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1. The effects of plasma exchange and glucocorticoids on early kidney function among patients with ANCA-associated vasculitis in the PEXIVAS trial

Author

Odler, Balazs, Riedl, Regina, Geetha, Duvuru, Szpirt, Wladimir M., Hawley, Carmel, Uchida, Lisa, Wallace, Zachary S., Walters, Giles, Muso, Eri, Tesar, Vladimir, Pusey, Charles D., Little, Mark A., Merkel, Peter A., Walsh, Michael, Jayne, David R.W., Kronbichler, Andreas, Paizis, Kathy, Walters, Giles, Jardine, Meg, Milton, Caroline, Ibraham, Abu, Siva, Brian, Desmond, Michael, Perkovic, Vlado, Kurtkoti, Jadadeesh, Vilayur, Eswari, Cass, Alan, Summers, Shaun, Brown, Fiona, Ryan, Jessica, Kerr, Peter, Noble, Euan, Luxton, Grant, Mudge, David W., Hawley, Carmel, Johnson, David W., Peh, Chen Au, Faull, Randall J., Ranganathan, Dwarakanathan, Jeffs, Lisa, Nicholls, Kathy, Hughes, Peter, Cooper, Bruce, Boudville, Neil, Ford, Sharon, Langham, Robyn, Reidlinger, Donna, AliciaMorrish, Badve, Sunil V., Pascoe, Elaine, Paul-Brent, Peta-Anne, Robison, Laura, Valks, Andrea, Blockmans, Daniel, Henckaerts, Liesbet, Sprangers, Ben, Suri, Rita, Brachemi, Soumeya, Clark, William, Garg, Amit, Carette, Simon, Pagnoux, Christian, Reich, Heather, Barth, David, Walsh, Michael, Khalidi, Nader, Cox, Gerry, Mazzetti, Andrea, Robins, Diane, Wald, Ron, Perl, Jeffrey, Pavenski, Katerina, Dacouris, Niki, Levin, Adeera, Copland, Michael, Fairhead, Todd, Pannu, Neesh, Qarni, Muhammad Uwais, Habib, Syed, Girard, Louis, Manns, Braden, Tesar, Vladimir, Hruskova, Zdenka, Chocova, Zdenka, Povlsen, Johan, Gregersen, Jon, Ivarsen, Per, Birn, Henrik, Krarup, Elizabeth, Pedersen, Erling B., Thomsen, Ingrid, Bech, Jesper Nørgaard, Szpirt, Wladmir, Egfjord, Martin, Mesbah, Rafik, Bataille, Pierre, Rey, Isabelle, Chantrel, François, Vanhille, Philipe, Quémeneur, Thomas, Carron, Pierre-Louis, Zaoui, Philippe, de Moreuil, Claire, Gosselin, Morgane, Delluc, Aurélien, Hanrotel-Saliou, Catherine, Le Jeune, Mathilde, Ficheux, Maxence, Aniort, Julien, Lavigne, Christian, Augusto, Jean Francois, Chauveau, Dominique, Guitard, Joëlle, Huart, Antoine, Ribes, David, Gatault, Philippe, Becmeur, Camille, Muller, Sandrine, Betz, Valérie, Klein, Alexandre, Blaison, Gilles, Seror, Raphaele, Francois, Hélène, Mariette, Xavier, Aubrun, Aurore, Coustet, Baptiste, Palazzo, Elisabeth, Ottaviani, Sébastien, Goulenok, Tiphaine, Daugas, Eric, Dieudé, Philipe, Papo, Thomas, Lebas, Céline, Lionet, Arnaud, Guillevin, Loïc, Mouthon, Luc, Puéchal, Xavier, Jourde-Chiche, Noémie, Ruivard, Marc, Karras, Alexandre, Limal, Nicolas, Kofman, Thomas, Le Quellec, Alain, Maurier, François, Gibelin, Aude, Parrot, Antoine, Bachmeyer, Claude, Gombert, Bruno, Nouvier, Mathilde, Lega, Jean-Christophe, Fain, Olivier, Andrès, Emmanuel, Cottet, Rachel, Gregorini, Gina, Jeannin, Guido, Possenti, Stefano, Buzio, Carlo, Vaglio, Augusto, Oliva, Elena, Makino, Hirofumi, Muso, Eri, Endo, Tomomi, Kakita, Hiroko, Suzuki, Hiroyuki, Handa, Takaya, Kang, Youngna, Ariyasu, Yuki, Tsukamoto, Tatsuo, Endo, Shuichiro, Miyata, Hitomi, Yamada, Hiroyuki, Ito-Ihara, Toshiko, Uchida, Shunya, Kono, Hajime, Fujigaki, Yoshihide, Kikuchi, Hirotoshi, Nanki, Toshihiro, Kato, Hideki, Okamoto, Akiko, Asako, Kurumi, Suzuki, Kazuo, Hamano, Yoshitomo, Yamagata, Kunihiro, Usui, Joichi, Fujimoto, Shouichi, Sato, Yuji, Kikuchi, Masao, Flores-Suárez, Luis Felipe, Sánchez-Guerrero, Sergio A., Collins, Michael, Schollum, John, de Zoysa, Janak, Quincy, Vicki, Sizeland, Peter, Aasarod, Knut, Solbu, Marit, Bruun, Trude Jannecke, Koldingsnes, Wenche, Wludarczyk, Anna, Nowak, Ilona, Gorka, Jacek, Sznajd, Jan, Padjas, Agnieszka, Jankowski, Milosz, Widawska, Agnieszka, Szczeklik, Wojciech, Ballarin, Jose, Bruchfeld, Annette, Efvergren, Mats, Eriksson, Per, Westman, Kerstin, Selga, Daina, Heijl, Caroline, Ohlsson, Sophie, Segelmark, Marten, Basu, Neil, Kidder, Dana, Fluck, Nicholas, Jayne, David R.W., Smith, Rona, Wilcocks, Lisa, McClure, Mark, Jones, Rachel, Trivedi, Sapna, Gopaluni, Seerapani, Brettell, Elizabeth, Crump, Paul, Feilbach, Annika, Hewitt, Catherine, Hilken, Nick, Howman, Andrew, Hughes, Terry, Ives, Natalie, Jarrett, Hugh, Mehta, Samir, Record, Rebecca, Ryan, Gemma, Sidile, Chaka, Wheatley, Keith, Sheerin, Brown, Alison, Baines, Laura Anne, Lordan, Jim, Pusey, Charles, Tanna, Anisha, McAdoo, Stephen, Levy, Jeremy, Griffith, Megan, Klebe, Bernhard, Doulton, Timothy, Warwick, Graham, Burton, James, Barratt, Jonathon, Topham, Peter, Baines, Richard, Brunskill, Nigel, Al-Jayyousi, Reem, Hamilton, Patrick, Patel, Mumtaz, Mitra, Sandip, Brown, Nina, Sharples, Edward, Luqmani, Raashid, Harper, Lorraine, Rhodes, Benjamin, Chanouzas, Dimitrios, Morgan, Matthew, Hewins, Peter, Floßmann, Oliver, Bhandary, Nitin, Foxton, Julie, Jones, Linda, King, Jenny, Smyth, Lucy, D’Souza, Richard, Haigh, Richard, Hough, Maxine, Smyth, Lucy, Haigh, Richard, Hough, Maxine, Salama, Alan, Burns, Aine, Little, Mark, Dhaun, Neeraj, Dhaygude, Ajay, Basnayake, Kolitha, Iggo, Neil, Jones, Daniel, Oliveira, David, MacPhee, Iain A.M., Dunn, Emma, Lewington, Andrew J.P., Fan, Stanley Linsun, Rajakariar, Ravindra, Yaqoob, Magdi, Short, Andrew, Geddes, Colin, Mackinnon, Bruce, Jardine, Alan G., Monach, Paul, Merkel, Peter A., Amudala, Naomi, Quillen, Karen, Weisman, Michael, Wallace, Daniel, Forbess, Lindsy, Venuturupalli, Swamy, Langford, Carol, Hajj-Ali, Rula, Koo, Anna, Hoffman, Gary, Specks, Ulrich, Keogh, Karina, Ytterberg, Steven, Winters, Jeff, Warrington, Kenneth, Cartin-Ceba, Rodrigo, Peikert, Tobias, Fervenza, Fernando, Baqir, Misbah, Nachman, Patrick, Detwiler, Randy, Mottl, Amy, Derebail, Vimal, McGregor, JulieAnne, Merkel, Peter A., Sreih, Antoine, Rhee, Rennie, McAlear, Carol, Aqui, Nicole, Moreland, Larry, Kiss, Joseph, Liang, Kimberly, Mohan, Niveditha, Balogun, Rasheed, Li, Tingting, and Brasington, Richard

Abstract

Therapeutic plasma exchange (PLEX) is an adjunctive treatment for patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and kidney involvement. Little is known about the effect of PLEX on early changes in kidney function. This post-hocanalysis of the PEXIVAS trial investigated the effects of PLEX on changes in kidney function within 12 months. PEXIVAS was a randomized controlled trial recruiting 691 patients with ANCA-associated glomerulonephritis, of whom 349 underwent PLEX and 342 received no-PLEX. The primary outcomes of this post hocstudy of PEXIVAS were change in estimated glomerular filtration rate (eGFR) from baseline and recovery of kidney function (defined as eGFR increase of 15ml/min/1.73m2or more). Baseline eGFR was 21.7 ± 20.3 and 20.6 ± 18.7 ml/min/1.73m2in the PLEX and no-PLEX groups, respectively. Mean improvements in eGFR at weeks two, four, and eight after initiation of therapy were greater for the PLEX vs. the no-PLEX groups. The greatest significant difference in recovery of kidney function in the PLEX compared to the no-PLEX groups was at week four (relative risk (RR): 1.41; 95% confidence interval:1.09-1.82). Increased eGFR or recovery of kidney function at week four were significantly associated with lower risk for end-stage kidney disease at week 52 (RR: 0.96: 0.95-0.97, and RR: 0.29: 0.16-0.52; respectively). Neither changes in eGFR nor recovery of kidney function differed by reduced- compared to standard-dose glucocorticoid group. Overall, our study indicates that PLEX improves early kidney function in patients with ANCA-associated glomerulonephritis.

Published
2025
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2. 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, and Chantrel, François

Abstract

La crise sanitaire liée à l'épidémie de COVID-19 a nécessité des mesures de confinement en France et des changements de pratiques dans les centres de dialyse. L'objectif était d'évaluer les symptômes d'anxiété, de dépression et de stress pendant le confinement chez les patients hémodialysés et leurs soignants. Nous avons adressé, pendant le confinement, entre avril et mai 2020, des autoquestionnaires à des sujets volontaires qui étaient traités par hémodialyse (patients) ou qui travaillaient en hémodialyse (soignants) dans l'un des 14 centres de France participants. Nous avons analysé leur perception des séances de dialyse (bénéfique ou inquiétante), leur niveau de stress (échelle visuelle analogique cotée de 0 à 10), et leur symptomatologie anxieuse et dépressive (échelle Hospital anxiety and depression scale). Les facteurs associés au stress, à l'anxiété et à la dépression ont été analysés avec des modèles de régression linéaire multiple. Parmi les 669 patients et 325 soignants ayant répondu, 70 % trouvaient bénéfique de venir en dialyse pendant le confinement. Les proportions de sujets présentant un niveau de stress ≥ 6 lié à l'épidémie, au confinement, à la peur de contracter la COVID-19 et à la peur de contaminer un proche étaient respectivement de 23,9, 26,2, 33,4 et 42 %. De plus, 39,2 % présentaient une symptomatologie anxieuse certaine (13,7 %) ou douteuse (19,2 %), et 21,2 % présentaient une symptomatologie dépressive certaine (7,9 %) ou douteuse (13,3 %). L'âge, le sexe, les antécédents de troubles psychologiques et la perception des séances de dialyse étaient les facteurs principaux associés aux niveaux de stress, d'anxiété et de dépression. Pendant le confinement, en France, la majorité des patients et des soignants en hémodialyse ont trouvé bénéfique de venir en séance de dialyse. Un sujet sur trois présentait une symptomatologie anxieuse et un sujet sur cinq présentait une symptomatologie dépressive. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Published
2021
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3. An open-label randomized controlled trial of low-dose corticosteroid plus enteric-coated mycophenolate sodium versus standard corticosteroid treatment for minimal change nephrotic syndrome in adults (MSN Study)

Author

Rémy, Philippe, Audard, Vincent, Natella, Pierre André, Pelle, Gaëlle, Dussol, Bertrand, Leray-Moragues, Helene, Vigneau, Cecile, Bouachi, Khedidja, Dantal, Jacques, Vrigneaud, Laurence, Karras, Alexandre, Pourcine, Frank, Gatault, Philippe, Grimbert, Philippe, Ait Sahlia, Nawelle, Moktefi, Anissa, Daugas, Eric, Rigothier, Claire, Bastuji-Garin, Sylvie, Sahali, Dil, Aldigier, Jean Claude, Bataille, Pierre, Canaud, Bernard, Chauveau, Dominique, Combe, Christian, Choukroun, Gabriel, Cornec-Legall, Emilie, Dahan, Karine, Delahousse, Michel, Desvaux, Dominique, Deteix, Patrice, Durrbach, Antoine, Esnault, Vincent, Essig, Marie, Fievet, Patrick, Frouget, Thierry, Guerrot, Dominique, Godin, Michel, Gontiers-Picard, Annie, Gosselin, Morgane, Hanrotel-Saliou, Catherine, Heng, Anne-Elisabeth, Huart, Antoine, Humbert, Antoine, Kofman, Tomek, Hummel, Aurélie, Lang, Philippe, Laville, Maurice, Lemeur, Yannick, Malvezzi, Paolo, Matignon, Marie, Mesbah, Rafik, Moulin, Bruno, Muller, Sandrine, Olagne, Jerome, Pardon, Agathe, Provot, François, Queffeulou, Guillaume, Plaisier, Emmanuelle, Raimbourg, Quentin, Rieu, Philippe, Stehlé, Thomas, and Vanhille, Philippe

Abstract

First-line therapy of minimal change nephrotic syndrome (MCNS) in adults is extrapolated largely from pediatric studies and consists of high-dose oral corticosteroids. We assessed whether a low corticosteroid dose combined with mycophenolate sodium was superior to a standard oral corticosteroid regimen. We enrolled 116 adults with MCNS in an open-label randomized controlled trial involving 32 French centers. Participants randomly assigned to the test group (n=58) received low-dose prednisone (0.5 mg/kg/day, maximum 40 mg/day) plus enteric-coated mycophenolate sodium 720 mg twice daily for 24 weeks; those who did not achieve complete remission after week 8 were eligible for a second-line regimen (increase in the prednisone dose to 1 mg/kg/day with or without Cyclosporine). Participants randomly assigned to the control group (n=58) received conventional high-dose prednisone (1 mg/kg/day, maximum 80 mg/day) for 24 weeks. The primary endpoint of complete remission after four weeks of treatment was ascertained in 109 participants, with no significant difference between the test and control groups. Secondary outcomes, including remission after 8 and 24 weeks of treatment, did not differ between the two groups. During 52 weeks of follow-up, MCNS relapsed in 15 participants (23.1%) who had achieved the primary outcome. Median time to relapse was similar in the test and control groups (7.1 and 5.1 months, respectively), as was the incidence of serious adverse events. Five participants died from hemorrhage (n=2) or septic shock (n=3), including 2 participants in the test group and 3 in the control group. Thus, in adult patients, treatment with low-dose prednisone plus enteric-coated mycophenolate sodium was not superior to a standard high-dose prednisone regimen to induce complete remission of MCNS.

Published
2018
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4. Prescription des eaux riches en bicarbonate en France : les malades au cœur de la prise en charge pour les néphrologues et les urologues.

Author

Citarda, Salvatore, Hanf, William, Vrigneaud, Laurence, Bataille, Stanislas, Gosselin, Morgane, Beaume, Julie, Dariane, Charles, Madec, François-Xavier, Larceneux, Fabrice, Fiard, Gaëlle, and Bertocchio, Jean-Philippe

Abstract

Résumé Le bicarbonate est utilisé notamment dans l’insuffisance rénale chronique et certaines maladies lithiasiques rénales : néphrologues et urologues en sont les premiers acteurs. Peu d’informations sont disponibles sur les déterminants de la prescription des eaux riches en bicarbonate en France. L’objectif de cette étude est de les évaluer : une enquête prospective a été réalisée auprès des néphrologues et des urologues. Les répondants étaient, sans distinction de genre, principalement des néphrologues. La majorité indique prescrire le traitement pour de longues périodes (> 1 mois). Les répondants prescrivant fréquemment du bicarbonate (> 50 % de leurs patients) étaient plus souvent des femmes et des néphrologues. La fréquence de prescription était, par ailleurs, associée au type de pathologies rencontrées et à l’efficacité perçue (par les médecins) du traitement. Les urologues indiquaient le prescrire majoritairement au cours de la maladie lithiasique rénale et les néphrologues au cours de la maladie rénale chronique. Les urologues avaient un meilleur score d’expertise sur la composition des eaux riches en bicarbonate. En analyse multivariée, les déterminants de la fréquence de prescription étaient le genre féminin, l’indication et l’efficacité perçue par les médecins, qui était elle-même influencée par le retour qu’ils avaient de la part des patients. Ces résultats peuvent avoir été influencés par la participation importante des néphrologues, mais ils encouragent les praticiens à poursuivre leur écoute des malades, en l’absence d’études cliniques sur l’efficacité des eaux riches en bicarbonate. Enfin, la formation des médecins (particulièrement les jeunes néphrologues) sur les eaux riches en bicarbonate devrait être intensifiée. Alkali therapy is frequently used during chronic kidney disease and nephrolithiasis: nephrologists and urologists are the key operators. Very few is known about the underlying conditions of such a prescription: the aim of this study was to delineate those determinants. We conducted a prospective survey where French nephrologists and urologists were involved. Responders were without gender distinction and principally nephrologists. Prescription frequency was associated with gender (women), specialty (nephrologists), indications and perceived efficiency. Urologists prescribe more often during nephrolithiasis and nephrologists during chronic kidney disease. Urologists were more expert (by scoring on mineral-based alkaline waters compositions knowledge). By multivariate analysis, prescription frequency is associated with gender (women), indications and perceived efficiency by prescribers, which is itself influenced by feedback from patients. These results could have been influenced by a huge representation of nephrologists but foster physicians to go on listening to feedback from patients, due to a lack of clinical trials on the efficiency of mineral-based alkaline waters in such a field. Finally, physicians’ education (especially young nephrologists) on mineral-based alkaline waters should be intensified. [ABSTRACT FROM AUTHOR]

Published
2016
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