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Objectifs Une relation en U entre la kaliémie et la mortalité chez les insuffisants rénaux a été décrite. Chez les hypertendus, cette relation n'est pas connue. L'objectif de cette analyse est d'évaluer l'influence conjointe de la kaliémie et de la fonction rénale sur la mort subite d'origine cardiaque (MSC) chez les sujets hypertendus âgés. Méthodes À partir de la base de données INDANA (qui regroupe les données de sept essais cliniques d'intervention randomisés dans l'HTA). Trois de ces essais (STOP, SHEP et EWEPH) ont recueilli les kaliémies et les créatininémies d'inclusion des patients. Les données individuelles de 3 620 hypertendus (PAS/PAD = 176 ± 16/81 ± 14 mmHg) âgés de plus de 70 ans (76,0 ± 4,9 ans) ont été extraites. En plus de la kaliémie et de la créatininémie, 15 variables (antécédent de maladies CV (angor, infarctus du myocarde, AVC, AOMI), âge, tabagisme, uricémie, glycémie, cholestérolémie totale, sexe, BMI, PAS/PAD, FC, diabète) enregistrées au début de l'étude ont été analysées en utilisant un réseau bayésien (Netica ® 2.05). La variable à décrire était la mort subite cardiologique. La fonction rénale a été considérée altérée (IRC) si la créatinémie des hommes était > 135; et celle des femmes > 103 μmol/l. La kaliémie a été classée en 4 stades. Hypokaliémie K < 3.5, normokaliémie (K entre 3.5 et 4.5) hyperkaliémie modérée (K entre 4.5 et 5) et hyperkaliémie sévère si K > 5.0 mmol/l Rèsultats Au cours d'un suivi moyen de 3,6 annèes [2.1 à 4.4], 81 patients (2.24 %) sont dècèdès de MSC. La distance de Kullback-Leibler qui èvalue la force de la dèpendance entre les variables a rèvèlè que l'AOMI, l'âge, l'angor, les antècèdents d'infarctus du myocarde, le tabagisme et la crèatininèmie ètaient par ordre dècroissant les variables plus lièes à la MSC. L'aire sous la courbe ROC du modèle bayèsien pour prèdire la MSC ètait de 0.90 Une hypokalièmie (< 3,5 mmol/l) augmente le risque de MSC plus que l'hyperkalièmie. Abstract CO-16 – Figure Une insuffisance rènale augmente le risque de MSC quelque-soit le niveau du potassium. Une hypokalièmie associèe à une IRC augmente de 370 % le risque de MSC. Une hyperkalièmie associèe à une IRC augmente d'environ 250 % le risque de MSC. Conclusion L'hypokalièmie et l'hyperkalièmie augmentent considèrablement la mort subite d'origine cardiaque des hypertendus âgès de plus de 70 ans d'autant plus que leur fonction rènale est altèrèe [ABSTRACT FROM AUTHOR]

Objectifs Prédire en ligne la survie avec ou sans évènements cardiovasculaires à 2 ans des diabétiques de type 2 protéinuriques Méthodes Les données proviennent de l'étude multicentrique observation-nelle prospective ALICE – Protect : 153 néphrologues exerçant en France ont recruté, entre janvier 2010 et février 2011, 986 adultes diabétiques de type 2 ayant une protéinurie clinique et un DFG > 15 ml/mn/1,73 m 2 . 27 variables ayant trait aux caractéristiques du sujet, à son traitement, à ses antécédents, à ses caractéristiques biologiques ont été recueillies. Le modèle de prédiction a été réalisé à l'aide d'une méthode non paramétrique s'appuyant sur la théorie des réseaux bayésiens. L'algorithme de découverte d'association utilisé est de type naïf augmenté. Résultats La population à l'inclusion était constituée de 74 % d'hommes (70 ± 10 ans), ayant un eDFG (MDRD) de 40,0 ± 20,3 ml/min/1,73 m 2 , aux stades de Maladie Rénale Chronique 2 (13 %), 3a (18 %), 3b (32 %), et 4 (37 %). Les taux de mortalité et morbidité observés parmi la population évaluable (n = 729) durant le suivi de 23 mois ont été de 8,2 % pour les décès (60 patients, dont 26 décès de cause cardiovasculaire) et 24,1 % pour les évènements cardiovasculaires. Le modèle prédit à 83.9 % le devenir à 2 ans des diabétiques inclus dans l'étude. L'ajustement du modèle aux données est très statistiquement significatif, l'AUC sous la courbe ROC est à 0.78. La valeur prédictive négative est de 94.6 % et la valeur prédictive positive pour la survenue d'un événement CV est de 34 %. Le risque d'avoir un évènement CV à 2 ans peut être calculé en ligne à l'adresse suivante : https://www.hed.cc/?s=cvevent&t=CV%20Event Conclusion Le modèle détecte très bien (à 95 %) les sujets qui n'auront pas de complication CV dans les 2 ans. Une surveillance accrue doit être apportée aux 90 sujets qui ont 66 % de malchance de développer à 2 ans un événement CV parfois mortel (28 %). [ABSTRACT FROM AUTHOR]

Abstract: Adrenal venous sampling (AVS) is a challenging technical procedure and few patients had AVS procedure twice. Aim: To evaluate the reproducibility of the AVS, why AVS were repeated and the conclusions drawn from them. Patients and methods: From 1997–2012, 12 patients underwent two AVS. A cortisol level in the adrenal vein greater than or equal to 1.1 to inferior vena cava defined a successful catheterization and a lateralization of secretion corresponded to an aldosterone-to-cortisol vein ratio greater than or equal to 2 between the one side to another. Results: The same side of lateralization of secretion was found in 75% of them. The second AVS were due to technical failure (n =4), unproven lateralization (n =2), a lateralization opposite to the main nodule and ipsilateral to hyperplasia (n =4) on first AVS. For two patients, as the CT was normal, AVS was required again. The second AVS was successful in all patients, including those with an initial technical failure but only patient with technical failure underwent surgery, as BP and kaliemia were controlled. Lateralization on the side of hyperplasia or opposite to the biggest nodule was confirmed in two of four cases. Conclusion: When AVS is unsuccessful for technical reasons, it is worth doing it again but after being sure that surgery is still possibly indicated. [Copyright &y& Elsevier]

a. dubouix, m. nieto, j. fauvel, h. chap, n. marty, j.-p. salles and f. gaits. 2004. To design a simple method to produce active recombinant Pseudomonas aeruginosa haemolytic phospholipase C (PLC). Pseudomonas aeruginosa PLC is a virulence factor mainly involved in inflammatory and cytotoxic responses. While ammonium sulphate purification requires large amounts of bacterial suspensions and leads to low yields, production of recombinant protein in Escherichia coli is no more successful because of frequent inclusion bodies and accumulation of inactive PLC in the periplasmic space. Using an inducible system based on the glucose-repressed inv1 promoter in the yeast Schizosaccharomyces pombe, we were able to produce up to 10 IU ml−1 of pure toxin within 24 h. This work describes the first method to easily get recombinant haemolytic PLC. This method provides a powerful tool to study the mechanisms leading to its cellular toxicity. [ABSTRACT FROM AUTHOR]

Évaluer la fiabilité de l'autoquestionnaire ExSel® pour détecter une consommation excessive de sel (≥ 12 g/24 h) chez les patients consultant pour hypertension et/ou insuffisance rénale. Les résultats obtenus par l'autoquestionnaire ExSel® ont été comparés à l'excrétion de sodium pendant 24 h à l'aide du test de Kappa de Cohen, et du test du Khi2. La sensibilité, la spécificité, les VPP et VPN ont été calculées. Une courbe ROC a été réalisée pour rechercher un seuil de positivité. Les caractéristiques moyennes des 101 patients avec des résultats fiables étaient les suivantes : âge de 67 ± 12 ans, indice de masse corporelle 28,4 + 5,6 kg/m2, SBP/DBP 139 ± 23/74 ± 13 mmHg (98 % étaient des hypertendus). La consommation de sel évaluée par la natriurèse dès 24 h était de 7,5 ± 3,1 g/24 h. La créatininurie était de 13,9 + 20,1 mmol/24 h. Une consommation excessive de sel (≥ 12 g/24 h) a été observée chez 8 % des patients. Le test Kappa à 0,17 et le Khi2 à 0,66 signifient que l'accord entre ExSel® et la natriurèse n'était pas significatif pour dépister un excès de consommation sodée. La sensibilité était de 37 %, la spécificité de 90 %, la VPP de 20 % et la VPN de 94 %. L'aire sous la courbe ROC était trop faible (0,665) pour espérer pouvoir déterminer un seuil de positivité d'ExSel® adapté aux patients consultant en néphrologie. L'autoquestionnaire ExSel® n'est pas adaptée aux patients ambulatoires suivis en consultation de néphrologie dont 98 % étaient hypertendus pour dépister une consommation excessive de sel > 12 g/24 h. To evaluate the reliability of the ExSel® self-questionnaire to detect an excess salt intake (≥ 12 g/24 h) in patients consulting for hypertension and/or renal failure. Results of the ExSel® self-questionnaire were compared to 24 h sodium excretion using the Cohen's kappa test and a Chi2 test. Sensitivity, specificity, VPP and VPN were calculated. A ROC curve was realized to find an accurate cut-off. Mean characteristics of the 101 patients with reliable results were: age of 67 ± 12 years, Body Mass Index 28.4 ± 5.6 kg/m2, SBP/DBP 139 ± 23/74 ± 13 mmHg (98% were hypertensives. Mean salt intake was 7.5 ± 3.1 g/24 h and mean creatininuria was 13.9 ± 20.1 mmol/24 h. An excess salt intake (≥ 12 g/24 h) was observed in 8% of the patients. The Kappa test at 0.17 and the Chi2 at 0.66 signify that the agreement was very low. Sensitivity was 37%, specificity 90%, PPV 20% and NPV 94%. The AUC under the ROC curve was too low (0.665) to determine a threshold adapted to the renal patients. The ExSel® autoquestionnaire is not adapted to outpatients, mainly hypertensives (98%) followed in a nephrology consultation to detect an excess salt consumption. [ABSTRACT FROM AUTHOR]

Current antihypertensive strategies do not take into account that individual characteristics may influence the magnitude of blood pressure (BP) reduction. Guidelines promote trial-and-error approaches with many different drugs. We conducted the Identification of the Determinants of the Efficacy of Arterial blood pressure Lowering drugs (IDEAL) Trial to identify factors associated with BP responses to perindopril and indapamide. IDEAL was a cross-over, double-blind, placebo-controlled trial, involving four 4-week periods: indapamide, perindopril and two placebo. Eligible patients were untreated, hypertensive and aged 25-70 years. The main outcome was systolic BP (SBP) response to drugs. The 112 participants with good compliance had a mean age of 52. One in every three participants was a woman. In middle-aged women, the SBP reduction from drugs was −11.5 mm Hg (indapamide) and −8.3 mm Hg (perindopril). In men, the response was significantly smaller: −4.8 mm Hg (indapamide) and −4.3 (perindopril) (P for sex differences 0.001 and 0.015, respectively). SBP response to perindopril decreased by 2 mm Hg every 10 years of age in both sexes (P=0.01). The response to indapamide increased by 3 mm Hg every 10 years of age gradient in women (P=0.02). Age and sex were important determinants of BP response for antihypertensive drugs in the IDEAL population. This should be taken into account when choosing drugs a priori. [ABSTRACT FROM AUTHOR]

Aim: We report the first experience of Lyon's university hospital regarding renal denervation to treat patients with resistant essential hypertension. Patients and methods: Over a one-year period, 17 patients were treated (12 men, 5 women) with renal denervation. Baseline characteristics were as follows: age 56.5 ± 11.5 years, BMI 33 ± 5 kg/m² and ambulatory blood pressure 157 ± 16/87 ± 13 mmHg with 4.2 ± 1.5 anti-hypertensive treatment. Results: We did not observe per procedural and early complications. After a median follow-up of 3 months and with the same anti-hypertensive treatment, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease respectively of 20 ± 15 (P < 0.001) and 10 ± 13 mmHg (P = 0.014) (n = 17). After six months of follow-up, ambulatory blood pressure (ABPM) decrease of 17.5 ± 14.9 mmHg (P = 0.027) for SBP and of 10.5 ± 9.6 mmHg (P = 0.029) for DBP (n = 6). Among these patients, five of them were controlled (ABPM inferior to 130/80 mmHg) and electrical left ventricular hypertrophy indexes decreased: R wave in aVL lead of 4 ± 3 mm (P = 0.031), Sokolow index of 3 ± 3 mm (P = 0.205), Cornell voltage criterion of 9 ± 7 mm (P = 0.027) and Cornell product of 1310 ± 1104 (P = 0.027). Conclusion: Our results are in accordance with data from other centers. On average blood pressure decreases significantly but important inter individual variations are observed. The procedure seems safe. [ABSTRACT FROM AUTHOR]

Objective The polymorphic deletion of exon 3 of the GH receptor (d3-GHR) has recently been linked to the magnitude of growth response to recombinant human GH (rhGH) therapy in short children with or without GH deficiency. We investigated this association in a large multinational cohort from the Network of European Studies of Genes in Growth (NESTEGG), comprising short children born small for gestational age (SGA). Design The study included short prepubertal SGA children treated with rhGH for 1 or 2 years. Population Two hundred and forty white Caucasian SGA children (138 male, 102 female) aged 6·6 ± 2·3 years with a height at –3·0 ± 0·7 SDS at start of rhGH treatment; 193 ethnically matched controls. Methods The GHR polymorphism (fl/fl, fl/d3 or d3/d3) was genotyped by polymerase chain reaction (PCR) multiplex assay. Growth velocity (G/V) in cm/year and changes in GV during the first and second year of rhGH treatment were evaluated. Results The change in GV was significantly greater in SGA children carrying one or two copies of the d3-GHR allele ( P = 0·038 for the first year and P = 0·041 for the second year of GH treatment), but the change in height was not significantly different. Birthweight was significantly lower in SGA children with the d3/d3 genotype than in SGA children with the fl/fl genotype ( P = 0·034) and in those with the fl/d3 genotype ( P = 0·016). Conclusion Our data, based on a large cohort, showed that the exon 3 GHR polymorphism is associated with responsiveness to rhGH treatment in SGA children with short stature. [ABSTRACT FROM AUTHOR]

Abstract: The authors report a case of paroxysmal, complete atrioventricular block during an anterior acute myocardial infarction, leading to asystolia. The different possible physiopathological mechanisms are discussed, suggesting a paroxysmal nodal conduction defect, secondary to transient parasympathetic stimulation, triggered by a Bezold-Jarish type of cardiac reflex. This reflex is frequently involved in various pathologic situations or diagnostic procedures, usual in cardiology. Although it is frequently observed in inferior myocardial infarction, it can occur during an anterior acute myocardial infarction. [Copyright &y& Elsevier]

Aims: Metabolic disorders depend on genetic, hormonal and environmental factors, whose relations may differ between genders. Therefore, we compared the contribution of metabolic disorders to the metabolic syndrome in women and men. Methods: To this end, we used a hierarchical classification statistical method to classify subjects into similarity groups according to clinical and biological parameters. Data were collected from 3,508 men and women aged 35–64 years, from a cardiovascular disease survey. Results: In both women and men, hierarchical classification identified a cluster corresponding to the metabolic syndrome representing 14 and 15% of the women’s and men’s sample, respectively. In women, elevated body weight (women’s Z-score: 1.59 vs. men’s Z-score: 1.29; p < 0.005), waist girth (1.62 vs. 1.30; p < 0.001) and low HDL cholesterol (–0.95 vs. –0.75; p < 0.05) were significantly larger contributors to the metabolic syndrome than in men. In contrast, systolic (0.59 vs. 0.95; p < 0.0001) and diastolic (0.55 vs. 0.99; p < 0.0001) blood pressure and apolipoprotein B (0.51 vs. 0.71; p < 0.0001) contributed significantly less in women than in men. Finally, insulin (n.s.), glucose (n.s.), triglycerides (n.s.) and LDL-cholesterol (n.s.) contributions were not different between genders. Conclusion: These results are consistent with the concept that a clustering of metabolic disorders occurs frequently in both women and men. However, the contribution of several metabolic disorders to the metabolic syndrome is different in men and women. This finding supports the concept that different criteria are necessary to define the metabolic syndrome in women and men. Copyright © 2004 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Although amikacin is primarily eliminated via glomerular filtration, drug concentrations are not consistently predicted in all patients. To better describe the relationship between amikacin clearance and both age and renal function, we used a new heuristic approach involving statistical analysis of dependence.Design and Setting: Retrospective pharmacokinetic study using data from seven centres in France.Participants: 634 patients with sepsis aged between 18 and 98 years of age who received intravenous amikacin.Methods: Clearance of amikacin was modelled using the NonParametric EM algorithm for a two-compartment model (NPEM2) with intravenous infusion.Results: A total of 2499 serum amikacin determinations was available for analysis. The relationship between the clearance of amikacin and age was weak. Interestingly, the Z method, which filters data based on dependence criteria, selected data that were best fitted by a polynomial function (r = 0.90; p < 0.001). This representation of the polynomial function was similar to a previously proposed theoretical model describing covariations between the clearance of amikacin and age. However, the polynomial function applied to only 33% of the patients that were selected by the Z method. The correlation between the clearance of amikacin and renal function was also relatively low (r = 0.39). The Z method exhibited a continuous and strong dependence pattern between the clearance of amikacin and age for 49% of the patients.Conclusions: The Z methodology, which filters data using dependence criteria, confirms that age, renal function and amikacin clearance are strongly related, but only in less than half of a large sample of patients with sepsis without renal pathology. These results suggest that other variables should be taken into account in order to improve the description of the behaviour of amikacin. The Z methodology improved the classical description of relationships between variables, and should be applied to better select pertinent variables in pharmacokinetic studies. [ABSTRACT FROM AUTHOR]