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15 results on '"MESH: Renal Insufficiency, Chronic"'

1. Sofosbuvir and risk of estimated glomerular filtration rate decline or end‐stage renal disease in patients with renal impairment

Author

Mark Sulkowski, Laura E. Telep, Massimo Colombo, Francois Durand, K. Rajender Reddy, Eric Lawitz, Marc Bourlière, Nelson Cheinquer, Stacey Scherbakovsky, Liyun Ni, Lindsey Force, Heribert Ramroth, Anuj Gaggar, Anand P. Chokkalingam, Meghan E. Sise, Johns Hopkins University School of Medicine [Baltimore], Gilead Sciences, Inc. [Foster City, CA, USA], IRCCS Ospedale San Raffaele [Milan, Italy], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Diderot - Paris 7 (UPD7), University of Texas Health Science Center at San Antonio [San Antonio, Tx, USA], Service d'hépatologie et de gastroentérologie [Hôpital Saint-Joseph - Marseille], Aix Marseille Université (AMU)-Hôpital Saint-Joseph [Marseille], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Massachusetts General Hospital [Boston, MA, USA], and Harvard Medical School [Boston] (HMS)

Subjects
Male, MESH: Antiviral Agents, [SDV]Life Sciences [q-bio], MESH: Renal Insufficiency, Chronic, GS-331007, Antiviral Agents, sofosbuvir, MESH: Renal Insufficiency, Humans, Pharmacology (medical), Renal Insufficiency, Renal Insufficiency, Chronic, Retrospective Studies, direct-acting antiviral, end-stage renal disease, MESH: Humans, Hepatology, Gastroenterology, MESH: Sofosbuvir, MESH: Retrospective Studies, MESH: Male, MESH: Glomerular Filtration Rate, MESH: Kidney Failure, Chronic, Disease Progression, Kidney Failure, Chronic, dialysis, Female, MESH: Disease Progression, MESH: Female, chronic kidney disease, Glomerular Filtration Rate
Abstract

Background: Sofosbuvir, a prodrug nucleoside inhibitor of hepatitis C virus, has a predominant circulating metabolite that is renally eliminated. Whether sofosbuvir is associated with chronic kidney disease (CKD) progression is not well understood.Methods: We performed a retrospective analysis of patients with estimated glomerular filtration rate (eGFR) 30-89 mL/min/1.73 m2 treated with sofosbuvir in 76 Phase 2/3 registrational trials. We evaluated eGFR at each study visit. Separately, we performed a retrospective analysis of an administrative claims database (IQVIA PharMetrics Plus™) to compare the risk of incident end-stage renal disease (ESRD) associated with the use of sofosbuvir or non-sofosbuvir regimens among patients with CKD using propensity score methods. Exposure, CKD status and outcomes were determined using diagnosis and medication claim codes. Cox proportional hazards methods were used to estimate ESRD risk.Results: Among 4642 trial participants with baseline stage 2 CKD (eGFR 60-89 ml/min/1.73 m2 ) and 682 trial participants with stage 3 CKD (eGFR 30-59 ml/min/1.73 m2 ) mean (SD) eGFR improved from baseline to 4 weeks post-treatment (+0.7 [9.3] and +2.6 [8.8] ml/min/1.73 m2 , respectively; p < 0.001 each). In the second analysis, among 2042 patients with CKD receiving sofosbuvir-based regimens compared to 431 receiving non-sofosbuvir-based regimens, after adjusting for baseline covariates and weighting based on treatment propensity scores, there was no significant difference in risk of ESRD (adjusted HR = 0.85, 95% CI: 0.51-1.42).Conclusions: Clinical trial participants with CKD did not experience worsening eGFR during sofosbuvir-based treatment, and sofosbuvir was not associated with an increased risk of ESRD in patients with CKD in a nationally-representative administrative claims database.

Published
2022
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2. MRI-based kidney radiomic analysis during chronic lithium treatment

Author

Paul Beunon, Maxime Barat, Anthony Dohan, Lynda Cheddani, Lisa Males, Pedro Fernandez, Bruno Etain, Frank Bellivier, Emeline Marlinge, François Vrtovsnik, Emmanuelle Vidal‐Petiot, Antoine Khalil, Jean‐Philippe Haymann, Martin Flamant, Nahid Tabibzadeh, Etain, Bruno, Sorbonne Université (SU), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Cité (UPCité), Épidémiologie et recherches translationnelles sur les maladies rénales et cardiovasculaires (EPREC) (U1018 (Équipe 5)), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Hôpital Ambroise Paré [AP-HP], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Université Paris Diderot - Paris 7 (UPD7), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Département Médico-Universitaire Neurosciences [Sorbonne Université] (DMU Neurosciences), CHU Charles Foix [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)-CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris Descartes - Paris 5 (UPD5), Université Paris-Saclay, CHU Tenon [AP-HP], Université Paris-Sud - Paris 11 (UP11), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Physiologie rénale et tubulopathies = Renal Physiology and tubulopathies [CRC], Centre National de la Recherche Scientifique (CNRS)-Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École pratique des hautes études (EPHE)

Subjects
bipolar disorder, MESH: Humans, MESH: Lithium, [SDV.MHEP.PSM] Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, MESH: Renal Insufficiency, Chronic, Clinical Biochemistry, MESH: Kidney, General Medicine, MESH: Lithium Compounds, Lithium, Kidney, Biochemistry, Magnetic Resonance Imaging, MESH: Magnetic Resonance Imaging, MESH: Glomerular Filtration Rate, radiomics, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, Lithium Compounds, Humans, Renal Insufficiency, Chronic, chronic kidney disease, Glomerular Filtration Rate
Abstract

International audience; Background: Lithium therapy during bipolar disorder is associated with an increased risk of chronic kidney disease (CKD) that is slowly progressive and undetectable at early stages. We aimed at identifying kidney image texture features as possible imaging biomarkers of decreased measured glomerular filtration rate (mGFR) using radiomics of T2-weighted magnetic resonance imaging (MRI).Methods: One hundred and eight patients treated with lithium were evaluated including mGFR and kidney MRI, with T2-weighted sequence single-shot fast spin-echo. Computed radiomic analysis was performed after kidney segmentation. Significant features were selected to build a radiomic signature using multivariable Cox analysis to detect an mGFR

Published
2022
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3. Standardised Outcomes in Nephrology – Chronic Kidney Disease (SONG-CKD): a protocol for establishing a core outcome set for adults with chronic kidney disease who do not require kidney replacement therapy

Author

Andrew S. Levey, Armando Teixeira-Pinto, Samuel Fung, Nicole Scholes-Robertson, Gloria Ashuntantang, Laura Cortés Sanabria, Samaya Anumudu, Amelie Bernier-Jean, Martin Howell, Louese Dunn, Tim Usherwood, Eduardo Lorca, Martin Wilkie, Andrea Matus Gonzalez, Magdalena Madero, Ikechi G. Okpechi, Daniel Gallego, Jonathan C. Craig, Adeera Levin, Allison Tong, Patrick Rossignol, Katherine Widders, Yeoungjee Cho, Ian H. de Boer, Andrea K. Viecelli, David C. Wheeler, Nicole Evangelidis, Bénédicte Sautenet, Laura Sola, Chandana Guha, The University of Sydney, Westmead Hospital [Sydney], MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Service de néphrologie et immunologie clinique [CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT), Instituto Nacional de Cardiologia Ignacio Chavez, Université de Yaoundé I, Hospital Universitario de Guadalajara, Department of Medicine, Kidney Research Institute, University of Washington, Kidney Research Institute [Seattle] (KRI), Princess Margaret Hospital, Hong Kong, Federacion Nacional ALCER (Spanish Kidney Patient's Federation), Tufts University School of Medicine [Boston], University of British Columbia (UBC), Hospital Salvador, University of Cape Town, University of Alberta, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Dialysis Unit, CASMU-IAMPP, Montevideo, University of New South Wales [Sydney] (UNSW), Centre for Nephrology, UCL Medical School, Translational Research Institute, University College of London [London] (UCL), University of Queensland [Brisbane], Princess Alexandra Hospital, Brisbane, Baylor College of Medecine, Sheffield Children's NHS Foundation Trust, Flinders University [Adelaide, Australia], This project is supported by the National Health and Medical Research Council (NHMRC) Program Grant 1092597. NE is supported by the National Health and Medical Research Council (NHMRC) Program Grant 1092597. AT is supported by The University of Sydney Robinson Fellowship. YC is supported by the NHMRC Early Career Fellowship 1126256. AV is supported by a Jacquot Research Establishment Fellowship. The funding bodies do not have a role in the design, collection, analysis, and interpretation of data, in the writing of the manuscript, and in the decision to submit the manuscript for publication., Division of Nephrology and Hypertension, Faculty of Health Sciences, Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Service de néphrologie et immunologie clinique [CHRU Tours] (EA4245 UT), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours, and BOZEC, Erwan

Subjects
Nephrology, Medicine (General), Delphi Technique, 030232 urology & nephrology, Medicine (miscellaneous), urologic and male genital diseases, MESH: Delphi Technique, law.invention, Study Protocol, Clinical trials, 0302 clinical medicine, Randomized controlled trial, law, Chronic kidney disease, Outcome Assessment, Health Care, Pharmacology (medical), 030212 general & internal medicine, MESH: Treatment Outcome, MESH: Research Design, MESH: Nephrology, female genital diseases and pregnancy complications, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Renal Replacement Therapy, Treatment Outcome, Research Design, Outcomes research, Adult, medicine.medical_specialty, MESH: Renal Insufficiency, Chronic, 03 medical and health sciences, R5-920, Quality of life (healthcare), [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, Renal Insufficiency, Chronic, MESH: Outcome Assessment, Health Care, Intensive care medicine, MESH: Humans, business.industry, Core outcome set, MESH: Quality of Life, MESH: Adult, medicine.disease, Transplantation, Clinical trial, Quality of Life, MESH: Renal Replacement Therapy, Patient-centred outcomes, MESH: Systematic Reviews as Topic, business, Systematic Reviews as Topic, Kidney disease, Qualitative research
Abstract

Background Globally, over 1.2 million people die from chronic kidney disease (CKD) every year. Patients with CKD are up to 10 times more likely to die prematurely than progress to kidney failure requiring kidney replacement therapy. The burden of symptoms and impaired quality of life in CKD may be compounded by comorbidities and treatment side effects. However, patient-important outcomes remain inconsistently and infrequently reported in trials in patients with CKD, which can limit evidence-informed decision-making. The Standardised Outcomes in Nephrology – Chronic Kidney Disease (SONG-CKD) aims to establish a consensus-based core outcome set for trials in patients with CKD not yet requiring kidney replacement therapy to ensure outcomes of relevance to patients, caregivers and health professionals are consistently reported in trials. Methods SONG-CKD involves four phases: a systematic review to identify outcomes (domains and measures) that have been reported in randomised controlled trials involving adults with CKD who do not require kidney replacement therapy; stakeholder key informant interviews with health professionals involved in the care of adults with CKD to ascertain their views on establishing core outcomes in CKD; an international two-round online Delphi survey with patients, caregivers, clinicians, researchers, policy makers and industry representatives to obtain consensus on critically important outcome domains; and stakeholder consensus workshops to review and finalise the set of core outcome domains for trials in CKD. Discussion Establishing a core outcome set to be reported in trials in patients with CKD will enhance the relevance, transparency and impact of research to improve the lives of people with CKD. Trial registration Not applicable. This study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database: http://www.comet-initiative.org/Studies/Details/1653.

Published
2021
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4. [How to estimate glomerular filtration rate in the context of drug dosage adaptation ?]

Author

Delanaye, Pierre, Bouquegneau, Antoine, Moranne, Olivier, Cavalier, Étienne, Centre Hospitalier Universitaire de Liège (CHU-Liège), and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)

Subjects
MESH: Glomerular Filtration Rate, MESH: Humans, Creatinine, MESH: Renal Insufficiency, Chronic, Humans, MESH: Creatinine, Renal Insufficiency, Chronic, urologic and male genital diseases, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, reproductive and urinary physiology, female genital diseases and pregnancy complications, Glomerular Filtration Rate
Abstract

In chronic kidney disease (CKD) patients, the dosage of many medications should be adapted according to the glomerular filtration rate (GFR). GFR estimation is obtained by using creatinine-based equations. Many different equations have been proposed in the literature, and they don't systematically lead to the same result in terms of drug dosage. There is an ongoing debate to determine which equations should be recommended, with the Cockcroft equation on one side and the MDRD (« Modified Diet in Renal Diseases ») or CKD-EPI (« Chronic Kidney Disease Epidemiology ») on the other side. The last two equations are especially used by nephrologists whereas the Cockcroft is still considered by geriatrists and pharmacologists. In the current article, we discuss the pro/cons from both sides, and propose recommendation for the clinical practice.En cas de maladie rénale chronique, il convient d’ajuster la dose des médicaments au débit de filtration glomérulaire (DFG). L’estimation du DFG est obtenue à partir de formules basées sur la mesure de la créatinine sérique. Plusieurs formules existent dans la littérature et elles n’aboutissent pas toujours à la même conclusion en termes d’adaptation posologique. Le débat dans la littérature sur le choix de la formule se pose entre celle de Cockcroft et Gault et celles appelées

Published
2020

5. Impact of age-related comorbidities on five-year overall mortality among elderly HIV-infected patients in the late HAART era — Role of chronic renal disease

Author

Maxime HENTZIEN, Dramé, M., Allavena, C., Jacomet, C., Valantin, A., André Cabié, Cuzin, L., Rey, D., Pugliese, P., Bani-Sadr, F., Hentzien, F., Dramé, D., Allavena, A., Centre Hospitalier Universitaire de Reims (CHU Reims), Service des maladies infectieuses et tropicales [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service des Maladies Infectieuses et Tropicales [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service de Maladies Infectieuses et Tropicales [Fort-de-France, Martinique], CHU de la Martinique [Fort de France]-Hôpital Pierre Zobda-Quitman [CHU de la Martinique], CHU de la Martinique [Fort de France]-Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], 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, Nouvel Hôpital Civil de Strasbourg, Service d'infectiologie [CHU Nice], Centre Hospitalier Universitaire de Nice (CHU Nice), IER - Institut d'Economie Rurale (IER), IER, Department of Genetics, Biology and Biochemistry, University of Turin, Service de Médecine interne, Maladies Infectieuses et Immunologie Clinique [Reims], Vieillissement, Fragilité (VIEFRA - EA 3797), Université de Reims Champagne-Ardenne (URCA), Service des maladies infectieuses [Clermont-Ferrand], CHU Clermont-Ferrand, Service des maladies infectieuses et tropicales [CHU Pitié-Salpêtrière], 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 d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Institut National de la Santé et de la Recherche Médicale (INSERM)-Université des Antilles et de la Guyane (UAG), and CHU Strasbourg

Subjects
Male, Aging, Medicine (miscellaneous), HIV Infections, MESH: Comorbidity, Comorbidity, MESH: Antiretroviral Therapy, Highly Active, Cohort Studies, surgery, MESH: Proportional Hazards Models, MESH: Cause of Death, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Antiretroviral Therapy, Highly Active, Cause of Death, Neoplasms, Prevalence, MESH: Aging, MESH: Neoplasms, Prospective Studies, 030212 general & internal medicine, MESH: Anti-HIV Agents, Prospective cohort study, MESH: Cohort Studies, ComputingMilieux_MISCELLANEOUS, MESH: Aged, 2. Zero hunger, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, MESH: Middle Aged, Nutrition and Dietetics, Mortality rate, Hazard ratio, MESH: HIV Infections, Hepatitis C, Middle Aged, Hepatitis B, 3. Good health, Cardiovascular Diseases, MESH: Fibrosis, Cohort, Female, 030211 gastroenterology & hepatology, France, Cohort study, medicine.medical_specialty, MESH: Diabetes Mellitus, Anti-HIV Agents, MESH: Renal Insufficiency, Chronic, valves, 03 medical and health sciences, Internal medicine, Diabetes Mellitus, medicine, Humans, Renal Insufficiency, Chronic, Intensive care medicine, MESH: Prevalence, Aged, Proportional Hazards Models, MESH: Hepatitis C, MESH: Humans, business.industry, MESH: Cardiovascular Diseases, medicine.disease, Fibrosis, mortality, infection, MESH: Male, MESH: Prospective Studies, MESH: France, prognosis, Geriatrics and Gerontology, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; To identify main prognostic factors for 5-year mortality among age-related comorbidities (ARCs) in older people living with HIV (PLHIV).; A prospective, multicentre cohort study with a 5-year follow-up period in the late HAART era (from January 2008 to December 2012).; The Dat'AIDS cohort involving 12 French hospitals.; All actively followed HIV-1 infected patients aged 60 or older.; The study endpoint was all-cause five-year mortality. The following ARCs were considered: chronic renal disease, cardiovascular diseases, cancer, chronic pulmonary disease, cirrhosis, diabetes and nutritional status. Hepatitis C (HCV), hepatitis B (HBV) co-infection and sociodemographic characteristics were also evaluated. Cox's Proportional Hazards model was used for multivariate analysis.; Among 1415 PLHIV aged 60 or more patients included, mean age was 66±5.5 years; 154 died (mortality rate 2.47/100 patient-years). The most prevalent ARCs were chronic renal disease (20.1%), diabetes (14.2%) and cardiovascular diseases (12.2%). By multivariate analysis, chronic renal disease (adjusted hazard ratio (aHR)=2.25; 95% confidence interval (CI) [1.58-2.21]; p

Published
2015
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6. The double challenge of resistant hypertension and chronic kidney disease

Author

Gérard M. London, Francesca Mallamaci, Eberhard Ritz, Ziad A. Massy, Gunnar H. Heine, Raymond Vanholder, Andrzej Wiecek, Carmine Zoccali, Patrick Rossignol, Mehmet Kanbay, David Goldsmith, Kitty J. Jager, Alberto Ortiz, Michel Azizi, George L. Bakris, Denis Fouque, Bénédicte Stengel, Adrian Covic, Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Association Lorraine pour le Traitement de l'Insuffisance Rénale (ALTIR), Service Néphrologie/Dialyse [AP-HP Ambroise-Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), 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), CIC - HEGP (CIC 1418), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-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), The University of Chicago Medicine [Chicago], Universität Heidelberg [Heidelberg], Nephrology Clinic Dialysis and Renal Transplant Center, Iasi, Nephrology Clinic, Dialysis and Renal Transplant Center, Iasi, Guy's and St Thomas' Hospitals, Universitätsklinikum des Saarlandes, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Koc University, School of Medicine, Istanbul, Azienda Ospedaliera Ospedali Civili Riuniti, CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hpertension Unit, Reggio Calabria, Reggio Calabria c/o Ospedali Riuniti, Fundacion Jimenez Diaz [Madrid] (FJD), Universidad Autonoma de Madrid (UAM), REDINREN Barcelona, Insituto Reina Sofia de Investigaciones Nefrológicas (IRSIN), Nephrology Section [Ghent], Ghent University Hospital, Medical University of Silesia, Katowice, Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), 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)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Néphrologie [Lyon], Hospices Civils de Lyon (HCL)-Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Medical University of Silesia (SUM), CIC-Nancy, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Néphrologie [Ambroise Paré], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Ambroise Paré, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), 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 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)-Institut National de la Santé et de la Recherche Médicale (INSERM), fundacion Jimenez Diaz, Université Paris Descartes - Paris 5 (UPD5)-Hôpital Européen Georges Pompidou [APHP] (HEGP), and 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, MESH: Renal Insufficiency, Chronic, Renal function, Blood Pressure, Renal artery stenosis, MESH: Hypertension, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH: Risk Factors, Risk Factors, Internal medicine, Epidemiology, medicine, Humans, MESH: Diuretics, Renal Insufficiency, Chronic, Diuretics, Intensive care medicine, Antihypertensive drug, Antihypertensive Agents, Dialysis, MESH: Treatment Outcome, MESH: Antihypertensive Agents, MESH: Humans, business.industry, MESH: Blood Pressure, General Medicine, Diet, Sodium-Restricted, medicine.disease, 3. Good health, Treatment Outcome, Blood pressure, MESH: Diet, Sodium-Restricted, Hypertension, Diuretic, business, Kidney disease
Abstract

International audience; Resistant hypertension is defined as blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease is the most frequent of several patient factors or comorbidities associated with resistant hypertension. The prevalence of resistant hypertension is increased in patients with chronic kidney disease, while chronic kidney disease is associated with an impaired prognosis in patients with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. New therapeutic innovations for resistant hypertension, such as renal denervation and carotid barostimulation, are under investigation especially in patients with advanced chronic kidney disease. We discuss resistant hypertension in chronic kidney disease stages 3-5 (ie, patients with an estimated glomerular filtration rate below 60 mL/min per 1·73 m(2) and not on dialysis), in terms of worldwide epidemiology, outcomes, causes and pathophysiology, evidence-based treatment, and a call for action.

Published
2015
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7. Antiplatelet and oral anticoagulant therapies in chronic hemodialysis patients: prescribing practices and bleeding risk

Author

Collette, Camille, Clerc-Urmès, Isabelle, Laborde-Castérot, Hervé, Frimat, Luc, Ayav, Carole, Peters, Nicolas, Martin, Alexandre, Agrinier, Nelly, Thilly, Nathalie, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), CHU Bordeaux [Bordeaux], Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CIC-Nancy, and Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, Risk, pharmacoepidemiology, MESH: Probability, MESH: Renal Insufficiency, Chronic, Administration, Oral, Hemorrhage, MESH: Anticoagulants, Cohort Studies, MESH: Proportional Hazards Models, MESH: Aged, 80 and over, prescribing practices, Renal Dialysis, oral anticoagulant, Humans, MESH: Renal Dialysis, Renal Insufficiency, Chronic, MESH: Cohort Studies, Aged, Probability, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, MESH: Aged, hemodialysis, MESH: Humans, MESH: Middle Aged, MESH: Risk, bleeding events, Anticoagulants, MESH: Adult, MESH: Retrospective Studies, MESH: Follow-Up Studies, Middle Aged, antiplatelet agent, MESH: Male, MESH: Drug Therapy, Combination, MESH: Platelet Aggregation Inhibitors, MESH: Administration, Oral, Drug Therapy, Combination, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female, Platelet Aggregation Inhibitors, MESH: Hemorrhage, Follow-Up Studies
Abstract

International audience; PURPOSE:Results of previous studies assessing the risk of bleeding associated with prescription of antiplatelet (AP) and/or oral anticoagulant (AC) therapy to hemodialysis patients are conflicting. Our purpose was to describe practices for prescription of AP and AC in hemodialysis patients in the Lorraine region, and to assess their effect on the risk of major bleeding events.METHODS:All adults with chronic kidney disease who began a first renal replacement therapy by hemodialysis in 2009 or 2010 in one of the 12 dialysis centers in Lorraine were included in the Thrombosis and Hemorrhage in HemoDialysis patients (T2HD) study and followed up until 30 June 2013. The association of each treatment (AP, AC, AP + AC) with the risk of major bleeding was estimated by three Cox proportional hazard models with an inverse probability of treatment weighting on a propensity score, considering the untreated patients as the reference.RESULTS:Among 502 patients included, 227 (45.2%) received an AP, 68 (13.5%) an AC, 81 (16.1%) a combination AP + AC, and 126 (25.1%) were untreated. As compared with untreated patients, those given AP (HR 5.52, 95% CI [3.11-9.80]), AC (HR: 4.15, 95% CI: [3.46-4.99]), and AP + AC (HR: 5.59, 95% CI [2.62-11.91]) were at greater risk of major bleeding events.CONCLUSIONS:The risk of major bleeding is higher in patients receiving an oral AC compared with untreated patients and those receiving an AP agent. A combination of the two drugs does not seem to increase the risk.

Published
2016
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8. Interarm blood pressure difference: more than an epiphenomenon

Author

Christopher E Clark, Victor Aboyans, Neuroépidémiologie Tropicale (NET), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, and Grelier, Elisabeth

Subjects
Nephrology, Male, medicine.medical_specialty, Systole, medicine.medical_treatment, MESH: Renal Insufficiency, Chronic, Epiphenomenon, Blood Pressure, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Chronic Kidney Diseases, medicine, Humans, 030212 general & internal medicine, Renal Insufficiency, Chronic, Intensive care medicine, Dialysis, ComputingMilieux_MISCELLANEOUS, Transplantation, MESH: Humans, business.industry, MESH: Cardiovascular Diseases, MESH: Blood Pressure, MESH: Systole, humanities, MESH: Male, Blood pressure, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Cardiovascular Diseases, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, business, MESH: Female
Abstract

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Nephrology Dialysis transplantation following peer review. The version of record is available online via the DOI in this record.

Published
2015

9. Rationale and design of MinerAlocorticoid Receptor antagonist Tolerability Study-Heart Failure (ARTS-HF): a randomized study of finerenone vs. eplerenone in patients who have worsening chronic heart failure with diabetes and/or chronic kidney disease

Author

So Young Kim, Piotr Ponikowski, Stefan D. Anker, Henry Krum, Michael Böhm, Lars Køber, Christina Nowack, Mihai Gheorghiade, Bertram Pitt, Gerasimos Filippatos, Adriaan A. Voors, Aldo P. Maggioni, Faiez Zannad, Nina Kimmeskamp-Kirschbaum, Alexander Pieper, University of Michigan [Ann Arbor], University of Michigan System, University Medical Center Göttingen (UMG), Universitätsklinikum des Saarlandes, Center for Cardiovascular Innovation, Feinberg School of Medicine, Northwestern University [Evanston]-Northwestern University [Evanston], Rigshospitalet [Copenhagen], Copenhagen University Hospital, Center of Cardiovascular Research and Education in Therapeutics [Monash University - Melbourne], Monash University [Melbourne], Research Center [Associazione Nazionale Medici Cardiologi Ospedalieri] (ANMCO Research Center), Associazione Nazionale Medici Cardiologi Ospedalieri [Firenze] (ANMCO), Wroclaw Medical University, University Medical Center Groningen [Groningen] (UMCG), Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Global Clinical Development, Bayer HealthCare AG, M.A.R.C.O. GmbH & Co, University General Hospital ' Attikon ' [Athens, Greece], and Cardiovascular Centre (CVC)

Subjects
EUROBSERVATIONAL RESEARCH-PROGRAM, Mineralocorticoid receptor, MESH: Comorbidity, Comorbidity, BAY 94-8862, 030204 cardiovascular system & hematology, chemistry.chemical_compound, DOUBLE-BLIND, 0302 clinical medicine, Chronic kidney disease, Natriuretic Peptide, Brain, MESH: Double-Blind Method, 030212 general & internal medicine, MESH: Natriuretic Peptide, Brain, MESH: Peptide Fragments, Mineralocorticoid Receptor Antagonists, education.field_of_study, MESH: Naphthyridines, SPIRONOLACTONE, 3. Good health, Eplerenone, Tolerability, BRAIN NATRIURETIC PEPTIDE, ALDOSTERONE ANTAGONISTS, MESH: Spironolactone, Cardiology, TRIAL, Natriuretic Agents, Cardiology and Cardiovascular Medicine, medicine.drug, MESH: Diabetes Mellitus, Type 2, medicine.medical_specialty, Finerenone, Population, MESH: Renal Insufficiency, Chronic, Heart failure, MESH: Mineralocorticoid Receptor Antagonists, 03 medical and health sciences, Double-Blind Method, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, Diabetes mellitus, Type 2 diabetes mellitus, medicine, Humans, Naphthyridines, Renal Insufficiency, Chronic, Intensive care medicine, education, HOSPITAL DISCHARGE, MESH: Humans, business.industry, Antagonist, medicine.disease, Peptide Fragments, chemistry, Diabetes Mellitus, Type 2, MESH: Heart Failure, MESH: Natriuretic Agents, Spironolactone, business, FOLLOW-UP, Kidney disease, TASK-FORCE
Abstract

International audience; AIMS:To investigate the safety and potential efficacy of the novel non-steroidal mineralocorticoid receptor antagonist finerenone in patients with worsening chronic heart failure and reduced left ventricular ejection fraction (HFrEF) and at high risk of hyperkalaemia and worsening renal dysfunction.METHODS AND RESULTS:The MinerAlocorticoid Receptor antagonist Tolerability Study-Heart Failure (ARTS-HF; NCT01807221) is a multicentre, randomized, double-blind, active-comparator-controlled, six-parallel-group, phase 2b dose-finding study. In total, 1060 patients with HFrEF and concomitant type 2 diabetes mellitus and/or chronic kidney disease (CKD) will be randomized within 7 days of emergency presentation to hospital for worsening chronic HF to receive finerenone (one of five doses in the range 2.5-20.0 mg once daily) or eplerenone (25 mg every second day to 50 mg once daily for 90 days). The primary objective is to investigate the safety and potential efficacy (measured as the percentage of individuals with a decrease in plasma N-terminal pro-B-type natriuretic peptide [NT-proBNP] of more than 30% relative to baseline at day 90 ± 2) of different oral doses of finerenone compared with eplerenone. Other objectives are to assess the effects of finerenone on a composite clinical endpoint (death from any cause, cardiovascular hospitalizations, or emergency presentations for worsening chronic HF), and on changes in health-related quality of life from baseline.CONCLUSIONS:ARTS-HF is the first phase 2b clinical trial to investigate the effects of finerenone on plasma NT-proBNP in a high-risk population of patients who have worsening chronic HF with type 2 diabetes mellitus and/or CKD presenting at the emergency department.

Published
2015
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10. Competing-risk analysis of death and dialysis initiation among elderly (≥80 years) newly referred to nephrologists: a French prospective study

Author

L. Frimat, Jean-Baptiste Beuscart, Bernadette Faller, Hôpital Louis Pasteur [Colmar] (CH Colmar), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Santé publique : épidémiologie et qualité des soins-EA 2694 (CERIM), and Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)

Subjects
Male, Nephrology, Hyperkalemia, medicine.medical_treatment, Competing-risk analysis, 030232 urology & nephrology, MESH: Risk Assessment, Elderly, 0302 clinical medicine, MESH: Aged, 80 and over, Chronic kidney disease, Medicine, MESH: Physicians, MESH: Renal Dialysis, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Referral and Consultation, Aged, 80 and over, 2. Zero hunger, education.field_of_study, MESH: Follow-Up Studies, 3. Good health, Conservative management, Female, France, medicine.symptom, Research Article, medicine.medical_specialty, Population, MESH: Renal Insufficiency, Chronic, Risk Assessment, Cachexia, 03 medical and health sciences, MESH: Referral and Consultation, Renal Dialysis, Physicians, Internal medicine, Humans, Renal replacement therapy, Renal Insufficiency, Chronic, education, MESH: Humans, business.industry, medicine.disease, MESH: Male, MESH: Prospective Studies, MESH: France, Blood pressure, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Follow-Up Studies, Kidney disease
Abstract

Background Reasons underlying dialysis decision-making in Octogenarians and Nonagenarians have not been further explored in prospective studies. Methods This regional, multicentre, non-interventional and prospective study was aimed to describe characteristics and quality of life (QoL) of elderly (≥80 years of age) with advanced chronic kidney disease (stage 3b-5 CKD) newly referred to nephrologists. Predictive factors of death and dialysis initiation were also assessed using competing-risk analyses. Results All 155 included patients had an estimated glomerular filtration rate (eGFR) below 45 ml/min/1.73 m2. Most patients had a non anaemic haemoglobin level (Hb) with no iron deficiency, and normal calcium and phosphate levels. They were well-fed and had a normal cognitive function and a good QoL. The 3-year probabilities of death and dialysis initiation reached 27% and 11%, respectively. The leading causes of death were cardiovascular (32%), cachexia (18%), cancer (9%), infection (3%), trauma (3%), dementia (3%), and unknown (32%). The reasons for dialysis initiation were based on uncontrolled biological abnormalities, such as hyperkalemia or acidosis (71%), uncontrolled digestive disorders (35%), uncontrolled pulmonary or peripheral oedema (29%), and uncontrolled malnutrition (12%). No patients with acute congestive heart failure or cancer initiated dialysis. Predictors of death found in both multivariate regression models (Cox and Fine & Gray) included acute congestive heart failure, age, any walking impairment and Hb 2 was the only predictor found in the Cox multivariate regression model whereas eGFR 2 and diastolic blood pressure were both independently associated with dialysis initiation in the Fine & Gray analysis. Such findings suggested that death and dialysis were independent events. Conclusions Octogenarians and Nonagenarians newly referred to nephrologists by general practitioners were highly selected patients, without any symptoms of the common geriatric syndrome. In this population, nephrologists’ dialysis decision was based exclusively on uremic criteria.

Published
2013
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11. Low-protein diet in chronic kidney disease: from questions of effectiveness to those of feasibility

Author

Nathalie Thilly, Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Epidémiologie Clinique (CIC-EC), and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, safety, Pathology, medicine.medical_specialty, MESH: Amino Acids, Essential, medicine.medical_treatment, MESH: Renal Insufficiency, Chronic, 030232 urology & nephrology, effectiveness, MESH: Dietary Supplements, compliance, 03 medical and health sciences, 0302 clinical medicine, Low-protein diet, Internal medicine, medicine, Diet, Protein-Restricted, Humans, MESH: Diet, Protein-Restricted, 030212 general & internal medicine, Renal Insufficiency, Chronic, ComputingMilieux_MISCELLANEOUS, Transplantation, MESH: Humans, business.industry, low-protein diet, medicine.disease, MESH: Male, 3. Good health, Compliance (physiology), Nephrology, Dietary Supplements, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Amino Acids, Essential, business, MESH: Female, chronic kidney disease, Kidney disease, feasibility
Abstract

International audience

Published
2013
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12. La pharmaco-épidémiologie pour évaluer les pratiques cliniques et leur impact sur la santé, à propos d’un exemple en néphrologie : l’étude AVENIR

Author

Thilly, Nathalie, Boini, Stephanie, Laurain, Emmanuelle, Ayav, Carole, Kessler, Michèle, Briançon, Serge, Frimat, Luc, Centre d'Epidémiologie Clinique (CIC-EC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), and Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, MESH: Survival Rate, MESH: Renal Insufficiency, Chronic, MESH: Pharmacoepidemiology, MESH: Hospitalization, MESH: Prognosis, MESH: Aged, 80 and over, Renal Dialysis, Humans, MESH: Renal Dialysis, Prospective Studies, MESH: Quality of Health Care, Practice Patterns, Physicians', Renal Insufficiency, Chronic, Aged, Quality of Health Care, Aged, 80 and over, MESH: Aged, MESH: Humans, MESH: Middle Aged, Pharmacoepidemiology, MESH: Quality of Life, MESH: Nephrology, Middle Aged, Prognosis, MESH: Prospective Studies, MESH: Male, Hospitalization, Survival Rate, MESH: France, MESH: Morbidity, Nephrology, MESH: Practice Patterns, Physicians', Quality of Life, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Morbidity, MESH: Female
Abstract

International audience; The AVENIR study is a pharmaco-epidemiological study, lead in Lorraine region (France) between 1st January, 2005 and 31st December, 2006, which aim at: evaluating the quality of therapeutic practices, delivered by nephrologists, for chronic kidney disease patients during the year preceding dialysis onset, assessing the association between quality of predialysis therapeutic practices and survival and hospitalization during the first year of dialysis, and health-related quality of life at dialysis onset. Several data were collected for the AVENIR study: demographic, clinical, biological and therapeutic data before dialysis, morbidity and mortality during dialysis treatment. These data were used for secondary analyses investigating the decline in glomerular filtration rate over the year preceding dialysis, the management of hypertension and proteinuria before dialysis, and characteristics and outcomes of patients with delayed dialysis initiation. Results from the AVENIR study have been published in various international journals. The aim of this manuscript is to present a summary of these results and the lessons we can learn for the nephrological practice.; L’étude AVENIR est une étude de pharmaco-épidémiologie, conduite en 2005 et 2006 en région Lorraine, et dont les objectifs principaux étaient : d’évaluer la qualité des pratiques néphrologiques de prise en charge médicamenteuse chez les insuffisants rénaux chroniques au cours de l’année précédant le démarrage de la dialyse, de mesurer l’impact de la qualité de ces pratiques sur la morbimortalité pendant la première année de dialyse et la qualité de vie à l’initiation de la suppléance rénale. De nombreuses données démographiques, cliniques, biologiques et thérapeutiques avant dialyse et de morbidité et mortalité pendant la dialyse, ont été recueillies dans le cadre de cette étude. Ces données ont permis de réaliser des analyses répondant à des objectifs secondaires de l’étude ; ces objectifs portaient sur déclin au cours du temps du débit de filtration glomérulaire dans l’année précédant la suppléance rénale, la prise en charge de l’hypertension artérielle (HTA) et de la protéinurie avant dialyse, le retard à l’initiation de la dialyse et ses conséquences sur la morbidité et la mortalité. Les résultats, correspondant aux objectifs principaux et secondaires de l’étude AVENIR, ont été publiés dans différentes revues internationales. L’objectif de cet article est de présenter une synthèse de ses résultats et les leçons à en tirer pour la pratique néphrologique.

Published
2013
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13. [Kidney diseases: new issues]

Author

Ronco, Pierre, Remodelage et Reparation du Tissu Renal, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), and RONCO, Pierre

Subjects
MESH: Kidney Diseases, MESH: Humans, MESH: Chronic Disease, MESH: Renal Insufficiency, Chronic, MESH: Biological Markers, MESH: Cardiovascular Diseases, urologic and male genital diseases, Prognosis, female genital diseases and pregnancy complications, MESH: Prognosis, MESH: France, Cohort Studies, Cardiovascular Diseases, [SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], Chronic Disease, Disease Progression, [SDV.BBM.GTP] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], Humans, MESH: Disease Progression, Kidney Diseases, France, Renal Insufficiency, Chronic, MESH: Cohort Studies, Biomarkers
Abstract

International audience; Chronic kidney disease (CKD) affects two to four million people in France and most of them are not aware of their disease. CKD is a major, independent risk factor of cardiovascular mortality and morbidity; the cardiovascular risk increases with the severity of renal failure. Evaluation of renal function (GFR) relies on MDRD and CKD-EPI equations. The French CKD-REIN cohort with more than 3000 patients followed for 5 years, will hopefully provide substantial advances in the knowledge of CKD epidemiology, of risk factors and mechanisms of CKD progression and medical practices. Improving CKD screening based on blood pressure, proteinuria (microalbuminuria in diabetic patients) and serum creatinine, is a national duty in high risk patients (with diabetes, hypertension and cardiovascular diseases). A major research goal is to identify new therapeutic targets and biomarkers, in order to treat kidney diseases before the occurrence of renal insufficiency, to halt their progression and to decrease cardiovascular risk. Careful therapeutic education of patients is required to successfully implement established guidelines, appropriate diets and new therapeutic strategies.

Published
2011
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14. Large kidneys predict poor renal outcome in subjects with diabetes and chronic kidney disease

Author

Benoit Vendrely, C. Lasseur, François Laurent, Magalie Garcia, Marie-Christine Beauvieux, Christian Combe, Vincent Rigalleau, Philippe Chauveau, Henri Gin, Michel Montaudon, Christelle Raffaitin, Nicole Barthe, Nutrition-Diabétologie, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], 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], Imagerie médicale, Médecine Nucléaire, Biochimie, This study was supported by a grant from the Programme Hospitalier de Recherche Clinique 2001., and BMC, Ed.

Subjects
Nephrology, Male, Renal Hypertrophy, medicine.medical_treatment, MESH: Organ Size, 030232 urology & nephrology, Kidney, lcsh:RC870-923, urologic and male genital diseases, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Diabetic nephropathy, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, Diabetic Nephropathies, Prospective Studies, Ultrasonography, MESH: Aged, MESH: Middle Aged, Organ Size, MESH: Follow-Up Studies, Middle Aged, MESH: Predictive Value of Tests, 3. Good health, medicine.anatomical_structure, Creatinine, Disease Progression, Female, MESH: Disease Progression, Glomerular Filtration Rate, medicine.medical_specialty, MESH: Diabetic Nephropathies, MESH: Renal Insufficiency, Chronic, Urology, Renal function, 030209 endocrinology & metabolism, MESH: Creatinine, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Research article, medicine, Humans, Renal Insufficiency, Chronic, Dialysis, Aged, MESH: Humans, business.industry, MESH: Kidney, medicine.disease, lcsh:Diseases of the genitourinary system. Urology, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Prospective Studies, MESH: Male, MESH: Glomerular Filtration Rate, Endocrinology, chemistry, business, MESH: Female, Kidney disease, Follow-Up Studies
Abstract

Background Renal hypertrophy occurs early in diabetic nephropathy, its later value is unknown. Do large kidneys still predict poor outcome in patients with diabetes and Chronic Kidney Disease (CKD)? Methods Seventy-five patients with diabetes and CKD according to a Glomerular Filtration Rate (GFR, by 51Cr-EDTA clearance) below 60 mL/min/1.73 m2 or an Albumin Excretion Rate above 30 mg/24 H, had an ultrasound imaging of the kidneys and were cooperatively followed during five years by the Diabetology and Nephrology departments of the Centre Hospitalier Universitaire de Bordeaux. Results The patients were mainly men (44/75), aged 62 ± 13 yrs, with long-standing diabetes (duration:17 ± 9 yrs, 55/75 type 2), and CKD: initial GFR: 56.5 (8.5-209) mL/min/1.73 m2, AER: 196 (20-2358) mg/24 H. Their mean kidney lenght (108 ± 13 mm, 67-147) was correlated to the GFR (r = 0.23, p < 0.05). During the follow-up, 9/11 of the patients who had to start dialysis came from the half with the largest kidneys (LogRank: p < 0.05), despite a 40% higher initial isotopic GFR. Serum creatinine were initially lower (Small kidneys: 125 (79-320) μmol/L, Large: 103 (50-371), p < 0.05), but significantly increased in the "large kidneys" group at the end of the follow-up (Small kidneys: 129 (69-283) μmol/L, Large: 140 (50-952), p < 0.005 vs initial). The difference persisted in the patients with severe renal failure (KDOQI stages 4,5). Conclusions Large kidneys still predict progression in advanced CKD complicating diabetes. In these patients, ultrasound imaging not only excludes obstructive renal disease, but also provides information on the progression of the renal disease.

Published
2010
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15. Predialysis therapeutic care and health-related quality of life at dialysis onset (The pharmacoepidemiologic AVENIR study)

Author

Serge Briançon, Stéphanie Boini, L. Frimat, Michèle Kessler, Nathalie Thilly, Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), The AVENIR study was supported by a grant from the Hospital Program of Clinical Research (PHRC 2004) of the French Ministry of Health., BMC, Ed., Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), and Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy )

Subjects
Male, Nephrology, MESH: Observation, Health Status, medicine.medical_treatment, MESH : Aged, MESH : Nephrology, 030232 urology & nephrology, Observation, MESH : Observation, Cohort Studies, 0302 clinical medicine, Cost of Illness, Surveys and Questionnaires, MESH : Cost of Illness, MESH : Female, MESH: Renal Dialysis, 030212 general & internal medicine, Disease management (health), MESH: Cohort Studies, MESH: Health Status, MESH: Aged, MESH: Middle Aged, MESH : Questionnaires, Disease Management, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Nephrology, General Medicine, MESH : Adult, Middle Aged, MESH: Cost of Illness, MESH : Renal Dialysis, humanities, 3. Good health, MESH: Kidney Failure, Chronic, lcsh:R858-859.7, Female, Cohort study, Adult, medicine.medical_specialty, MESH : Male, MESH: Renal Insufficiency, Chronic, MEDLINE, MESH : Cohort Studies, MESH : Renal Insufficiency, Chronic, lcsh:Computer applications to medicine. Medical informatics, MESH: Disease Management, MESH : Kidney Failure, Chronic, MESH: Multivariate Analysis, 03 medical and health sciences, Quality of life (healthcare), Renal Dialysis, Internal medicine, medicine, Humans, MESH : Middle Aged, Renal replacement therapy, MESH : Health Status, Renal Insufficiency, Chronic, Intensive care medicine, Dialysis, Aged, Health related quality of life, MESH: Humans, business.industry, Research, MESH: Questionnaires, MESH : Humans, Public Health, Environmental and Occupational Health, MESH : Multivariate Analysis, MESH: Quality of Life, MESH: Adult, MESH : Quality of Life, MESH : Disease Management, MESH: Male, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Multivariate Analysis, Quality of Life, Kidney Failure, Chronic, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

Background To determine the impact of the quality of pre-dialysis nephrological care on health-related quality of life (HRQoL) at dialysis onset, which has not been well evaluated. Methods All adults who began a dialysis treatment in the administrative region of Lorraine (France) in 2005 or 2006, were enrolled in this prospective observational study. HRQoL was measured using the Kidney Disease Quality of Life V36 questionnaire, which enables calculation of two generic (physical and mental) and three specific dimensions (Symptoms/problems, Effects and Burden of kidney disease). The specific dimensions were scored from 0 to 100 (worst to best possible functioning). Pre-dialysis nephrological care was measured using three indicators: quality of therapeutic practices (evaluated across five main aspects: hypertension/proteinuria, anemia, bone disease, metabolic acidosis and dyslipidemia), time since referral to a nephrologist and number of nephrology consultations in the year preceding dialysis treatment. Results Two thousand and eighty-three (67.4%) patients were referred to a nephrologist more than 1 month before dialysis initiation and completed the HRQoL questionnaire. Quality of therapeutic practices was significantly associated with the Mental component. Time since referral to a nephrologist was associated with Symptoms/problems and the Effects of kidney disease dimensions, but no relationship was found between the number of nephrology consultations and HRQoL. Conclusions HRQoL at dialysis onset is significantly influenced by the quality of pre-dialysis nephrological care. Therefore, disease management should be emphasized.

Published
2011
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