidemiology, Renal Insufficiency, Chronic therapy
Abstract

Background: To be able to assess the impact of the bundled payment system on real-life management of patients with chronic kidney disease, an overview of patient-care management before its implementation is needed., Patients and Methods: We describe patterns of nephrology care over 3 years in 2835 patients with moderate to severe chronic kidney disease, who were followed-up from 2013 to 2019 in the CKD-REIN cohort study. Compliance with health authority guidelines during this period is also studied., Results: At baseline, patients' mean age was 67 years, 65% were men, and 43% had chronic kidney disease stage 4 or 5. The mean number of nephrology visits increased from 1.1 to 2.7 per year, from chronic kidney disease stage 3A to stage 5. The minimum number of nephrology visits as recommended by health authorities was achieved in 84%, 63%, and 33% of patients with chronic kidney disease stages 3B, 4, and 5, respectively. In chronic kidney disease stages 4 and 5, only 34% and 40% of patients had seen a dietitian, and 33% and 54% had received information about treatment options, respectively. The average waiting time for a first appointment with a nephrologist was longer, 60 days and its duration shorter, 30 vs 38 to 40 minutes, in university hospitals compared with non-university hospitals and private clinics., Conclusion: The significant gap between received and recommended care reflects human resources and organizational limits in chronic kidney disease management in the nephrology setting. Improvements with bundled payment are expected., (Copyright © 2021 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Published
2021
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35. [Psychological impact of lockdown and the COVID-19 epidemic on haemodialysis patients and carers in France].

Author

Guerraoui A, Idier L, Hallonet P, Dolley-Hitze T, Gosselin M, Duneau G, Vendrely B, Hirigoyen MD, Azzouz L, Bouillier M, Pelletier S, Fouque D, Fessi H, De-Precigout V, Vigneau C, Kolko A, Pinçon É, Duquennoy S, Delezire A, Chantrel F, Combe C, Chauveau P, Caillette-Beaudoin A, Lasseur C, and Prézelin-Reydit M

Subjects
Age Factors, Aged, Caregivers psychology, Epidemics, Female, France epidemiology, Humans, Male, Middle Aged, Sex Factors, Surveys and Questionnaires, Anxiety etiology, COVID-19, Communicable Disease Control, Depression etiology, Fear, Stress, Psychological etiology
Abstract

Introduction: The health crisis linked to the COVID-19 epidemic has required lockdown measures in France and changes in practices in dialysis centers. The objective was to assess the depressive and anxiety symptoms during lockdown in hemodialysis patients and their caregivers., Methods: We sent, during lockdown period, between April and May 2020, self-questionnaires to voluntary subjects (patients and caregivers), treated by hemodialysis or who worked in hemodialysis in one of the 14 participating centers in France. We analyzed their perception of dialysis sessions (beneficial or worrying), their stress level (VAS rated from 0 to 10), their anxiety and depressive symptoms (Hospital anxiety and depression scale). Factors associated with stress, anxiety and depression were analyzed with multiple linear regression models., Results: 669 patients and 325 caregivers agreed to participate. 70 % of participants found it beneficial to come to dialysis during confinement. The proportions of subjects with a stress level ≥ 6 linked to the epidemic, confinement, fear of contracting COVID-19 and fear of infecting a loved one were respectively 23.9%, 26.2%, 33.4% and 42%. 39.2% presented with certain (13.7%) or doubtful (19.2%) anxious symptoms. 21.2% presented a certain (7.9%) or doubtful (13.3%) depressive symptomatology. Age, gender, history of psychological disorders and perception of dialysis sessions were associated with levels of stress, anxiety and depression., Conclusion: During the lockdown period, in France, the majority of hemodialysis patients and caregivers found it beneficial to come to dialysis. One in three subjects had anxiety symptoms and one in five subjects had depressive symptoms., (Copyright © 2021. Published by Elsevier Masson SAS.)

Published
2021
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36. [Metabolic complications in chronic kidney disease: hyperphosphatemia, hyperkalemia and anemia].

Author

Hannedouche T, Fouque D, and Joly D

Subjects
Anemia, Iron-Deficiency drug therapy, Humans, Hyperkalemia therapy, Hyperphosphatemia therapy, Renal Dialysis methods, Renal Insufficiency, Chronic therapy, Anemia, Iron-Deficiency etiology, Hyperkalemia etiology, Hyperphosphatemia etiology, Renal Insufficiency, Chronic complications
Abstract

Metabolic complications of chronic kidney disease (CKD) are frequent; the aims of this review are to present a 2018 update for hyperkalemia, hyperphosphatemia and anemia. Hyperkalemia is defined by a plasma level above 5.0 mmol/L, after ruling out pre-analytical problems such as hemolysis. It is frequent in CKD, most often due to drugs and notably renin/ angiotensin blockers. Chronic hyperkalemia is deleterious, with an increased risk of mortality. Therapeutic strategies to decrease the incidence and severity of hyperkalemia are therefore crucial in nephrology: experts recommend to maintain the renin/angiotensin blockers as long as possible, whilst associating diuretics and potassium binders. There are apparent discrepancies between optimal protein intake and decreased phosphate intake in CKD; this is even more important in dialysis since protein decrease is associated with denutrition and subsequent increased risk of mortality. Nutritional phosphate intake from vegetables are less absorbed; in contrast, phosphate additives are almost completely absorbed in the gastro-intestinal tract. These "hidden" intake may increase the total daily phosphate intake by 1 000 mg. As such in addition to optimized dialysis, phosphate binders should be used but compliance may be challenging on the long-term. Educational programs focused on phosphate are also mandatory in CKD patients. "Absolute" iron deficiency is less frequent than "functional" iron deficiency in CKD patients: both require the use of iron supplementation, and the latter may benefit from additional erythropoietin stimulating agents (ESA) when hemoglobin is below 10 g/dL. Intravenous iron is more efficient to correct iron deficiency both in pre-dialysis and dialysis especially in patients with chronic deficiency. Last generation intravenous preparations have largely demonstrated their safety. One indication of iron supplementation one should not forget in nephrology is the patient with moderate CKD and heart failure since the expected benefits are multiple, notably in terms of quality of life, renal function and functional capacity. Cet article fait partie du numéro supplément Innovations en Néphrologie réalisé avec le soutien institutionnel de Vifor Fresenius Medical Care Renal Pharma., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Published
2018
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37. [Management of bone and mineral metabolism disorders before the dialysis stage remains still perfectible. Data from the French Phosphorus and Calcium Survey Photo-Graphe].

Author

Jean G, Daugas É, Roth H, Drueke T, Bouchet JL, Hannedouche T, London G, and Fouque D

Subjects
Aged, Aged, 80 and over, Calcium blood, Chronic Kidney Disease-Mineral and Bone Disorder therapy, Female, France, Humans, Male, Middle Aged, Parathyroid Hormone blood, Phosphorus blood, Renal Dialysis, Renal Insufficiency, Chronic therapy, Surveys and Questionnaires, Vitamin D blood, Chronic Kidney Disease-Mineral and Bone Disorder epidemiology, Renal Insufficiency, Chronic complications
Abstract

Only limited data is available on the management of the chronic kidney disease-associated bone and mineral metabolism disorder (CKD-MBD) in the pre-dialysis stages of CKD in France. A better knowledge of current management habits could lead to an improvement in the implementation of international recommendations (KDIGO). The 3rd version of the French Phosphorus and Calcium Survey Photo-Graphe (Sanofi) included a cohort of CKD stages 4 and 5 patients, whose aim was to examine the prevalence of CKD-MBD and the quality of its management in patients under the care of 62 nephrologists from over 20 geographical regions in France. The study started in October 2011, i.e. one year after patient enrollment. We examined in particular the percentage of patients presenting with laboratory parameter abnormalities indicative of CKD-MBD who were not receiving adequate treatment. A total of 456 patients with CKD stage 4 and 154 with CKD stage 5 were studied. Their mean age was 72.9±14.2 years, and male/female ratio was 58/42. KDIGO targets of serum PTH for CKD stages 4 and 5 were not achieved in respectively 80 and 84% of the patients, for serum calcium in 8 and 22% and for serum phosphate in 12 and 46%. As a potential explanation, insufficient therapy was estimated to account for respectively 45 and 60% of insufficiently controlled secondary hyperparathyroidism, and for 36% of persistent hyperphosphatemia in stage 5. It should be noted that 55.5 and 57.5% of patients were receiving native vitamin D. In this national observatory, the management of CKD-MBD stages 4 and 5 appears suboptimal, especially as regards the control of secondary hyperparathyroidism, which remained untreated in nearly 50% of the patients. Hyperphosphatemia was also common and inadequately controlled in CKD stage 5. To improve the management of CKD-MBD, nephrologists need to be more aware of the importance of aiming for recommended laboratory targets and how this can be achieved., (Copyright © 2017. Published by Elsevier Masson SAS.)

Published
2017
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38. [Wasting in chronic kidney disease: Refeeding techniques and artificial nutrition practices].

Author

Pasian C, Azar R, and Fouque D

Subjects
Body Mass Index, Humans, Nutrition Therapy methods, Nutritional Status, Renal Dialysis methods, Renal Insufficiency, Chronic mortality, Renal Insufficiency, Chronic therapy, Survival Analysis, Treatment Outcome, Enteral Nutrition methods, Parenteral Nutrition methods, Protein-Energy Malnutrition etiology, Protein-Energy Malnutrition therapy, Renal Insufficiency, Chronic complications
Abstract

Protein energy wasting (PEW) is an independent factor associated with morbi-mortality in chronic kidney disease. Wasting is particularly common in chronic diseases of organs such as kidney disease with a major impact at the stage of dialysis. It covers 20 to 70% of patients diagnosed with chronic kidney disease according to the degree of evolution of the disease and the diagnostic method used patients. Mechanisms of PEW are based mainly on anorexia and metabolic abnormalities caused by kidney disease. Nutritional treatment differs depending on the stage of the kidney disease acute or chronic treated whether or not by dialysis. Nutritional monitoring should be regular, individualized and collaborative to detect a risk of PEW or treat installed PEW. Refeeding techniques should allow all the nutritional needs. Their indications depend on the clinic, biochemical assessment and nutrient intake., (Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Published
2016
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39. [Changes in mineral and bone disorder management in a French cohort of hemodialysis patients between 2008 and 2012: The National Bone and Mineral Metabolism observatory (Photo-Graphe 2 and 3)].

Author

Pelletier S, Roth H, Bouchet JL, Drueke TB, Hannedouche T, Jean G, London G, and Fouque D

Subjects
Aged, Cross-Sectional Studies, Female, France, Humans, Male, Time Factors, Chronic Kidney Disease-Mineral and Bone Disorder therapy, Renal Dialysis
Abstract

Introduction: Chronic kidney disease progressively induces a disorder of mineral and bone metabolism (CKD-MBD) which also leads to cardiovascular abnormalities. Previous studies showed that only few hemodialysis patients had serum calcium, phosphate and parathyroid hormone levels within the K/DOQI (Kidney-Disease Outcomes Quality Initiative) targets of 2003. Our aim was to identify the impact of different therapeutic strategies and that of the KDIGO (Kidney-Disease: Improving Global Outcomes) targets of 2009 on the control of CKD-MBD., Patients and Methods: The French calcium and phosphate observatory monitors the mineral metabolism of patients with CKD at the local, regional and national level every six months. We compared the data recorded in June 2008 (n=1914 patients) with those collected in October 2012 (n=2481) for patients aged 18 years or more, who started hemodialysis therapy within the last 12 months., Results: As compared with 2008, in 2012 fewer patients had hyperphosphatemia (55.1 % versus 64.7 %), hypocalcemia (35.5 % versus 40.3 %) and hyperparathyroidism (9.8 % versus 10.1 %) according to the KDIGO guideline, and more had hypophosphatemia (9.6 % versus 6.5 %), hypercalcemia (3.9 % versus 2.2 %) and hypoparathyroidism (31.5 % versus 25.8 %) (P<0.001, P<0.001 and P=0.002 respectively for differences in serum phosphate, calcium and PTH levels). Mean (± standard deviation [SD]) serum 25 OH vitamin D levels increased by 1.6-fold, from 48.3±42.6 nmol/L in 2008 to 76.6±45.8 nmol/L in 2012. Between 2008 and 2012, the prescription of native vitamin D derivatives and sevelamer (HCl or carbonate) increased whereas that of cinacalcet, lanthanum carbonate, calcium-chelating agents and active vitamin D derivatives decreased., Conclusion: Despite a slight improvement of biochemical CKD-MBD parameters in the observation period only few patients reached the three KDIGO targets (11.5 % in 2012 versus 11.1 % in 2008)., (Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Published
2016
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40. [The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study: To better understand chronic kidney disease].

Author

Stengel B, Combe C, Jacquelinet C, Briançon S, Fouque D, Laville M, Frimat L, Pascal C, Herpe YÉ, Morel P, Deleuze JF, Schanstra JP, Pisoni RL, Robinson BM, and Massy ZA

Subjects
Aged, Aged, 80 and over, Cohort Studies, Disease Progression, Female, Follow-Up Studies, France epidemiology, Humans, Kidney Failure, Chronic epidemiology, Male, Middle Aged, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic therapy, Renal Replacement Therapy methods, Information Services, Quality of Life, Renal Insufficiency, Chronic epidemiology
Abstract

Background: Preserving kidney function and improving the transition from chronic kidney disease to end stage is a research and healthcare challenge. The national Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort was established to identify the determinants, biomarkers and practice patterns associated with chronic kidney disease outcomes., Methods: The study will include more than 3000 adult patients with moderate to advanced chronic kidney disease from a representative sample of 40 nephrology clinics with respect to regions and legal status, public or private. Patients are recruited during a routine visit and followed for 5 years, before and after starting renal replacement therapy. Patient-level clinical, biological, and lifestyle data are collected annually, as well as provider-level data on clinical practices, coordinated with the International Chronic Kidney Disease Outcomes and Practice Pattern Study. Blood and urine samples are stored in a biobank. Major studied outcomes include survival, patient-reported outcomes, disease progression and hospitalizations., Results: More than 13,000 eligible patients with chronic kidney disease were identified, 60% with stage 3 and 40% with stage 4. Their median age is 72 years [interquartile range, 62-80 years], 60% are men and 38% have diabetes. By the end of December 2015, 2885 patients were included., Conclusion: The CKD-REIN cohort will serve to improve our understanding of chronic kidney disease and provide evidence to improve patient survival and quality of life as well as health care system performances., (Copyright © 2016 Association Société de néphrologie. All rights reserved.)

Published
2016
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41. [Recommendations for the measurement of blood 25-OH vitamin D].

Author

Souberbielle JC, Deschenes G, Fouque D, Groussin L, Guggenbuhl P, Jean G, Linglart A, and Thomas T

Subjects
Humans, Malabsorption Syndromes blood, Malabsorption Syndromes complications, Osteolysis, Essential blood, Osteolysis, Essential complications, Renal Dialysis, Renal Insufficiency, Chronic blood, Renal Insufficiency, Chronic complications, Transplant Recipients, Vitamin D analysis, Vitamin D blood, Vitamin D Deficiency blood, Blood Chemical Analysis standards, Practice Guidelines as Topic, Vitamin D analogs & derivatives, Vitamin D Deficiency diagnosis
Abstract

The 25-hydroxyvitamin D (25OHD) serum concentration should not be measured to everybody but recommendations for this measurement in several clinical situations are available from numerous guidelines and expert positions. It can be proposed to measure 25OHD in diseases where a target range of 25OHD concentrations associated with better outcomes is defined with a sufficient level of evidence, and when this target concentration is difficult to reach without previous measurement (or may be exceeded in case of too large doses are provided). Many National and International Medical Societies recommend to measure 25OHD at least in any situation of « bone fragility » (defined by a low bone mineral density and/or a low energy fracture), in malabsorptions, in chronic kidney disease, in any « phosphocalcic pathology, in patients with clinical signs of profound vitamin D deficiency or excess, and, more generally in any biological exploration of calcium/phosphorus metabolism that includes the measurement of PTH. Although these recommandations may seem discordant with the recent French restriction in the reimbursment of 25OHD measurement, they may still be reimbursed.

Published
2016
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42. [Sclerostin: a new biomarker of interest in nephrology].

Author

Pelletier S, Jean G, and Fouque D

Subjects
Adaptor Proteins, Signal Transducing, Biomarkers, Humans, Nephrology, Bone Morphogenetic Proteins physiology, Genetic Markers physiology, Renal Insufficiency, Chronic etiology, Vascular Calcification etiology
Abstract

Sclerostin is an osteocyte-specific glycoprotein secreted by the osteocyte and involved in the regulation of bone mass. High sclerostin levels are associated with osteoporosis, whereas low sclerostin levels are correlated with higher bone mineral density. It seems interesting to investigate a potential association between sclerostin levels and vascular calcifications since sclerostin is considered as a potent inhibitor of bone formation. In chronic kidney disease, serum sclerostin levels rise as renal function declines. Preliminary studies show a positive association between serum sclerostin and vascular calcification, but the link between sclerostin and survival of patients remains unclear in the absence of large-scale studies.

Published
2015
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43. [Weakening osteopathies, chronic kidney disease, malabsorption, biological anomalies of calium/phosphorus metabolism: appropriate indications for a reasoned reimbursment of serum vitamin D measurement].

Author

Souberbielle JC, Benhamou CL, Cortet B, Rousière M, Roux C, Abitbol V, Annweiler C, Audran M, Bacchetta J, Bataille P, Beauchet O, Bardet R, Benachi A, Berenbaum F, Blain H, Borson-Chazot F, Breuil V, Briot K, Brunet P, Carel JC, Caron P, Chabre O, Chanson P, Chapurlat R, Cochat P, Coutant R, Christin-Maitre S, Cohen-Solal M, Combe C, Cormier C, Courbebaisse M, Debrus G, Delemer B, Deschenes G, Duquenne M, Fardellone P, Fouque D, Friedlander G, Gauvain JB, Groussin L, Guggenbuhl P, Houillier P, Hannedouche T, Jacot W, Javier RM, Jean G, Jeandel C, Joly D, Kamenicky P, Knebelmann B, Lafage-Proust MH, LeBouc Y, Legrand E, Levy-Weil F, Linglart A, Machet L, Maheu E, Mallet E, Marcelli C, Marès P, Mariat C, Maruani G, Maugars Y, Montagnon F, Moulin B, Orcel P, Partouche H, Personne V, Pierrot-Deseilligny C, Polak M, Pouteil-Noble C, Prié D, Raynaud-Simon A, Rolland Y, Sadoul JL, Salle B, Sault C, Schott AM, Sermet-Gaudelus I, Soubrier M, Tack I, Thervet É, Tostivint I, Touraine P, Tremollières F, Urena-Torres P, Viard JP, Wemeau JL, Weryha G, Winer N, Young J, and Thomas T

Subjects
Humans, Bone Diseases blood, Calcium Metabolism Disorders blood, Malabsorption Syndromes blood, Phosphorus Metabolism Disorders blood, Renal Insufficiency, Chronic blood, Vitamin D blood
Published
2014
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44. [Nutritional care and clinical improvement in a renal ward: a pilot multimodal approach].

Author

Pasian C, Guebre-Egziabher F, Kalbacher E, Pommerol C, and Fouque D

Subjects
Aged, Female, France epidemiology, Humans, Male, Malnutrition epidemiology, Nutritional Status, Pilot Projects, Serum Albumin, Dietary Services, Hospitalization, Malnutrition diagnosis, Malnutrition therapy, Patient Care Team, Renal Insufficiency epidemiology
Abstract

Unlabelled: Malnutrition is an independent factor associated with morbi-mortality in chronic kidney disease. It is particularly common and may increase during hospitalization., Objectives: To measure nutritional and physical performance evolution as well as patients' physical autonomy during a hospitalization in a university hospital renal ward. Treatments were adjusted according to different diagnoses (nutritional care, body composition, physical activity) along with a multidisciplinary approach. In this way, it can show the impact of this care on nutritional status of the patient., Design: Regardless of their nutritional status and kidney disease (acute or chronic kidney disease, chronic hemodialysis), patients were included at day 0, within 2 days from admission; nutritional interventions and measurements were assessed on day 7, day 14 and day 21. The study was run from December 2011 till June 2012, and 48 patients were included., Results: On admission, patients had a low energy intake (20.9±8.6 kcal/kg/day). This intake was improved by means of a dietetic intervention (28.1±6.5 kcal/kg/day after two weeks of hospitalization, 29±6.1 kcal/kg/day after three weeks and 29±8.4 kcal/kg/day after four weeks). Seventy-three percent of the hospitalized patients were malnourished, among them 91% had a decreased serum albumin (26.8±6.6 g/L). Weight and muscle mass (measured by impedancemetry) were maintained, prealbumin increased by 16.5 mg/L after two weeks (n=48; P=0.61), 27.8 mg/L after three weeks (n=31; P=0.018), 52.3 mg/L after four weeks (n=13; P=0.002) and albuminemia by 1.8 g/L (n=13 patients monitoring four weeks; P=0.13). Both physical autonomy (assessed with Test moteur minimum) and muscle strength (Hand Grip Test) were significantly improved., Conclusion: A systematic screening of wasting and a multidisciplinary care improved nutritional status and physical ability of patients hospitalized in a renal ward., (Copyright © 2014 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Published
2014
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45. [HAS report on vitamin D measurement: don't go from an extreme situation to another as extreme situation].

Author

Souberbielle JC, Benhamou CL, Cortet B, Rousière M, Roux C, Abitbol V, Audran M, Bachetta J, Beauchet O, Blain H, Breuil V, Briot K, Brunet P, Chanson P, Cormier C, Courbebaisse M, Fardellone P, Fouque D, Friedlander G, Gauvain JB, Groussin L, Houillier P, Jacot W, Jean G, Kamenicky P, Lafage-Proust MH, Legrand E, Levy-Weil F, Linglart A, Mallet E, Marcelli C, Maruani G, Montagnon F, Personne V, Prié D, Raynaud-Simon A, Rolland Y, Salle B, Sault C, Schott AM, Thervet E, Urena-Torres P, Viard JP, Weryha G, Pierrot-Deseilligny C, Young J, and Thomas T

Subjects
Dose-Response Relationship, Drug, Humans, Vitamin D administration & dosage, Vitamin D blood, Vitamin D Deficiency diagnosis
Published
2014
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46. [Higher dialysate calcium is not associated with mortality in hemodialysis patients: results from the French ARNOS study].

Author

Jean G, Lataillade D, Genet L, Legrand E, Kuentz F, Moreau-Gaudry X, and Fouque D

Subjects
Aged, Aged, 80 and over, Cross-Sectional Studies, Female, France, Humans, Kidney Failure, Chronic mortality, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Survival Analysis, Calcium analysis, Dialysis Solutions analysis, Kidney Failure, Chronic therapy, Renal Dialysis mortality
Abstract

Finding the optimal dialysate calcium (DCa) in haemodialysis (HD) patients remains a therapeutic challenge. Besides, the Dialysis Outcomes and Practice Pattern Study (DOPPS) has reported a greater mortality rate using higher DCa doses. The objective was to assess the impact of DCa prescription on survival. Baseline DCa prescriptions were recorded using a cross-sectional analysis of HD patients from the regional ARNOS French cohort. A prospective 42-month survival analysis study was performed. In July 2005, 1294 HD patients were included in this study. DCa at doses of 1.25, 1.5, and 1.75 mmol/L was prescribed in 13.6%, 74.1%, and 12.3% patients, respectively. Using a Cox proportional model adjusted for several parameters, DCa was found to be not significantly associated with survival. Patients receiving 1.75 mmol/L DCa were more frequently treated with online haemodiafiltration, cinacalcet, and shorter dialysis sessions; they had a more frequent history of parathyroidectomy and lower calcium levels. The DCa prescription remained stable after 12 months in 80% of cases. This is an observational study; therefore, only baseline data were recorded for analysis. Higher DCa concentration is not associated with mortality, in contrast to the findings by DOPPS. Prescribing DCa on an individual basis according to various mineral metabolism parameters and treatments appears to be safe irrespective of the DCa dosage., (Copyright © 2012 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Published
2013
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47. [Secondary hyperparathyroidism and anemia. Effects of a calcimimetic on the control of anemia in chronic hemodialysed patients. Pilot Study].

Author

Mpio I, Boumendjel N, Karaaslan H, Arkouche W, Lenz A, Cardozo C, Cardozo J, Pastural-Thaunat M, Fouque D, Silou J, Attaf D, and Laville M

Subjects
Adult, Aged, Aged, 80 and over, Alkaline Phosphatase blood, Anemia, Iron-Deficiency blood, Anemia, Iron-Deficiency etiology, Biomarkers, Calcium blood, Calcium Phosphates blood, Cinacalcet, Drug Resistance, Drug Therapy, Combination, Female, Hemoglobins metabolism, Humans, Hyperparathyroidism, Secondary blood, Hyperparathyroidism, Secondary etiology, Male, Middle Aged, Phosphorus blood, Pilot Projects, Prospective Studies, Treatment Outcome, Anemia, Iron-Deficiency drug therapy, Hematinics therapeutic use, Hyperparathyroidism, Secondary drug therapy, Kidney Failure, Chronic therapy, Naphthalenes therapeutic use, Renal Dialysis adverse effects
Abstract

Unlabelled: The main cause of resistance to erythropoiesis-stimulating agents (ESA) used for treatment of anemia in chronic hemodialysed patients (CHP) is the iron deficiency, absolute or functional. Secondary hyperparathyroidism (SHPT) is a secondary factor of resistance. Indeed, it has been reported in the literature an improvement of anemia parameters after surgical parathyroidectomy (PTX). The objective of this study is to assess in CHP, the impact of the correction of SHPT by a calcimimetic, cinacalcet (CI), (which is considered as a pharmacological PTX) on the response to ESA, measured by the erythropoietin resistance index (ERI). Twenty-two CHP with severe SHPT documented by an intact parathyroid hormone (iPTH) above 800pg/mL were included in this prospective pilot study. Mineral bone metabolism, anemia and nutritional parameters were measured baseline and after 6 months of treatment by CI. The effect on anemia was assessed at the end of study by the ERI, the change in Hb concentration, and the proportion of patients with Hb levels above 11g/dL., Results: At the end of study there was a significant decrease (M6 vs M0) in iPTH (1302 vs 674pg/mL or -48%, p=0.006), serum calcium (2.39 vs 2.15mmol/L or -10%), serum phosphate (2 vs 1.7mmol/L or -15%), serum calcium-phosphorus product (CaxP) (4.8 vs 3.8mmol(2)/L(2) or - 20% (p<0.05), and the number of patients with CaxP>4.4mmol(2)/L(2) (64 vs 32%, p<0.05). The level of bone alkaline phosphatase remained stable during the study (28 vs 27 IU/L). The Hb levels increased from 11 to 11.4g/dL, as did the proportion of patients whose Hb concentration reached 11g/dL or higher (50 vs 70%, p<0.05) without important change of the median weekly ESA dosis in the majority of patients, 18 cases (81%) vs four (19%). Two subgroups were identified from the median decreases in iPTH (delta iPTH) between M0 and M6, Group 1 (delta iPTH≥400pg/mL, n=10) and group 2 (delta iPTH<400pg/mL, n=12): in group 1, we found a correlation between the decrease in iPTH by CI and the stability or decrease in ERI (group 1), at comparable dose of dialysis, nutritional and iron intakes and inflammatory profiles; in group 2 without a significant effect of CI on PTH reduction the levels of ERI and ESA dosis were more elevated., Conclusion: A treatment by calcimimetic improves the control of anemia by ESA in CHP and interferes positively on a cause of secondary resistance to ESA represented by SHPT. The mechanism of these effects could be linked to the decreased of bone marrow fibrosis and inflammation and to the triptych formed by the reduction in iPTH, CaxP and phosphate., (Copyright © 2011 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Published
2011
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48. [Direct medical cost of erythropoiesis-stimulating agents in anaemia treatment of chronic renal failure patient: a literature review].

Author

Ranchon F, Hédoux S, Laville M, Fouque D, Decullier E, Chapuis F, and Huot L

Subjects
Anemia etiology, Darbepoetin alfa, Direct Service Costs, Drug Costs, Epoetin Alfa, Erythropoietin administration & dosage, France, Hematinics administration & dosage, Humans, Injections, Intravenous, Injections, Subcutaneous, Recombinant Proteins, Anemia drug therapy, Anemia economics, Erythropoietin analogs & derivatives, Erythropoietin economics, Health Care Costs, Hematinics economics, Kidney Failure, Chronic complications
Abstract

Introduction: Management of anaemia in chronic renal insufficiency (CRI) represents an important medico-economic challenge because of the great number of patients and the cost of the erythropoiesis-stimulating agent (ESA). The aim of this study was to identify determinants of the costs associated with these treatments in order to choose, with equal efficacy, the most efficient ASE., Method: A bibliographic research was realised by Medline database interrogation., Results: Among the direct medical costs, five studies showed that acquisition of epoetine alfa (EA) compared to darbepoetin alfa (DA) was less expensive. Concerning the costs associated with the route of administration, the subcutaneous injection (SC) of epoetine allowed a gain in costs because of the decrease of doses compared to the intravenous (IV) route. The switch from EA in SC to DA in IV, for hemodialysis patients, was associated with a reduction of the number of injections and with a treatment's cost lower by DA than by EA. Costs related to the regimen of administration, notably those related to nursing, medical and pharmaceutical time, were negligible towards those associated to the acquisition of the ASE. Finally, the costs of the therapeutic follow-up and treatment of the adverse effects of the ASE were similar between the EA and the DA., Conclusion: The costs associated with the prices of acquisition of the ASE, negotiated by the structure of care, represent the most important part of the direct medical costs., (Copyright 2009 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Published
2010
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49. [Mineral and bone status in French maintenance hemodialysis patients: a comparison of June 2005 and June 2008].

Author

Pelletier S, Roth H, Bouchet JL, Drueke T, Hannedouche T, London G, and Fouque D

Subjects
Aged, Cross-Sectional Studies, Female, France, Humans, Male, Time Factors, Bone and Bones metabolism, Calcium metabolism, Phosphates metabolism, Renal Dialysis
Abstract

Introduction: Because of the high associated morbi-mortality, phosphate and calcium disorders remain a major therapeutic challenge for nephrologists. Previous studies showed that only few patients had serum calcium, phosphate and parathyroid hormone within Kidney-Disease Outcomes Quality Initiative (K/DOQI) targets., Patients and Methods: The French calcium and phosphate observatory monitors mineral metabolism at local, regional and national level and its follow-up every six months since 2005. More than 200 nephrologists collected more than 9000 patients' data. We compared the results recorded in June 2005 with those collected in June 2008., Results: As compared with June 2005, in June 2008 fewer patients were hypercalcemic according to the K/DOQI targets (-26.2%, p<0.001) and hyperphosphatemic (-16.5%, p<0.001), more patients were hypocalcemic (+45.5%, p<0.001) and hypophosphatemic (+8.8%, p<0.02). A greater number of patients had elevated serum PTH above 300ng/l (+17.6%, p<0.001) and fewer had a PTH lower than 150ng/l (-25.4%, p<0.001). Serum 25OH vitamin D level was 21.7+/-20.0microg/l in June 2008. Overall, 10.5% of patients met all three K/DOQI targets, an improvement compared with June 2005 (6.8%, p<0.001). Between 2005 and 2008, cinacalcet, lanthane carbonate and native vitamin D derivatives prescription increased whereas calcium-based phosphate binders, sevelamer-HCL and active vitamin D derivatives decreased., Conclusion: Despite a significant improvement between 2005 and 2008, only few patients reach the three K/DOQI targets (10.5%) in 2008. The prospective biannual follow-up during three years will allow us to identify the impact of different treatments on calcium and phosphate metabolic control and patient's survival.

Published
2010
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