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1. The ROMANOV study found impaired humoral and cellular immune responses to SARS-CoV-2 mRNA vaccine in virus-unexposed patients receiving maintenance hemodialysis

Author: Christine Bouz, Thomas Barba, X. Charmetant, E. Chalencon, Emilie Kalbacher, Olivier Thaunat, Denis Fouque, Laurence Pellegrina, Laetitia Koppe, Virginie Mathias, Caroline C. Pelletier, Laurent Juillard, Maxime Espi, Emmanuel Morelon, Emmanuelle Cart-Tanneur, Anne Ovize, Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Hôpital Edouard Herriot [CHU - HCL], Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Etablissement Français du Sang [Décines-Charpieu] (EFS Auvergne-Rhône-Alpes), Eurofins Biomnis – Biologie Médicale Spécialisée [Lyon] (EB-BMS), Université de Lyon, CarMeN, laboratoire, Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: COVID-19 Vaccines, [SDV]Life Sciences [q-bio], medicine.medical_treatment, CD8-Positive T-Lymphocytes, Antibodies, Viral, Virus, Immune system, Renal Dialysis, Interferon, Humans, Medicine, Clinical Investigation, RNA, Messenger, BNT162 Vaccine, Immunity, Cellular, Messenger RNA, SARS-CoV-2, business.industry, Effector, COVID-19, [SDV] Life Sciences [q-bio], Vaccination, mRNA vaccine, Nephrology, Hemodialysis, Immunology, BNT162b2, business, CD8, medicine.drug
Abstract: Patients on maintenance hemodialysis (MHD), which are at high risk of infection by SARS-CoV-2 virus and death due to COVID-19, have been prioritized for vaccination. However, because they were excluded from pivotal studies and have weakened immune responses, it is not known whether these patients are protected after the “standard” two doses of mRNA vaccines. To answer this, anti-spike receptor binding domain (RBD) IgG and interferon gamma-producing CD4+ and CD8+ specific-T cells were measured in the circulation 10-14 days after the second injection of BNT162b2 vaccine in 106 patients receiving MHD (14 with history of COVID-19) and compared to 30 healthy volunteers (four with history of COVID-19). After vaccination, most (72/80, 90%) patients receiving MHD naïve for the virus generated at least one type of immune effector, but their response was weaker and less complete than that of healthy volunteers. In multivariate analysis, hemodialysis and immunosuppressive therapy were significantly associated with absence of both anti-RBD IgGs and anti-spike CD8+ T cells. In contrast, previous history of COVID-19 in patients receiving MHD correlated with the generation of both types of immune effectors anti-RBD IgG and anti-spike CD8+ T cells at levels similar to healthy volunteers. Patients receiving MHD naïve for SARS-Cov-2 generate mitigated immune responses after two doses of mRNA vaccine. Thus, the good response to vaccine of patients receiving MHD with a history of COVID-19 suggest that these patients may benefit from a third vaccine injection., Graphical abstract
Published: 2021

2. Reconsidering adsorption in hemodialysis: is it just an epiphenomenon? A narrative review

Author: Fitsum Guebre-Egziabher, Laurent Juillard, Nans Florens, Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and ROSSI, Sabine
Subjects: Dialysis adequacy, medicine.medical_treatment, 030232 urology & nephrology, Hemodiafiltration, 030204 cardiovascular system & hematology, Dialysis membrane, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Dialysis tubing, Hydrophobic effect, 03 medical and health sciences, 0302 clinical medicine, Adsorption, Renal Dialysis, Humans, Medicine, Renal replacement therapy, business.industry, Membranes, Artificial, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Membrane, Nephrology, Hemodialysis, Biophysics, Kidney Failure, Chronic, business, Dialysis (biochemistry)
Abstract: International audience; Since the first attempt at extracorporeal renal replacement therapy, renal replacement therapy has been constantly improved. In the field of hemodialysis, substantial efforts have been made to improve toxin removal and biocompatibility. The advent of hemodiafiltration (HDF) and, more recently, of mid cut-off membranes have contributed to management of patients with end-stage renal disease (ESRD). Although several uremic toxins have been discovered, we know little about the clinical impact of their clearance in hemodialysis patients. In addition, a great deal of progress has been made in the areas of filtration and diffusion, but the adsorptive properties of hemodialysis membranes remain under-studied. The mechanism of action of adsorption is based on the attraction between the polymer of the dialysis membrane and the solutes, through hydrophobic interactions, ionic or electrostatic forces, hydrogen bonds or van der Waals forces. Adsorption on the dialysis membrane depends on the membrane surface, pore size, structure and electric load. Its involvement in toxin removal and biocompatibility is significant, and is not just an epiphenomenon. Diffusive and convective properties cannot be improved indefinitely and high permeability membranes, despite their high performance in the clearance of many toxins, have several limitations for long-term use in hemodialysis. This review will discuss why adsorption should be reconsidered and better characterized to improve efficiency and adequacy of dialysis.
Published: 2021

3. Urinary Sodium-to-Potassium Ratio and Blood Pressure in CKD

Author: Natalia Alencar de Pinho, Jean Kaboré, Maurice Laville, Marie Metzger, Céline Lange, Christian Jacquelinet, Christian Combe, Denis Fouque, Luc Frimat, Carol Ayav, Bruce M. Robinson, Tilman Drueke, Ziad A. Massy, Bénédicte Stengel, Thierry Hannedouche, Bruno Moulin, Sébastien Mailliez, Gaétan Lebrun, Eric Magnant, Gabriel Choukroun, Benjamin Deroure, Adeline Lacraz, Guy Lambrey, Jean Philippe Bourdenx, Marie Essig, Thierry Lobbedez, Raymond Azar, Hacène Sekhri, Mustafa Smati, Mohamed Jamali, Alexandre Klein, Michel Delahousse, Séverine Martin, Isabelle Landru, Eric Thervet, Philippe Lang, Xavier Belenfant, Pablo Urena, Carlos Vela, Dominique Chauveau, Viktor Panescu, Christian Noel, François Glowacki, Maxime Hoffmann, Maryvonne Hourmant, Dominique Besnier, Angelo Testa, François Kuentz, Philippe Zaoui, Charles Chazot, Laurent Juillard, Stéphane Burtey, Adrien Keller, Nassim Kamar, 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, Institut de Recherche en Sciences de la Santé (IRSS), CNRST, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Agence de la biomédecine [Saint-Denis la Plaine], Service de Néphrologie Transplantation, Dialyse et Aphérèse [CHU Bordeaux], CHU Bordeaux [Bordeaux], Bioingénierie tissulaire (BIOTIS), Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), 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), Arbor Research Collaborative for Health, Hôpital Ambroise Paré [AP-HP], Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Agence Nationale de la Recherche, ANR Agence Nationale de la Recherche, ANR, The CKD-REIN study is funded by the Agence Nationale de la Recherche through the 2010 «Cohortes-Investissements d’Avenir » program (ANR) and by the 2010 national Programme Hospitalier de Recherche Clinique . CKD-REIN is also supported through a public–private partnership with Amgen , Fresenius Medical Care , and GlaxoSmithKline (GSK) since 2012, Lilly France since 2013, Otsuka Pharmaceutical since 2015, Baxter and Merck Sharp & Dohme-Chibret (MSD France) from 2012 to 2017, Sanofi-Genzyme from 2012 to 2015, and Vifor Fresenius and AstraZeneca , since 2018. Inserm Transfert set up and has managed this partnership since 2011., Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Chronic Kidney Disease - Réseau Epidémiologie et Information en Néphrologie (CKD REIN), and Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, Urinary system, Population, 030232 urology & nephrology, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Gastroenterology, Excretion, 03 medical and health sciences, 0302 clinical medicine, Clinical Research, Interquartile range, Internal medicine, medicine, salt, 10. No inequality, education, sodium, education.field_of_study, business.industry, potassium, blood pressure, medicine.disease, 3. Good health, Blood pressure, Quartile, Nephrology, Albuminuria, medicine.symptom, business, chronic kidney disease, Kidney disease
Abstract: Introduction In the general population, urinary sodium-to-potassium (uNa/K) ratio associates more strongly with high blood pressure (BP) than either urinary sodium or potassium alone. Whether this is also the case among patients with chronic kidney disease (CKD) is unknown. Methods We studied the associations of spot urine sodium-to-creatinine (uNa/Cr), potassium-to-creatinine (uK/Cr), and uNa/K ratios with a single office BP reading in 1660 patients with moderate to severe CKD at inclusion in the CKD-REIN cohort. Results Patients' median age was 68 (interquartile range [IQR], 59–76) years; most were men (65%), had moderate CKD (57%), and albuminuria (72%). Mean systolic and diastolic BP was 142/78 mm Hg. Spot uNa/Cr and uNa/K ratios were positively associated with systolic, mean arterial, and pulse pressures. The mean adjusted difference in systolic BP between the highest and the lowest quartile (Q4 vs. Q1) was 4.24 (95% confidence interval [CI], 1.53–6.96) mm Hg for uNa/Cr and 4.79 (95% CI, 2.18–7.39) mm Hg for uNa/K. Quartiles of spot uK/Cr were not associated with any BP index. The higher the quartile of uNa/K, the higher the prevalence ratio of uncontrolled (Q4 vs. Q1, 1.43; 95% CI, 1.19–1.72) or apparently treatment-resistant hypertension (Q4 vs. Q1, 1.35; 95% CI, 1.14–1.60). Findings were consistent in a subset of 803 individuals with 2 BP readings. Conclusion In patients with CKD, higher urinary sodium excretion is associated with higher BP, but unlike in general population, lower potassium excretion is not. Urinary Na/K does not add significant value in assessing high BP risk, except perhaps for hypertension control assessment., Graphical abstract
Published: 2020

4. A prospective observational study for justification, safety, and efficacy of a third dose of mRNA vaccine in patients receiving maintenance hemodialysis

Author: Bechade Clémence, Tivollier Jean-Michel, Cyrille Mathieu, Daures Jean-Pierre, Cécile Couchoud, Anne Ovize, Gabriel Jean-Marc, Halimi Jean Michel, Nguyen Jean-Michel, Bauwens Marc, Wolak Aurore, Testevuide Pascale, Laetitia Koppe, Iacobelli Silvia, Laurence Pellegrina, Mercadal Lucile, Jais Jean-Philippe, Toure Fatouma, Loos-Ayav Carole, Sarraj Ayman, Longlune Nathalie, Sautenent Bénédicte, Laurent Juillard, Cerasuolo Damiano, Gervolino Shirley, Tendron-Franzin Anaïs, Bayat Sahar, Emilie Kalbacher, Glowacki François, Boucaut Maitre Denis, Merle Sylvie, Devictor Bénédicte, Denis Fouque, Ranlin Alex, Maxime Espi, Olivier Thaunat, Chantrel François, Brunet Philippe, Emmanuel Morelon, Salmi Louis Rachid, Virginie Mathias, Monnet Elisabeth, Galland Roula, Edet Stéphane, Kazes Isabelle, Berard Etienne, Lavainne Fréderic, Schauder Nicole, Tiple Aurélien, Courivaud Cécile, Hazzan Marc, Nacher Mathieu, Vacher Coponat Henri, Laurain Emmanuelle, Caroline C. Pelletier, Vergnenegre Alain, Reydit Mathilde, Christine Bouz, Vigneau Cécile, E. Chalencon, Thomas Barba, Xavier Charmetant, Bemrah Abdelkader, Gentile Stéphanie, Merle Véronique, Moranne Olivier, Emmanuelle Cart-Tanneur, Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Hôpital Edouard Herriot [CHU - HCL], Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Eurofins Biomnis, Université de Lyon, Agence de la biomédecine [Saint-Denis la Plaine], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Registre REIN, École des Hautes Études en Santé Publique [EHESP] (EHESP), REIN Registry: Chantrel François, Reydit Mathilde, Tiple Aurélien, Bechade Clémence, Bemrah Abdelkader, Vigneau Cécile, Sautenent Bénédicte, Kazes Isabelle, Courivaud Cécile, Gabriel Jean-Marc, Edet Stéphane, Mercadal Lucile, Moranne Olivier, Toure Fatouma, Laurain Emmanuelle, Ranlin Alex, Longlune Nathalie, Glowacki François, Tivollier Jean-Michel, Brunet Philippe, Lavainne Fréderic, Berard Etienne, Sarraj Ayman, Bauwens Marc, Testevuide Pascale, Vacher Coponat Henri, Galland Roula, Schauder Nicole, Salmi Louis-Rachid, Cerasuolo Damiano, Tendron-Franzin Anaïs, Bayat Sahar, Halimi Jean Michel, Wolak Aurore, Gentile Stéphanie, Devictor Bénédicte, Monnet Elisabeth, Boucaut Maitre Denis, Nacher Mathieu, Merle Véronique, Jais Jean-Philippe, Daures Jean-Pierre, Vergnenegre Alain, Loos-Ayav Carole, Merle Sylvie, Hazzan Marc, Gervolino Shirley, Nguyen Jean-Michel, Iacobelli Silvia, Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and CarMeN, laboratoire
Subjects: medicine.medical_specialty, T cell, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Interferon gamma release assay, Antibodies, Viral, Gastroenterology, Renal Dialysis, Internal medicine, Epidemiology, Medicine, Humans, Clinical Investigation, BNT162 Vaccine, Vaccines, Synthetic, business.industry, SARS-CoV-2, Incidence (epidemiology), COVID-19, Vaccination, [SDV] Life Sciences [q-bio], Titer, medicine.anatomical_structure, mRNA vaccine, Nephrology, Hemodialysis, Cohort, BNT162b2, mRNA Vaccines, business
Abstract: The level of protection achieved by the standard two doses of COVID-19 mRNA vaccines in patients receiving maintenance hemodialysis (MHD) remains unclear. To study this we used the French Renal Epidemiology and Information Network (REIN) Registry to compare the incidence and severity of 1474 cases of COVID-19 diagnosed in patients receiving MHD after none, one or two doses of vaccine. Vaccination significantly reduce COVID-19 incidence and severity but 11% of patients infected after two doses still died. Lack of vaccinal protection in patients naïve for SARS-CoV-2 could be due to defective Tfh response [38% patients with negative spike-specific CD4+ T cell interferon gamma release assay] and failure to generate viral neutralizing titers of anti-spike receptor binding domain (RBD) IgGs (63% patients with titer at or under 997 BAU/ml, defining low/no responders) after two doses of vaccine. To improve protection, a third dose of vaccine was administered to 75 patients [57 low/no responders, 18 high responders after two doses] from the ROMANOV cohort that prospectively enrolled patients receiving MHD vaccinated with BNT162b2 (Pfizer). Tolerance to the third dose was excellent. High responders to two doses did not generate more anti-RBD IgGs after three doses but had more side effects. Importantly, 31 (54%) of low/no responders to two doses reached neutralizing titers of anti-RBD IgGs after three doses. A positive interferon gamma release assay and/or suboptimal titer of anti-RBD IgGs after two doses were the only predictive variables for response to three doses in multivariate analysis. Thus, the standard scheme of vaccination insufficiently protects patients receiving MHD. Anti-RBD IgG and specific CD4+ T cell response after two doses can guide personalized administration of the third dose, which improves the humoral response of SARS-CoV-2 naïve patients receiving MHD., Graphical abstract
Published: 2021

5. Justification, safety, and efficacy of a third dose of mRNA vaccine in maintenance hemodialysis patients: a prospective observational study

Author: Emilie Kalbacher, Caroline C. Pelletier, Denis Fouque, E. Chalencon, Laurence Pellegrina, Virginie Mathias, Cécile Couchoud, Laurent Juillard, Maxime Espi, Thomas Barba, Emmanuelle Cart-Tanneur, Anne Ovize, Emmanuel Morelon, Xavier Charmetant, Olivier Thaunat, Laetitia Koppe, and C. Bouze
Subjects: medicine.medical_specialty, Multivariate analysis, business.industry, Vaccination, Titer, Immune system, Interferon, Internal medicine, Cohort, medicine, Observational study, business, CD8, medicine.drug
Abstract: BackgroundPatients on maintenance hemodialysis (MHD) are at high risk of infection with SARS-Cov-2 and death due to COVID-19. This vulnerable population has been prioritized for vaccination, but the level of protection achieved in these immunocompromised patients is unclear.ObjectivesTo evaluate the protection of MHD patients against COVID-19 after 2 doses (2D) of BNT162b2, and the safety and impact on immune responses of a 3rddose (3D).DesignProspective observational.Setting, Patients, intervention and measurementsREIN national registry was used to compare the severity of 1474 cases of COVID-19 diagnosed in MHD patients after 0, 1 or 2 doses of mRNA vaccine. Anti-spike receptor binding domain (RBD) IgG and interferon gamma-producing CD4+ and CD8+ specific-T cells were measured after 2D and 3D of BNT162b2 in a monocentric cohort of 75 MHD patients.ResultsVaccination reduced disease severity but 11% of MHD patients infected after 2D still died. Tolerance to 3D of BNT162b2 was excellent. MHD patients with humoral response similar to healthy volunteers after 2D did not generate more immune effectors after 3D and had more side effects. In contrast, 2/3 of MHD patients with suboptimal response after 2D reached optimal titer of anti-RBD IgG and/or developed spike-specific CD8+ T cells after 3D. Presence of spike-specific CD4+ T cells after 2D was associated with response to 3D in multivariate analysis (OR=4.80 [1.23−21.54]; p=0.029).LimitationsLimited number of patients injected with 3D.ConclusionStandard scheme of vaccination provides insufficient protection to some MHD patients. Anti-RBD IgG and specific CD4+ T cells should be measured after 2D. Among patients with suboptimal humoral response, those with specific CD4+ T cells could benefit of a 3rddose of vaccine.RegistrationNCT04881396Funding SourceNone
Published: 2021

6. Classification of Uremic Toxins and Their Role in Kidney Failure

Author: Manish Kaushik, Peter Stenvinkel, Kianoush Kashani, Ziad A. Massy, Li Zuo, Faeq Husain-Syed, Thiago Reis, Peter J. Blankestijn, Hideki Kawanishi, Colin A. Hutchison, Raymond Vanholder, Laurent Juillard, Claudio Ronco, Mario Cozzolino, Mitchell H. Rosner, Tammy L. Sirich, University of Virginia [Charlottesville], University of Brasilia [Brazil] (UnB), Justus-Liebig-University [Gießen, Germany], Ghent University Hospital, University of Southern Queensland (USQ), Hawke's Bay District Health Board [Hastings, New Zealand], Karolinska Institutet [Stockholm], University Medical Center [Utrecht], University of Milan, Università degli Studi di Milano [Milano] (UNIMI), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Université de Lyon, Mayo Clinic [Rochester], National University Hospital [Singapore] (NUH), Tsuchiya General Hospital [Hiroshima, Japan] (TGH), Hôpital Ambroise Paré [AP-HP], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), 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, Veterans Affairs Palo Alto Health Care System [Palo Alto, CA, USA], Stanford University, People's Hospital of Peking University (PEKING - PHPU), Peking University [Beijing], University of Padova Medical School, International Renal Research Institute [Vicenza, Italy] (I2RI), University of Virginia, Justus-Liebig-Universität Gießen = Justus Liebig University (JLU), Università degli Studi di Milano = University of Milan (UNIMI), People's Hospital of Peking University (PKUPH), Università degli Studi di Padova = University of Padua (Unipd), and CarMeN, laboratoire
Subjects: medicine.medical_specialty, Epidemiology, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Reviews, Classification scheme, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Medicine, definition, In patient, Intensive care medicine, Dialysis, uremia, Transplantation, business.industry, Consensus conference, medicine.disease, Uremia, 3. Good health, middle molecule, [SDV] Life Sciences [q-bio], classification, Nephrology, Uremic toxins, dialysis, Hemodialysis, business, Middle molecule
Abstract: International audience; Advances in our understanding of uremic retention solutes, and improvements in hemodialysis membranes and other techniques designed to remove uremic retention solutes, offer opportunities to readdress the definition and classification of uremic toxins. A consensus conference was held to develop recommendations for an updated definition and classification scheme on the basis of a holistic approach that incorporates physicochemical characteristics and dialytic removal patterns of uremic retention solutes and their linkage to clinical symptoms and outcomes. The major focus is on the removal of uremic retention solutes by hemodialysis. The identification of representative biomarkers for different classes of uremic retention solutes and their correlation to clinical symptoms and outcomes may facilitate personalized and targeted dialysis prescriptions to improve quality of life, morbidity, and mortality. Recommendations for areas of future research were also formulated, aimed at improving understanding of uremic solutes and improving outcomes in patients with CKD.
Published: 2021

7. MO352RENAL DYSFUNCTION AS A MAJOR PREDICTOR OF CLINICAL OUTCOMES IN ANTERIOR STEMI PATIENTS

Author: Fitsum Guebre-Egziabher, Camille Amaz, Michel Ovize, Laurent Juillard, and Florence Sens
Subjects: Transplantation, medicine.medical_specialty, Nephrology, business.industry, Internal medicine, Medicine, business
Abstract: Background and Aims Among ST-segment elevation myocardial infarction (STEMI) patients, the respective impact of the baseline renal function, of the development of acute kidney injury (AKI), and of their combination, on the long-term cardiovascular outcomes, remain unclear. Method The present study was based on a post hoc analysis of the CIRCUS trial database, a multicentre randomized study which gathered 969 patients with anterior STEMI treated by primary percutaneous intervention (PPCI) within 12 hours of symptoms onset. Uni and multivariate regressions were performed to identify if the estimated glomerular filtration rate (eGFR) at admission and the development of AKI were associated with (1) cardiovascular death and heart failure (HF) at one year and (2) sub-optimal treatment prescription at discharge. Results A total of 822 patients were included. The mean baseline eGFR was 86 ± 19 mL/min/1.73m2. AKI occurred in 97 patients (11.8%). Baseline eGFR Conclusion In anterior STEMI patients undergoing PPCI, the development of AKI was the strongest independent predictor of poor clinical outcome at one year. The study suggests the need for a tailored monitoring of STEMI patients with AKI or baseline kidney dysfunction.
Published: 2021

8. MO336RENAL CONTRAST-ENHANCED ULTRASOUND (CEUS) TO EVALUATE EARLY AND CHRONIC MODIFICATIONS OF RENAL PERFUSION AND TO PREDICT RENAL DYSFUNCTION AFTER RENAL ISCHEMIA-REPERFUSION IN MICE

Author: Sandrine Lemoine, Delphine Baetz, Bruno Pillot, Maxime Schleef, C. Leon, Gabriel Bidaux, Fitsum Guebre-Egziabher, and Laurent Juillard
Subjects: Transplantation, medicine.medical_specialty, Supine position, Nephrology, business.industry, Internal medicine, medicine, Cardiology, Renal perfusion, business, Renal ischemia reperfusion, Contrast-enhanced ultrasound
Abstract: Background and Aims Renal ischemia-reperfusion can lead to acute kidney injury (AKI), increasing the risk of developing chronic kidney disease (CKD) through inflammation and vascular lesions. Serum urea or creatinine level routinely used as diagnostic indices of renal function are always delayed from the onset of the disease. Therefore, we currently lack reliable markers to early detect AKI, especially in animals. We aimed to show that non-invasive renal contrast-enhanced ultrasound (CEUS) could be a reliable tool to assess early and chronic changes of renal perfusion after renal ischemia-reperfusion. Method Male C57BL6 mice underwent 15 minutes of unilateral renal ischemia by clamping of the left renal vascular pedicle (n = 7), or a sham procedure (n = 3), under inhaled general anesthesia by Sevoflurane. A renal ultrasound was performed on the left ischemic kidney at baseline 1 week before the surgery, then, 20 minutes after reperfusion to assess early modifications of renal perfusion, and 1 month after reperfusion to follow chronic modifications. CEUS was performed in supine position by using a high-resolution ultrasonic imaging system (VEVO 3100 Fujifilm Visualsonics, Toronto, Canada) with a MX550D probe fixed in place with an iron support, ensuring the constant imaging plane throughout acquisition. First, a continuous infusion of microbubbles (VS-11913, Fujifilm Visualsonics, Toronto, Canada) was done through the tail vein, then a high mechanical index burst was given to destroy microbubbles when the contrast enhancement had reached a steady state, and finally, low mechanical-index imaging mode was used until, and 30 sec after the contrast agent concentration reached the plateau. Images were recorded and were analyzed using the “destruction-replenishment” fitting model of the Vevo LAB software (Fujifilm Visualsonics, Toronto, Canada). Renal perfusion was estimated by the total renal Blood Volume (rBV) parameter and was expressed as percentage of the baseline value for each animal. Renal function was also assessed by serum urea concentration 1 month after reperfusion, and the long axis lengths of both the kidneys were measured ex vivo after the mice were euthanized. Results Renal perfusion of the ischemic kidney measured by CEUS was significantly decreased as soon as 20 minutes of reperfusion compared to baseline (median 28,8% of baseline value; interquartiles [20,1 – 69,8%]). 1 month after reperfusion, renal perfusion recovered partially but was still significantly decreased compared to baseline (median 79,9% of baseline value; interquartiles [52,8 – 99,9%]) (Figure A). In sham operated mice, renal perfusion did not differ from baseline at 20 minutes or 1 month (p > 0.05). The renal function, assessed by serum urea, was mildly but significantly impaired 1 month after ischemia-reperfusion compared with sham (median serum urea 9,8 vs. 7,6 mmol/L) (p = 0.02), and this was consistent with the observed kidney atrophy in the ischemic group when compared to the contralateral kidney (median long axis length 7,5 vs 10,8 mm) (p = 0.03). Moreover, the decrease of renal perfusion 20 minutes after reperfusion was significantly correlated with the impairment of renal perfusion 1 month after reperfusion (Pearson r = 0.836, p = 0.005) and with the serum urea level at 1 month (Pearson r = -0.710, p = 0.03) (Figure B-C). Conclusion Renal CEUS was able to detect early impairment of renal perfusion as soon as 20 minutes after 15 minutes of renal ischemia in mice, and perfusion was still decreased 1 month after reperfusion, compared to baseline. This early impairment of perfusion was correlated with the chronic decrease of renal perfusion and renal function 1 month after reperfusion. This was also associated with a significant kidney atrophy. CEUS is an interesting non-invasive tool to assess renal lesions dynamically after ischemia-reperfusion.
Published: 2021

9. COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study

Author: Jérôme Avouac, Elodie Drumez, Eric Hachulla, Raphaèle Seror, Sophie Georgin-Lavialle, Soumaya El Mahou, Edouard Pertuiset, Thao Pham, Hubert Marotte, Amélie Servettaz, Fanny Domont, Pascal Chazerain, Mathilde Devaux, Pascal Claudepierre, Vincent Langlois, Arsène Mekinian, Alexandre Thibault Jacques Maria, Béatrice Banneville, Bruno Fautrel, Jacques Pouchot, Thierry Thomas, René-Marc Flipo, Christophe Richez, Florence Aeschlimann, Christian Agard, Nassim Ait-Abdallah, Jean-David Albert, Didier Alcais, Jean-Sébastien Allain, Yannick Allanore, Blanca Amador-Borreiro, Zahir Amoura, Emma Andre, Anaïs Arbault, Jean-Benoît Arlet, Laurent Arnaud, Denis Arniaud, Herliette Arty-Hue, Lucie Atlan, Alexandra Audemard-Verger, Christine Audoin-Pajot, Victor Audren, Maxime Bach-Bunner, Hélène Bacquet-Deschryver, Brigitte Bader-Meunier, Nathalie Balandraud, Jean-Charles Balblanc, Stéphane Bally, Frédéric Banal, Pierre Barbery, Thomas Barnetche, Audre Barrelet, André Basch, Vincent Baumier, Guillaume Bayer, Sophie Bayle, Catherine Beauvais, Rudie Beinat, Véronique Belin, Rakiba Belkhir, Ruben Benainous, Alexandre Belot, Mohammed Benammar, Mathilde Benhamou, Ygal Benhamou, Ahmed Benmansour, Pascal Bennet, Brigitte Bernoux-Manat, Elise Berthet, Emilie Berthoux, Ewa Bertolini, Adrien Bigot, Aurélia Bisson-Vaivre, Gilles Blaison, Gilles Bolla, Olivier Bonidan, Christine Bonnet, Raphaël Borie, Marie Bossert, Laurence Boudou, Françoise Bouhour, Kévin Bouiller, Bastien Bouldoires, Karima Boussoualim, Eric Bouvard, Regine Brondino, Pierre Buchlin, Laurence Cabantous, Patrice Cacoub, Simon Cadiou, Maurizio Carteni, Aurélia Carbasse, Brice Castel, Pascal Cathebras, Hervé Caumont, Annalisa Celant, Benjamin Chaigne, Benoît Chaillous, Romuald Champy, Agnès Charcot, Pierre Charles, Isabelle Charlot-Lambrecht, Caroline Charpin, Emmanuel Chatelus, Bernard Chaudier, Pascale Chertok, Xavier Chevalier, Maxime Chevreau, Emilie Chotard, Delphine Chu Miow Lin, Gaëlle Clavel, Cyril Clavel-Osorio, Fleur Cohen, Gregory Cohen, Marie-Eve Colette-Cedoz, Nived Collercandy, Antoine Colombey, Chloé Comarmond, Bernard Combe, Céline Comparon, Elodie Constant, Pascal Coquerelle, Justine Corli, Clémence Corre, Nathalie Costedoat-Chalumeau, Marie Couret, Natacha Courvoisier, Fabienne Coury-Lucas, Cécile Coutarel, Fabrice Coutier, Richard Damade, Laurence Daver-Malaterre, Sarahe Dehimat, Michel Delahousse, Emilie Barrois-Delattre, Delphine Denarie, Camille Deprouw, Emanuelle Dernis, Alban Deroux, Renaud Desbarbieux, Elise Descamps, Chantal Deslandre, Marie Desmurs, Jacques Despaux, Marie Desplats, Frédérick Detree, Valérie Devauchelle-Pensec, Robin Dhote, Philippe Dieude, Yannick Dieudonne, Elisabeth Diot, Guillaume Direz, Djamal-Dine Djeddi, Sarah Douvier, Béatrice Drouet, Catherine Duc, Angélique Ducornet, Carine Dufauret-Lombard, Alain Duhamel, Cécile Dumaine, Anne-Elisabeth Dumel, Chantal Dumoulin-Richez, Agnès Duquesne, Géraldine Durand, Mariane Durandin-Truffinet, Pierre-Marie Duret, Maïka Duval, Mikaël Ebbo, Esther Ebstein, Andra Economu-Dubosc, Stéphanie Emilie, Romain Euvrard, Philippe Evon, Sylvie Fabre, Dorothée Fagedet, Meryem Farhat, Marion Fauconier, Jacques Fechtenbaum, Renaud Felten, Fanny Fernandes, Nicole Ferreira-Maldent, Elodie Feurer, Amandine Fichet, Françoise Flaisler, Nans Florens, Violaine Foltz, Elisabeth Fontanges, Jennifer Foret, Anne-Claire Fougerousse, Anne Fouque-Aubert, Catherine Foutrier-Morello, Hélène Francois-Pradier, Léa Frantzen, Pierre Fritz, Antoine Froissart, Jean Fulpin, Piera Fuzibet, Francis Gaches, Laurence Gagneux-Lemoussu, Mélanie Penhoat-Gahier, Joris Galland, Frédérique Gandjbakhch, Nicole Garnier, Thomas Garraud, Jean-François Garrot, Romain Gastaldi, Véronique Gaud-Listrat, Maud Gauthier-Prieur, Dana Georgescu, Nathalie Gerard, Elisabeth Gervais, Christelle Gibert, Eric Gibert, Ghislaine Gill, Jérôme Gillard, Mélanie Gilson, Pauline Gimonnet, Jeanine-Sophie Giraudet-Le Quintrec, Aude Giraud-Morelet, Baptiste Glace, Camille Glanowski, Bertrand Godeau, Bruno Gombert, Camille Gonnet-Gracia, Tiphaine Goulenok, Philippe Goupille, Olivier Gourmelen, Sophie Govindaraju-Audouard, Franck Grados, Martine Grall-Lerosey, Bruno Grardel, Anne Grasland, Gilles Grateau, Monica Groza, Constance Guillaud, Séverine Guillaume, Caroline Guillibert, Xavier Guillot, Philippe Guilpain, Aline Gury, Marie-Hélène Guyot, Cécile Hacquard-Bouder, Marie-Noelle Havard, Jean-Pierre Hellier, Pascal Hennequin, Basile Henriot, Julien Henry, Véronique Hentgen, Marion Hermet, Muriel Herasse, Julie Hernandez, Miguel Hie, Pascal Hilliquin, Olivier Hinschberger, Ambre Hittinger-Roux, Jan Holubar, Christophe Hudry, Serge Huguenel, Clara Jaccard, Jean-Michel, Jacquemier, Bénédicte Jamard, Catherine Jan, Sylvie Jean, Mathieu Jouvray, Pierre-Antoine Juge, Laurent Juillard, Denis Jullien, Anna Kabala, Abdelkrim Kabchou, Ludovic Karkowski, Françoise Karman, Farid Kemiche, Jérémy Keraen, Pierre Kieffer, Isabelle Kone-Paut, Abdeldajallil Koreichi, Marie Kostine, Sylvain La Batide Alanore, Pierre Lafforgue, Sophie Lahalle, Marc Lambert, Isabelle Lambrecht, Sylvain Lanot, Aurélia Lanteri, Jean-Paul Larbre, Augustin Latourte, Christian Lavigne, Sophie Le Guen Guegan, Guillaume, Le Guenno, Diane Leguy, Agnès Lebrun, Emmanuel Ledoult, Nathalie Legoupil, Erick Legrand, Charlotte Lejeune, Olivier Leloire, Christophe Leroux, Rémi Leroy, Marie Leroy-Gouix, Tifenn Leturcq, Amélie Leurs, Céline Leveque-Michaud, François-Xavier Limbach, Frédéric Liote, Anne Lohse, Pierre Lozac'h, Virginie Lucas, Aurélie Madelon, Nadine Magy-Bertrand, Matthieu Mahevas, Hélène Maillard, Thibault Maillet, Sandrine Malochet-Guinamand, Quentin Mangon, Sylvie Marchou-Lopez, Nathalie Margarit, Thierry Marhadour, Xavier Mariette, Claire Martin, Alexis Mathian, François Maurier, Frédéric Maury, Betty Mazet-Guillaume, Arnaud Mazouyez, Hassan Mazyad, Nadia Mehsen-Cetre, Ulrich Meinzer, Isabelle Melki, Laurent Messer, Corinne Miceli, Martin Michaud, Catherine Michel, Matthias Michel, Mathilde Michon, Anne-Marie Milesi-Lecat, Anna Molto, Marie Moly, Olivier Moranne, Gautier Morel, Hugo Morel, Jacques Morel, Franck Morin, Laurence Moulinier, Guillaume Moulis, Bertrand Moura, Minh Nguyen, Sabine Nicolas-Vullierme, Hubert Nielly, Gaétane Nocturne, Aurore Nottez, Henri-Olivier Ollagnon, Isabelle Pacaud-Vitoux, Anne Pagnier, Caroline Paris, Antoine Parrot, Tristan Pascart, Yasmina Pascaud-Mansour, Lætitia Paulin, Stephan Pavy, Laurent Perard, Yves-Marie Pers, Micheline Pha, Maud Pichon, Audrey Pierreisnard, Gabrielle Pizana, Sylvaine Poignant, Elsa Poix, Agnès Portier, Antoine Poulet, Samira Plassard, Grégory Pugnet, Déborah Puyraimond-Zemmour, Pierre Quartier-Dit-Maire, Marion Quenet, Viviane Queyrel, Loïc Raffray, Philippe Remy, Myriam Renard, Jessica Rene, Sabine Revuz, Bénédicte Rey, Gaëlle Richard-Colmant, Etienne Riviere, Sébastien Riviere, Sophie Robin, Julien Rohmer, Isabelle Roitg, Mélanie Romier, Michel Rolland, Mélanie Roriz, Carole Rosenberg, Linda Rossi, Olivier Roth, Sid-Ahmed Rouidi, Mathilde Roumier, Mickaël Rousiere, Clémentine Rousselin, Bénédicte Rouviere, Christian Roux, Fabienne Roux, Marielle Roux, Nicolas Roux, Diane Rouzaud, Sylvie Rozenberg, Isabelle Sacco, Fatiha Sadji, Laurent Sailler, Carine Salliot, Jean-Hugues Salmon, Alain Saraux, Jean Schmidt, Julie Seguier, Jérémie Sellam, Eric Senbel, Thomas Sene, Patricia Senet, Pascal Seve, Aurélie Sicaud, Perrine Smets, Vincent Sobanski, Christelle Sordet, Elisabeth Sornay-Rendu, Odile Souchaud-Debouverie, Lætitia Sparsa, Lionel Spielmann, Sarah Steib, Chloé Stavris, Catherine Straus, Victor Strotz, Paulina Szafors, Séverine Taffignon-Clave, Justine Simoens, Claire Theillac, Nora Tenenbaum, Benoît Thomachot, Nathalie Tieulie, Soizic Tiriau, Alice Tison, Eric Toussirot, Ludovic Trefond, Sophie Trijau, Sébastien Trouillier, Anne-Priscille Trouvin, Marie-Elise Truchetet, Marc Ulrich, Jacques Vaquier, Eric Veillard, Laurent Veillon, Guillaume Vial, Jean-François Viallard, Judith Victor, Claire Vidon, Mathias Vidon, Camille Vigne, Alexandre Virone, Ursula Warzocha, Daniel Wendling, Claude Werle, Cécile Wibaux, Alexandra Willems, Michel Wisniewski, Juliette Woessner, Bernadette Xerri-Campano, Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de médecine interne [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Immunologie des Maladies Virales et Autoimmunes (IMVA - U1184), Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Tourcoing, Centre Hospitalier René Dubos [Pontoise], Assistance Publique - Hôpitaux de Marseille (APHM), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Biologie Intégrative du Tissu Osseux (LBTO), Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne (CIC-EC), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Pitié-Salpêtrière [AP-HP], Groupe Hospitalier Diaconesses Croix Saint-Simon, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Epidemiology in Dermatology and Evaluation in Therapeutics (EpiDermE), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Saint-Antoine [AP-HP], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), 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), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), CHU Bordeaux [Bordeaux], Composantes innées de la réponse immunitaire et différenciation (CIRID), Université Bordeaux Segalen - Bordeaux 2-Centre National de la Recherche Scientifique (CNRS), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Maladies génétiques d'expression pédiatrique (U933), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Médecine Interne = Hôpital de jour de médecine [CHU Tenon], INSERM U1059, SAINBIOSE - Santé, Ingénierie, Biologie, Saint-Etienne (SAINBIOSE-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Biologie intégrative du tissu osseux, Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC Saint Etienne, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Nord (Saint Etienne), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Service de rhumatologie, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Service de Médecine Interne [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de rhumatologie [CH Gustave Dron, Tourcoing], Centre Hospitalier Gustave Dron [Tourcoing], Hopital Réné Dubos, Université Paris 1 Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), and Université Paris 1 Panthéon-Sorbonne (UP1)
Subjects: medicine.medical_specialty, Immunology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, immune system diseases, law, hemic and lymphatic diseases, Internal medicine, Clinical endpoint, Immunology and Allergy, Medicine, 030212 general & internal medicine, 030203 arthritis & rheumatology, business.industry, Hazard ratio, Odds ratio, Articles, medicine.disease, Intensive care unit, 3. Good health, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Rheumatoid arthritis, Cohort, Rituximab, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Cohort study, medicine.drug
Abstract: Summary Background Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases. Methods In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609. Findings Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55·2 years [SD 16·4]); 734 (67%) were female and 356 (33%) were male. Of the 1090 patients, 137 (13%) developed severe COVID-19 and 89 (8%) died. After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3·26, 95% CI 1·66–6·40, p=0·0006) and the duration of hospital stay was markedly longer (0·62, 0·46–0·85, p=0·0024) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group. 13 (21%) of 63 patients in the rituximab group died compared with 76 (7%) of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1·32, 95% CI 0·55–3·19, p=0·53). Interpretation Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases. Funding None.
Published: 2021

10. Effect of periodontal treatment on the glomerular filtration rate, reduction of inflammatory markers and mortality in patients with chronic kidney disease: A systematic review

Author: François Gueyffier, Brigitte Grosgogeat, Emilie Kalbacher, Théo Delbove, Kerstin Gritsch, Patrice Nony, Delphine Maucort-Boulch, Laurent Juillard, Laboratoire des Multimatériaux et Interfaces (LMI), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon, Hospices Civils de Lyon (HCL), Unité de Pharmacologie Clinique et d'Essais Thérapeutiques [Lyon] (UPCET - EZUS - UNIV Lyon), Hospices Civils de Lyon (HCL)-Faculté de Médecine Laennec, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Edouard Herriot [CHU - HCL], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), and CarMeN, laboratoire
Subjects: Teeth, Physiology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Systemic inflammation, law.invention, 0302 clinical medicine, Medical Conditions, Randomized controlled trial, Oral Diseases, law, Chronic Kidney Disease, Tooth loss, Medicine and Health Sciences, Prospective Studies, 10. No inequality, Prospective cohort study, Multidisciplinary, 3. Good health, [SDV] Life Sciences [q-bio], Nephrology, Research Design, Medicine, medicine.symptom, Anatomy, Glomerular Filtration Rate, Research Article, medicine.medical_specialty, Drug Research and Development, Inflammatory Diseases, Science, Oral Medicine, Renal function, Research and Analysis Methods, 03 medical and health sciences, Internal medicine, medicine, Renal Diseases, Humans, Clinical Trials, Renal Insufficiency, Chronic, Periodontitis, Periodontal Diseases, Pharmacology, Renal Physiology, business.industry, Biology and Life Sciences, Retrospective cohort study, 030206 dentistry, medicine.disease, Randomized Controlled Trials, Jaw, Clinical Medicine, business, Digestive System, Head, Kidney disease
Abstract: Aim To assess the effect of periodontal treatment (PT) on glomerular filtration rate (GFR), systemic inflammation, or mortality in patients with chronic kidney disease (CKD). Methods A literature search was performed on PubMed and Web of Science databases on articles published until December 2019. The PRISMA guidelines were used throughout the manuscript. Results Of the total studies found, only 18 met the inclusion criteria; four retrospective and 14 prospective studies (including 3 randomized controlled trials–RCT). After PT, 3 studies investigated GFR, 2 found significant improvement; 11 (including 2 RCTs) investigated C-reactive protein levels, 9 found a significant improvement (including the 2 RCTs); 5 (including 3 RCTs) investigated Interleukine-6 level, 4 found a significant improvement (including 2 RCTs) and 2 studies evaluated mortality, one (retrospective study) found a significant difference. Conclusions Within the limitations of the present study, PT seems to improve CKD status, especially by reducing the systemic inflammation. Further RCTs are needed to confirm the results and specifically assess the influence of different types of PT in CKD patients. Taking into consideration the ability of PT to prevent further tooth loss and denutrition, early management of periodontitis is extremely important in patients with impaired renal function.
Published: 2021

11. Recommandations cliniques pratiques sur les soins péri- et postopératoires des fistules et greffes artérioveineuses pour hémodialyse chez l’adulte

Author: François Vrtovsnik, Catherine Lasseur, Philippe Chauveau, L Mercadal, Philippe Brunet, Laurent Juillard, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), AURAD Aquitaine, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Mode de vie, génétique et santé : études intégratives et transgénérationnelles (U1018 (Équipe 9)), Institut Gustave Roussy (IGR)-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, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Subjects: medicine.medical_specialty, business.industry, [SDV]Life Sciences [q-bio], Peri, 030232 urology & nephrology, MEDLINE, Guideline, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 3. Good health, Clinical Practice, 03 medical and health sciences, 0302 clinical medicine, Nephrology, Medicine, business, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2020

12. P0388ABC-R ANCA STUDY ESTABLISHMENT OF AN ANATOMOPATHOLOGICAL BIOLOGICAL AND CLINICAL PROGNOSTIC SCORE IN THE MANAGEMENT OF ANCA VASCULITIS WITH RENAL IMPAIRMENT

Author: Frédérique Dijoud, Arnaud Hot, Florine Hodique, Denis Fouque, Maud Rabeyrin, Nicole Fabien, Laurent Juillard, Thomas Barba, Mathilde Nouvier, and Cécile Picard
Subjects: Nephrology, Transplantation, Kidney, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Renal function, Glomerulonephritis, Kidney Glomerulus, urologic and male genital diseases, medicine.disease, Gastroenterology, medicine.anatomical_structure, Internal medicine, Biopsy, medicine, Renal biopsy, business, Vasculitis
Abstract: Background and Aims Glomerulonephritis is common in ANCA associated vasculitis (GN-AAV). There is extensive published data on the renal prognosis of these conditions. However, few authors have described predictive factors for end-stage renal disease (ESRD) in patients with GN-AAV. Many authors suggest that renal biopsy should be abandoned in patients whose diagnosis would be established by antibody positivity alone. The aim of the study was to establish a prognostic score for renal damage during ANCA vasculitis and demonstrate need for prognostic renal biopsy. Method One Hundred and eighteen patients referred to 2 french nephrology departments in Lyon between January 2003 and January 2019 were retrospectively analysed. Patients were randomly divided in 2 cohorts at a ratio of 70/30: training and validation cohorts. ESRD was defined as glomerular filtration rate (eGFR) ≤ 15mL/min/1.73m2,need of chronic dialysis or renal transplantation. Results Of the 118 patients, 38 (32.20%) developed ESRD. We identified 3 criteria associated with development of ESRD in patients with GN-AAV. One point was assigned to each criterion according to a threshold value: eGFR at the time of renal biopsy ≤ 15 mL/min; percentage of sclerotic glomeruli ≥ 11% and percentage of normal glomeruli < 20%. A new prognostic renal score was established in patients with GN-AAV. It classifies patients into 3 categories at risk of developing ESRD: low (≤ 1 point), moderate (2 points) and high (3 points). Conclusion Two of the three criteria of our score are histological. Biopsy remains, when possible, an essential tool for diagnosis and especially to predict renal prognosis of ANCA vasculitis with renal impairment.
Published: 2020

13. P0047PREVALENCE OF FABRY DISEASE IN DIALYSIS PATIENTS IN FRANCE (FABRYDIAL STUDY)

Author: Léa Lancelot, Mohammed A Chakir, Valérie De-Précigout, Laurent Juillard, Dominique P. Germain, Estelle Bravant, Cécile Couchoud, Gabriel Choukroun, Florence Sens, Bertrand Knebelmann, Laure Guittard, and Olivier Moranne
Subjects: Transplantation, Pediatrics, medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, medicine.disease, Dialysis patients, Fabry disease, Peritoneal dialysis, Angiokeratoma, Nephrology, Reference values, medicine, Polycystic kidney disease, Renal biopsy, Hemodialysis, business
Abstract: Background and Aims Fabry Disease (FD) is an X linked lysosomal storage disease due to pathogenic α-galactosidase A (GLA) variants. It leads to damage in kidney and other organs. Numerous prevalence studies have been conducted over the past twenty years in ESRD patients in different countries. However, many screening studies did not perform confirmatory GLA variant analyses, and included recently recognized ‘benign/likely-benign’ variants, thereby inflating prevalence estimates. Thus, the prevalence of Fabry disease in patients with end-stage renal disease remains controversial. The FABRYDIAL study aimed to measure the prevalence of Fabry disease in patients aged 18 to 75 years and treated by chronic dialysis, either hemodialysis or peritoneal dialysis. Method The study was conducted in France in 5 geographic sectors (Aquitaine, Ile-de-France, Rhône-Alpes and Picardie regions, and the Gard department). One hundred and twenty-four dialysis centers participated in the study, which targeted patients undergoing chronic dialysis during the week of November 20, 2017. The exclusion criteria were the existence of a proven nephropathy unrelated to FD (polycystic kidney disease, type 1 diabetes or biopsy-proven IgA nephropathy, membranous glomerulonephritis or ANCA-associated vasculitis), the absence of health insurance coverage or guardianship or tutelage. α-galactosidase A in men, and both α-galactosidase A and lyso-GL3 in women, were measured on a drop of dried blood during the usual care of patients. GLA gene sequencing was performed in patients in whom one biological value was outside normal values. If a genetic variant was identified, a multidisciplinary Diagnosis Validation Committee (DVC) concluded, based on precise literature, clinical, biological and genetic data, as to the reality of Fabry disease. Results Among the 6,032 patients aged 18 to 75 years under chronic dialysis during the period considered, 714 were no longer treated in the participating centers when the research staff visited for eligibility assessment. 1,121 had non-inclusion criteria, which in 89% of cases were a confirmed diagnosis of kidney disease (by renal biopsy or other means) making the existence of Fabry disease very unlikely. 4,197 patients met the inclusion criteria, of which 3,088 were included (1,888 men and 1,200 women). Valid biological analyzes were available for 2815 patients (1721 men and 1094 women), and a genetic test was indicated for 91 patients (52 men and 39 women). Ninety-seven percent of the samples were analyzed with a unique assay technique in a unique laboratory. Five patients had a genetic variant (4 men and one woman). After discussion in the DVC, one male patient was considered to have a confirmed Fabry disease. He presented early signs of the disease (first-degree family history of cardiac or unexplained death, hypohidrosis, heat intolerance, tendency to chronic diarrhea, angiokeratoma, hypoacousia and tinnitus) which could have been identified earlier. The GLA variant was c.1185dupG / p.Phe396Glyfs, a clearly pathogenic frameshift variant. The prevalence of FD in included patients with biological data was 0.035% [0.006; 0.201] (0.058% [0.010; 0.33] in men, 0.000 % [0,000; 0.350] in women). If we consider that patients who were not included because of a specific renal diagnosis unrelated to FD did not have FD, the estimated prevalence decreased to 0.028% [0.006; 0.121]. Conclusion The estimated prevalence of FD in a cohort of French dialysis patients is 0.035% [0.006; 0.201], and by sex 0.058% in men [0.010; 0.328] and 0,000% in women [0,000; 0.35]. Although it appears extremely low, it remains justified to bring up this diagnosis in the event of an evocative sign, whether for the patient or his relatives as FD benefit of effective specific treatments. Funding for this Investigator Sponsored Study was provided by Sanofi Genzyme
Published: 2020

14. P0536HYPOTHERMIA DURING RENAL ISCHEMIA-REPERFUSION IN MICE: A PROTECTIVE EFFECT ON RENAL AND MITOCHONDRIAL FUNCTIONS

Author: Christelle Leon, Michel Ovize, Delphine Baetz, Bruno Pillot, Fitsum Guebre-Egziabher, Maxime Schleef, Sandrine Lemoine, Laurent Juillard, and Noelle Gallo-Bona
Subjects: Transplantation, Nephrology, business.industry, Medicine, Pharmacology, business, Renal ischemia reperfusion
Abstract: Background and Aims Renal ischemia reperfusion (RIR) can induce mitochondrial stress triggering cell death and eventually leading to acute kidney injury (AKI). It has been suggested that mild hypothermia could be protective in RIR without clear underlying mechanisms. We aimed to show that mild hypothermia (34°C) during RIR protects renal mitochondrial function and prevents AKI. Method Male C57BL6 mice were assigned to 4 groups: normothermic ischemic (RIR-37°C) group (n=14) and hypothermic ischemic (RIR-34°C) group (n=14) with body temperature maintained at respectively 37°C or 34°C during 20 minutes of renal ischemia by bilateral renal clamping under general anesthesia; normothermic sham (Sham-37°C) group (n=10) and hypothermic sham (Sham-34°C) group (n=10) with only anesthesia and laparotomy at 37°C or 34°C respectively. Renal function (serum urea concentration) and isolated renal mitochondria function (capacity of mitochondria to retain calcium i.e. calcic retention capacity (CRC), and oxidative phosphorylation capacity of electron transport chain complexes (complex I, II and IV)) were assessed 2 hours and 24 hours after reperfusion. All animal procedures were approved by local Ethics Committee. Data are presented as median with IQR. Results All the parameters monitored were not modified by the temperature in the sham groups, and there was no mortality in those 2 groups. Mortality was 33% in the RIR-37°C group and 11% in the RIR-34°C group 24 hours after reperfusion (p=0.58). Renal ischemia was responsible for a significant increase of serum urea level 2 hours after reperfusion at 37°C [18.7 (17.3–19.0) mmol/L] compared to sham groups (p=0.02), whereas no significant increase was observed in the RIR-34°C group. After 24 hours of reperfusion serum urea level was improved in the RIR-34°C group [22.7 (11.5–42.0) mmol/L] compared to RIR-37°C [60.8 (58.0–69.7) mmol/L, p=0.001]. CRC was not modified by RIR after 2 hours of reperfusion in both groups. CRC was preserved 24 hours after reperfusion in the RIR-34°C group [260 (210–320) nmol Ca2+/mg protein] with no difference compared to Sham-37°C [320 (280–360) nmol Ca2+/mg protein p=0.18] whereas CRC was significantly decreased in the RIR-37°C group compared to Sham-37°C [120 (0–130) vs 320 (280–360) nmol Ca2+/mg protein p=0.004). Complexes I, II and IV were lowered after 2 hours of reperfusion in the RIR-37°C group (p Conclusion Mild hypothermia (34°C) during RIR significantly protected renal mitochondrial respiration and mitochondrial stress, associated with a preserved renal function after 2 hours of reperfusion and an improved renal function 24 hours after reperfusion compared to normothermic mice (37°C).
Published: 2020

15. Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study

Author: Dimitri Titeca-Beauport, Vincent Audard, Laurent Juillard, Marie-Noëlle Peraldi, Jean-François Subra, Eric Thervet, Jean-Michel Halimi, Thierry Lobbedez, Gabriel Choukroun, Mathilde Tamain, Marc Hazzan, Alexandre Ganea, Maité Daroux, Thomas Quemeneur, Dominique Guerrot, Pauline Caillard, Marie Essig, François Vrtovsnik, Jean-Michel Rebibou, Cécile Vigneau, R. Makdassi, Marion Rabant, Morgane Heitz, Vincent Vuiblet, Alexandre Hertig, Adnane Lamrani, Jonchère, Laurent, CHU Amiens-Picardie, CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), CHU Grenoble, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Henri Mondor, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Innate Immunity and Immunotherapy (CRCINA-ÉQUIPE 7), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Rouen, Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Clermont-Ferrand, Service de Néphrologie, Dialyse, Transplantations [CHU Limoges], CHU Limoges, Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de néphrologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Ecotaxie, microenvironnement et développement lymphocytaire (EMily (UMR_S_1160 / U1160)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), CHU Lille, Inserm, Université de Lille, Lille Inflammation Research International Center - U 995 [LIRIC], Paris-Centre de Recherche Cardiovasculaire [PARCC (UMR_S 970/ U970)], Cardiovasculaire, métabolisme, diabétologie et nutrition [CarMeN], Institut Mondor de Recherche Biomédicale [IMRB], Université Paris Descartes - Paris 5 [UPD5], Centre de Recherche en Cancérologie Nantes-Angers [CRCNA], Centre Hospitalier Universitaire de Reims [CHU Reims], Service de Néphrologie - Hémodialyses [CHU Clermont-Ferrand], Ecotaxie, microenvironnement et développement lymphocytaire [EMily (UMR_S_1160 / U1160)], CHU Henri Mondor [Créteil], Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), and Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
Subjects: medicine.medical_specialty, Urinary system, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, lcsh:Medicine, Disease, Anti-Glomerular Basement Membrane Disease, Gastroenterology, survival, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Stage (cooking), Adverse effect, anti-GBM disease, 030203 arthritis & rheumatology, urogenital system, business.industry, ANCA, Mortality rate, lcsh:R, Glomerulonephritis, General Medicine, medicine.disease, infection, 3. Good health, age, [SDV] Life Sciences [q-bio], Bacteremia, business
Abstract: In patients presenting with anti-glomerular basement membrane (GBM) disease with advanced isolated kidney involvement, the benefit of intensive therapy remains controversial due to adverse events, particularly infection. We aim to describe the burden of severe infections (SI) (requiring hospitalization or intravenous antibiotics) and identify predictive factors of SI in a large cohort of patients with anti-GBM disease. Among the 201 patients (median [IQR] age, 53 [30&ndash, 71] years) included, 74 had pulmonary involvement and 127 isolated glomerulonephritis. A total of 161 SI occurred in 116 patients during the first year after diagnosis. These infections occurred during the early stage of care (median [IQR] time, 13 [8&ndash, 19] days after diagnosis) with mainly pulmonary (45%), catheter-associated bacteremia (22%) and urinary tract (21%) infections. In multivariable analysis, positive ANCA ([HR] 1.62, 95% [95% CI] 1.07&ndash, 2.44], p = 0.02) and age at diagnosis (HR [95% CI] 1.10 [1.00&ndash, 1.21], p = 0.047) remained independently associated with SI. Age-adjusted severe infection during the first three months was associated with an increased three-year mortality rate (HR [95% CI] 3.13 [1.24&ndash, 7.88], p = 0.01). Thus, SI is a common early complication in anti-GBM disease, particularly in the elderly and those with positive anti-neutrophil cytoplasmic antibodies (ANCA). No significant association was observed between immunosuppressive strategy and occurrence of SI.
Published: 2020

16. The Case | Hypokalemia and severe renal loss of sodium

Author: Philippe Froguel, Dominique Eladari, Sandrine Lemoine, Laurent Juillard, Amélie Bonnefond, Laurence Dubourg, Centre de Recherche des Cordeliers (CRC (UMR_S 872)), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP), Université Lille Nord de France (COMUE), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Biologie Tissulaire et d'ingénierie Thérapeutique UMR 5305 (LBTI), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)
Subjects: medicine.medical_specialty, Sodium, [SDV]Life Sciences [q-bio], MEDLINE, chemistry.chemical_element, Hypokalemia, 030204 cardiovascular system & hematology, Kidney, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, medicine, Humans, 030304 developmental biology, 0303 health sciences, business.industry, Acidosis, Renal Tubular, chemistry, Nephrology, Potassium, medicine.symptom, business
Published: 2019

17. Achievement of Low-Density Lipoprotein Cholesterol Targets in CKD

Author: Ziad A. Massy, Jean Ferrières, Eric Bruckert, Céline Lange, Sophie Liabeuf, Maja Velkovski-Rouyer, Bénédicte Stengel, Carole Ayav, Christian Combe, Denis Fouque, Luc Frimat, Yves-Edouard Herpe, Maurice Laville, Ziad Massy, Karine Legrand, Marie Metzger, Elodie Speyer, Bruno Moulin, Gaétan Lebrun, Éric Magnant, Gabriel Choukroun, Jean Philippe Bourdenx, Marie Essig, Raymond Azar, Mustafa Smati, Mohamed Jamali, Alexandre Klein, Michel Delahousse, Séverine Martin, Eric Thervet, Xavier Belenfant, Pablo Urena, Carlos Vela, Dominique Chauveau, Viktor Panescu, François Glowacki, Maxime Hoffmann, Maryvonne Hourmant, Dominique Besnier, Angelo Testa, Philippe Zaoui, Charles Chazot, Laurent Juillard, Stéphane Burtey, Adrien Keller, Nassim Kamar, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, Hôpital Ambroise Paré [AP-HP], Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Service d'Endocrinologie, Métabolisme et Prévention des Maladies Cardio-vasculaires [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut E3M [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Agence de la biomédecine [Saint-Denis la Plaine], CHU Amiens-Picardie, Université Paris-Sud - Paris 11 (UP11), 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), Service d’Endocrinologie, Métabolisme et Prévention des Risques Cardio-Vasculaires [CHU Pitié-Salpêtrière], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Nephrology, medicine.medical_specialty, Statin, medicine.drug_class, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, 030204 cardiovascular system & hematology, lcsh:RC870-923, lipids, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Ezetimibe, Clinical Research, cardiovascular disease, Diabetes mellitus, Internal medicine, medicine, Prospective cohort study, Kidney transplantation, low-density lipoprotein cholesterol, lipid-regulating agents, business.industry, Cholesterol, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, chronic kidney diseases, 3. Good health, chemistry, business, medicine.drug, Kidney disease
Abstract: Introduction: We describe the characteristics of patients with moderate/advanced chronic kidney disease (CKD) according to receipt of lipid-lowering therapy (LLT), and whether they achieved low-density lipoprotein cholesterol (LDL-C) targets for high- and very high-risk patients. Methods: CKD-REIN (NCT03381950), a prospective cohort study conducted in 40 nephrology clinics in France, enrolled 3033 patients with moderate (stage G3) or advanced (stage G4/G5) CKD (2013−2016) who had not been on chronic dialysis or undergone kidney transplantation. Data were collected from patients’ interviews and medical records. Patients were followed up at 1 year. Results: Among 2542 patients (mean [SD] age 67 [13] years, 34% women) with LDL-C measurements at baseline (mean [SD] LDL-C 2.7 [1.1] mmol/l; cholesterol 4.8 [1.3] mmol/l), 63% were on LLT; 24% were at high (CKD stage G3, no cardiovascular disease [CVD] or diabetes) and 74% at very high (CKD stage G3 with diabetes or CVD, or CKD stage G4/5) cardiovascular risk. Among high-risk patients, 45% of those on statin and/or ezetimibe achieved the LDL-C treatment target (
Published: 2019

18. Défaut de réponse humorale et cellulaire à la vaccination anti-SARS-CoV2 à ARNm chez les patients hémodialysés naïfs

Author: Laetitia Koppe, X. Charmetant, Laurent Juillard, Olivier Thaunat, Emilie Kalbacher, Thomas Barba, Caroline C. Pelletier, E. Chalencon, M. Espi, and Denis Fouque
Subjects: Gynecology, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Nephrology, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine, business, Po-D26
Abstract: Introduction Les patients hémodialysés chroniques (HD) sont à haut risque d’infection par le SARS-CoV2 et de décès en cas de COVID-19, justifiant la priorisation de la vaccination dans cette population. Cependant, ces patients étaient exclus des études pivots, et sont connus pour avoir un défaut de réponse vaccinale. Description Il est donc urgent d’établir si les patients HD sont protégés après un schéma vaccinal « standard » par 2 doses de vaccin ARNm. Méthodes Nous avons mesuré le taux d’IgG dirigé contre le domaine de fixation de la protéine Spike (IgG anti-RBD) ainsi que la réponse interféron-gamma (IFNγ) des lymphocytes T CD4 et CD8 spécifiques 10 à 14 jours après la 2nde injection vaccinale chez 106 patients hémodialysés chroniques (dont 14 avec un antécédent de COVID-19). En l’absence de corrélat de protection, nous avons utilisé une cohorte de 30 volontaires sains comme référence. Résultats Dix à 14 jours après la 2nde injection, 19/106 (18 %) des patients n’avaient pas d’IgG anti-RBD, 47/106 (44 %) des IgG anti-RBD détectables mais inférieurs aux volontaires sains, et 40/106 (38 %) un titre d’IgG anti-RBD similaire aux volontaires sains. En analyse multivariée, les facteurs indépendamment associés à une réponse IgG anti-RBD optimale étaient une absence d’immunosuppression (OR = 0,16, p = 0,05), un antécédent de COVID-19 (OR = 9,55 ; p = 0,004) et de meilleurs paramètres d’hémodialyse (OR = 6,11 ; p = 0,014). Les réponses CD4 étaient corrélées aux IgG anti-RBD (p
Published: 2021

19. Rationnel, tolérance et immunogénicité d’une 3e dose de vaccin ARNm anti SARS-Cov2 chez les patients hémodialysés chroniques

Author: Denis Fouque, Caroline C. Pelletier, M. Espi, Olivier Thaunat, X. Charmetant, Laetitia Koppe, Emilie Kalbacher, Thomas Barba, E. Chalencon, and Laurent Juillard
Subjects: Gynecology, medicine.medical_specialty, 2019-20 coronavirus outbreak, animal structures, Coronavirus disease 2019 (COVID-19), Nephrology, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine, Pc-03, business, complex mixtures
Abstract: Introduction Les patients hémodialysés chroniques (HD) présentent un défaut de réponse immunitaire après 2 doses de vaccin ARNm anti SARS-Cov2, ayant conduit les autorités de santé françaises à recommander l’injection d’une 3e dose vaccinale. Description Notre objectif était d’évaluer : – la nécessité clinique ; – la tolérance ; – l’immunogénicité d’une 3e injection vaccinale chez les patients HD. Méthodes Nous avons comparé la gravité des maladies COVID des patients HD non vaccinés, après 1 dose ou 2 dose vaccinale issues du registre national français REIN. Nous avons ensuite mesuré les taux d’IgG anti-RBD et la réponse interféron gamma des lymphocytes T CD4 et CD8 spécifiques 10 à 14 jours après la 3e injection vaccinale chez 56 patients hémodialysés ayant un défaut de réponse après 2 doses. Résultats obtenus ou attendus Entre le 01/02/2021 et le 18/05/2021, 105 cas de COVID-19 sont survenus chez des HD après 2 injections vaccinales, 179 après 1 dose et 1094 chez des HD non vaccinés. Si la vaccination diminue la sévérité de la maladie COVID(p
Published: 2021

20. Microangiopathie thrombotique secondaire à la gemcitabine : peut-on améliorer le dépistage et la prise en charge ?

Author: X. Charmetant, Laurent Juillard, Sandrine Lemoine, Thomas Fournier, Philippe Cassier, Jean-Charles Puthet, and Anne Jolivot
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Nephrology, business.industry, 030220 oncology & carcinogenesis, 030232 urology & nephrology, medicine, business, 3. Good health
Abstract: Resume La microangiopathie thrombotique est une complication rare mais grave du traitement par gemcitabine. Sa prevalence augmente du fait de l’elargissement des indications de cette chimiotherapie. Nous rapportons quatre cas pour lesquels la presentation clinicobiologique est relativement typique, associant hypertension arterielle, proteinurie et augmentation de la creatinine plasmatique. En revanche, la gravite du tableau est variable, necessitant le recours inconstant a une technique d’hemodialyse. Les strategies therapeutiques, outre l’arret systematique de la gemcitabine, ne sont pas consensuelles. Elles ont ete guidees par la gravite du tableau : echanges plasmatiques d’efficacite variable et eculizumab, qui s’est avere efficace lorsqu’il a ete utilise. Il ressort surtout que ce syndrome est compose de signes banals et frequents chez des patients recevant des chimiotherapies, comme les cytopenies et la majoration de la creatinine. Mais ces signes devraient inciter a rechercher d’autres signes plus specifiques, tels qu’une hypertension arterielle, des stigmates d’hemolyse mecanique, une proteinurie ou une hematurie, afin de reconnaitre le plus precocement possible la microangiopathie thrombotique et permettre sa prise en charge rapide, en evitant de nouvelles injections.
Published: 2017

21. Factors associated with Clostridium difficile infection: A nested case-control study in a three year prospective cohort

Author: Nagham, Khanafer, Philippe, Vanhems, Frédéric, Barbut, Christine, Luxemburger, Clarisse, Demont, Monique, Hulin, Olivier, Dauwalder, François, Vandenesch, Laurent, Argaud, Lionel, Badet, Xavier, Barth, Malik, Bertrand, Carole, Burillon, Roland, Chapurlat, Michel, Chuzeville, Brigitte, Comte, François, Disant, Michel Henry, Fessy, Christian, Gouillat, Laurent, Juillard, Patrick, Lermusiaux, Olivier, Monneuse, Emmanuel, Morelon, Jacques, Ninet, Thierry, Ponchon, Emmanuel, Poulet, Thomas, Rimmele, and Karim, Tazarourte
Subjects: Adult, Diarrhea, Male, 0301 basic medicine, Pediatrics, medicine.medical_specialty, genetic structures, 030106 microbiology, Microbiology, Hospitals, University, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Humans, Medicine, Infection control, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Beta-Lactamase Inhibitors, Aged, Aged, 80 and over, Cross Infection, Clostridioides difficile, business.industry, Case-control study, Middle Aged, Clostridium difficile, Anti-Bacterial Agents, Infectious Diseases, Case-Control Studies, Nested case-control study, Clostridium Infections, Female, France, medicine.symptom, business, Cohort study
Abstract: Background Clostridium difficile infection (CDI) is a serious medical condition that is associated with substantial morbidity and mortality. Identification of risk factors associated with CDI and prompt recognition of patients at risk is key to successfully preventing CDI. Methods A 3-year prospective, observational, cohort study was conducted in a French university hospital and a nested case-control study was performed to identify risk factors for CDI. Inpatients aged 18 years or older, suffering from diarrhea suspected to be related to CDI, were asked to participate. Results A total of 945 patients were included, of which 233 cases had a confirmed CDI. CDI infection was more common in men (58.4%) (P = 0.04) compared with patients with diarrhea not related to C. difficile. Previous hospitalization (P
Published: 2017

22. Prise en charge de la sténose athéromateuse d’artère rénale en 2016

Author: Olivier Rouvière, Antoine Millon, Thomas Fournier, Laurent Juillard, and Florence Sens
Subjects: medicine.medical_specialty, Percutaneous, Endovascular revascularization, Medical treatment, business.industry, 030232 urology & nephrology, Renal function, 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, Clinical Practice, 03 medical and health sciences, Stenosis, 0302 clinical medicine, Nephrology, medicine, Prospective cohort study, business, Intensive care medicine, Cohort study
Abstract: Endovascular revascularization as treatment of atherosclerotic renal-artery stenosis (aRAS) is controversial since 3 large and multicentric randomised trials (CORAL, ASTRAL, STAR) failed to prove the superiority of percutaneous transluminal renal-artery stenting (PTRAS) over medical treatment only (MT). However, considering the multiple bias of these trials, among which questionable inclusion criterias, these results must be extrapolated in clinical practice with caution. New pathophysiological data have been helping to understand why restoring blood flow does not necessarily lead to kidney function improvement. Today, the diagnostic approach must in one hand confirm the artery stenosis and on the other hand assess its severity and impact on the kidney. Therapeutic options still lie on the American guidelines published in 2006, since no study data can be reasonably used in everyday practice. However, particular sub-groups of patients who could benefit from revascularisation have been identified through recent cohort studies. Further prospective studies are needed in order to confirm the superiority of PTRAS in these populations. Meanwhile, multidisciplinary approach should be promoted, in order to provide the best treatment for each patient.
Published: 2017

23. Effectiveness of IHD with Adsorptive PMMA Membrane in Myeloma Cast Nephropathy: A Cohort Study

Author: Frank Bridoux, Déborah Chaintreuil, Laurent Juillard, Fitsum Guebre-Egziabher, Lionel Karlin, Florence Sens, Philip Robinson, Anne Jolivot, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Male, [SDV]Life Sciences [q-bio], medicine.medical_treatment, DIAGNOSED MULTIPLE-MYELOMA, 030232 urology & nephrology, Pharmacology, Bortezomib, 0302 clinical medicine, Multiple myeloma, Myeloma cast nephropathy, Cast nephropathy, Hazard ratio, Acute kidney injury, Middle Aged, CHEMOTHERAPY, IMPAIRMENT, Combined Modality Therapy, BORTEZOMIB-BASED REGIMENS, 3. Good health, Treatment Outcome, Nephrology, Hemodialysis, chains, REVERSIBILITY, 030220 oncology & carcinogenesis, HIGH CUTOFF HEMODIALYSIS, Female, LIGHT-CHAINS, Free light, medicine.medical_specialty, FREE, Urology, Nephropathy, 03 medical and health sciences, Renal Dialysis, medicine, Humans, Polymethyl Methacrylate, Glucocorticoids, Dialysis, Aged, Retrospective Studies, Chemotherapy, business.industry, Membranes, Artificial, medicine.disease, POLYMETHYLMETHACRYLATE MEMBRANE, Immunoglobulin Light Chains, business, ACUTE-RENAL-FAILURE
Abstract: Background: In patients with cast nephropathy and acute kidney injury (AKI) requiring dialysis, the reduction of serum free light chains (FLC) using chemotherapy and intensive hemodialysis (IHD) with a high cut-off filter may improve renal and patient outcomes. We evaluated the effectiveness of a combination of chemotherapy and IHD with an adsorbent polymethylmethacrylate membrane (IHD-PMMA) on renal recovery and survival. Methods: A single-center retrospective cohort-study was conducted. Between 2007 and 2014, patients with dialysis-dependent acute cast nephropathy treated with chemotherapy and IHD-PMMA were included. Patients had six 6-h hemodialysis sessions a week, until predialysis serum FLC fell below 200 mg/L, for a maximum of 3 weeks. Primary outcomes were renal recovery, defined as dialysis independence, and survival. Results: Seventeen patients were included, all with stage 3 AKI. All received chemotherapy, mostly based on bortezomib and steroids (88%). Twelve patients (71%) achieved renal recovery, usually within 60 days (92%). At 3 months, the overall hematological response rate was 57%; hematological response was maintained for at least 2 years in 86% of responders. At 6, 12, and 24 months, 76, 75, and 62% of patients were alive, respectively. Higher reduction in involved FLC by day 12 (p = 0.022) and day 21 (p = 0.003) was associated with renal recovery. Patients with FLC reduction rate >50% by day 21 experienced a lower mortality (hazard ratio 0.10, 95% CI 0.02–0.63). Conclusion: In patients with dialysis-dependent myeloma cast nephropathy, early FLC removal by IHD-PMMA combined with chemotherapy was associated with high rates of renal recovery and survival.
Published: 2017

24. Measurement of glomerular filtration rate in lung transplant recipients highlights a dramatic loss of renal function after transplantation

Author: Laurence Dubourg, François Parant, Sandrine Lemoine, François Philit, Jean François Mornex, Laurent Bitker, Emilie Kalbacher, Laurent Juillard, Nans Florens, Fitsum Guebre-Egziabher, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France (Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France), Infections Virales et Pathologie Comparée - UMR 754 (IVPC), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hospices Civils de Lyon (HCL), ROSSI, Sabine, Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Subjects: medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Urology, Renal function, 030230 surgery, urologic and male genital diseases, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, Medicine, Lung transplantation, Stage (cooking), AcademicSubjects/MED00340, measured GFR, Transplantation, Receiver operating characteristic, business.industry, Odds ratio, Original Articles, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, lung transplant, Confidence interval, female genital diseases and pregnancy complications, Nephrology, epidemiology, business, chronic kidney disease, Kidney disease
Abstract: Background Chronic kidney disease (CKD) after lung transplantation (LT) is underestimated. The aim of the present study was to measure the loss of glomerular filtration rate (GFR) 1 year after LT and to identify the risk factors for developing Stage ≥3 CKD. Methods LT patients in the University Hospital of Lyon had a pre- and post-transplantation measurement of their GFR (mGFR), and GFR was also estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. Results During the study period, 111 patients were lung transplant candidates, of which 91 had a pre-transplantation mGFR, and 29 had a mGFR at 1 year after LT. Six patients underwent maintenance haemodialysis after transplantation. Mean mGFR was 106 mL/min/1.73 m2 before LT and 58 mL/min/1.73 m2 1 year after LT (P Conclusion The present study underlines the value of mGFR in the pre-LT stage and found major renal function loss after LT, and consequently two-thirds of patients have Stage ≥3 CKD at 1 year. All patients with a pre-LT mGFR
Published: 2019

25. FO002INTRACELLULAR ATP AND INORGANIC PHOSPHATE DEPLETION DURING MAINTENANCE HEMODIALYSIS

Author: Olivier Rouviere, Sandrine Lemoine, Gabriel Kocevar, Laurent Juillard, Laetitia Gabrielle Normand, Dominique Sappey-Marinier, Guillaume Chazot, and Emilie Kalbacher
Subjects: Transplantation, Inorganic phosphate, Nephrology, business.industry, medicine.medical_treatment, Medicine, Maintenance hemodialysis, Hemodialysis, Pharmacology, business
Published: 2019

26. FP183Averange Creatinine-Urea Clearance: Revival of an Old Analytical Technique?

Author: Laurent Juillard, Gisele Da Silva Fonseca, Muriel Rabilloud, Da Silva Selistre Luciano, Carlos Eduardo Poli-de-Figueiredo, Ana Elizabeth Figueiredo, Pierre Cochat, Vandréa De Souza, Sandrine Lemoine, and Laurence Dubourg
Subjects: Transplantation, medicine.medical_specialty, Nephrology, business.industry, Analytical technique, Urology, Creatinine urea, Medicine, business
Published: 2019

27. FP617Proteome of HDL from non-diabetic hemodialysis patients

Author: Soulage Christophe O, Page Adeline, Nans Florens, Laurent Juillard, Calzada Catherine, Delolme Frederic, and Guebre-Egziabher Fitsum
Subjects: Transplantation, medicine.medical_specialty, Nephrology, business.industry, medicine.medical_treatment, Internal medicine, medicine, Hemodialysis, business, Non diabetic
Published: 2019

28. SaO022Adductome of HDL from non-diabetic hemodialysis patients

Author: Soulage Christophe O, Nans Florens, Guebre-Egziabher Fitsum, Laurent Juillard, Calzada Catherine, Page Adeline, and Delolme Frederic
Subjects: Transplantation, medicine.medical_specialty, Nephrology, business.industry, Internal medicine, medicine.medical_treatment, medicine, Hemodialysis, business, Non diabetic
Published: 2019

29. Estimated Glomerular Filtration Rate Bias in Participants with Severe Obesity Regardless of Deindexation

Author: Fitsum Guebre-Egziabher, Sandrine Lemoine, Charlotte Brunelle, Laurence Dubourg, Caroline C Pelletier, Laurent Juillard, Gabrielle Normand, Jouve Thomas, Service de néphrologie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Université Grenoble Alpes (UGA), Morton K. Blaustein Department of Earth and Planetary Sciences [Baltimore], Johns Hopkins University (JHU), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Laboratoire de Biologie Tissulaire et d'ingénierie Thérapeutique UMR 5305 (LBTI), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Service de néphrologie, dialyse, aphérèses et transplantation, Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Male, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Medicine (miscellaneous), urologic and male genital diseases, surgery, 0302 clinical medicine, Endocrinology, body-composition, Risk Factors, Medicine, 030212 general & internal medicine, accurate, Aged, 80 and over, Body surface area, Kidney, Nutrition and Dietetics, Data Collection, Middle Aged, female genital diseases and pregnancy complications, Obesity, Morbid, medicine.anatomical_structure, Female, Glomerular Filtration Rate, medicine.drug, Adult, medicine.medical_specialty, Adolescent, Urology, Renal function, 030209 endocrinology & metabolism, equation, serum creatinine, Young Adult, 03 medical and health sciences, Endocrinology & Metabolism, Humans, Renal Insufficiency, Chronic, Aged, Retrospective Studies, Nutrition & Dietetics, business.industry, association, kidney-disease, Retrospective cohort study, medicine.disease, Obesity, gfr, ckd, Iohexol, business, Body mass index, Kidney disease
Abstract: International audience; Objective Morbid obesity is associated with a higher independent risk of chronic kidney disease (CKD). Estimated glomerular filtration rate (eGFR) has been evaluated in a limited number of study participants with severe obesity. Methods A total of 706 measured GFR (mGFR) results from 598 participants with obesity (BMI \textgreater= 35 kg/m(2)) were retrospectively collected. The performance of the Modification of Diet in Renal Disease (MDRD) equation, Chronic Kidney Disease-Epidemiology (CKD-EPI) equation, and deindexed eGFR were compared with mGFR from the gold standard technique (inuline or iohexol), adjusted (mGFRr) or nonadjusted (mGFR) to body surface area. Absolute bias, precision, and accuracy were calculated. Results Mean mGFRr (58 +/- 31 mL/min/1.73 m(2)) was significantly different from CKD-EPI and MDRD (P \textless 0.001). Mean mGFR (nonindexed) (70 +/- 40 mL/min) was significantly higher than mGFRr (P \textless 0.001). eGFR showed important biases and low accuracies for CKD-EPI and MDRD (10.7 +/- 10.7 and 12.2 +/- 13.7 mL/min/1.73 m(2); 78% vs. 75% respectively). Deindexation worsened bias and accuracy 30% (percentage of GFR estimates within 30% of mGFRr or mGFR) between eGFR and mGFR. Conclusions eGFR overestimates mGFR and is associated with important biases and inaccuracies in patients with severe obesity, and deindexing eGFR worsens the overestimation. These findings may have important implications in examining kidney function in patients with obesity.
Published: 2019

30. Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting

Author: Thomas Fournier, Olivier Rouvière, Stéphane Luong, Florence Sens, Gabrielle Normand, Caroline C. Pelletier, Philip Robinson, Nellie Della-Schiava, Sandrine Lemoine, Laurent Juillard, Laboratoire de Chimie Moléculaire et Environnement (LCME), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Application des ultrasons à la thérapie (LabTAU), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Université Grenoble Alpes (UGA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
Subjects: Male, Cardiovascular Procedures, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Blood Pressure, 030204 cardiovascular system & hematology, Pathology and Laboratory Medicine, Vascular Medicine, Cohort Studies, 0302 clinical medicine, Medicine and Health Sciences, 030212 general & internal medicine, Resistant Hypertension, Stenosis, Aged, 80 and over, Multidisciplinary, Drugs, Arteries, Middle Aged, 3. Good health, Antihypertensive Drugs, Hypertension, Renovascular, Treatment Outcome, Hypertension, Cardiology, Medicine, Female, Anatomy, Research Article, Glomerular Filtration Rate, Cohort study, medicine.medical_specialty, Science, Decision Making, Renal function, Surgical and Invasive Medical Procedures, Renal Artery Obstruction, Revascularization, 03 medical and health sciences, Signs and Symptoms, Renal Arteries, Diagnostic Medicine, Internal medicine, medicine.artery, Angioplasty, medicine, Humans, Renal artery, Antihypertensive Agents, Aged, Retrospective Studies, Pharmacology, Treatment Guidelines, Health Care Policy, business.industry, Biology and Life Sciences, Kidneys, Retrospective cohort study, Renal System, Atherosclerosis, medicine.disease, Health Care, Blood pressure, Reperfusion, Cardiovascular Anatomy, Blood Vessels, business, Angioplasty, Balloon
Abstract: International audience; BACKGROUND: In atherosclerotic renal artery disease, the benefit of revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital. OBJECTIVES: To investigate whether this decisional process ensured a clinical benefit to patients assigned to renal revascularization. METHODS: Single-centre retrospective cohort study, including patients diagnosed from April 2013 to February 2015 with an atherosclerotic renal artery disease with a peak systolic velocity \textgreater180cm/s. For each patient, the decision taken in multidisciplinary meeting (medical treatment or revacularization) was compared to the one guided by international guidelines. Blood pressure values, number of antihypertensive medications, presence of an uncontrolled or resistant hypertension, and glomerular filtration rate at one-year follow-up were compared to baseline values. Safety data were collected. RESULTS: Forty-nine patients were included: 26 (53%) were assigned to a medical treatment and 23 (47%) to a renal revascularization. Therapeutic decision was in accordance with the 2013 American Health Association guidelines and with the 2017 European Society of Cardiology guidelines for 78% and 22% of patients who underwent revascularization, respectively. Patients assigned to revascularization presented a significant decrease in systolic blood pressure (-23+/-34mmHg, p = 0.007), diastolic blood pressure (-12+/-18mmHg, p = 0.007), number of antihypertensive medications (-1.00+/-1.03, p = 0.001), and number of uncontrolled or resistant hypertension (p = 0.022 and 0.031) at one-year follow-up. Those parameters were not modified among patients assigned to medical treatment alone. There was no grade 3 adverse event. CONCLUSION: Based on a multidisciplinary selection of revascularization indications, patients on whom a renal revascularization was performed exhibited a significant improvement of blood pressure control parameters with no severe adverse events.
Published: 2019

31. PET C-11 acetate is also a perfusion tracer for kidney evaluation purposes

Author: Nicolas Costes, Didier Le Bars, Inés Mérida, Zacharie Irace, Sandrine Lemoine, Gabrielle Normand, Thomas Troalen, Laurent Juillard, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Neurosciences précliniques, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Siemens Healthcare [France], Siemens AG [Munich], Centre de Recherche et d'Application en Traitement de l'Image et du Signal (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre d'Exploration et de Recherche Médicales par Émission de Positons (CERMEP), Université Joseph Fourier - Grenoble 1 (UJF)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Centre d'Etude et de Recherche Multimodal Et Pluridisciplinaire en imagerie du vivant (CERMEP - imagerie du vivant), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Siemens Healthineers France collaboration program, ANR-11-EQPX-0026,LILI,Lyon - Imagerie Intégrée du Vivant : IRM-TEP hybride(2011), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lyon-Université de Lyon-CHU Grenoble-Hospices Civils de Lyon (HCL)-CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), CCSD, Accord Elsevier, and Equipements d'excellence - Lyon - Imagerie Intégrée du Vivant : IRM-TEP hybride - - LILI2011 - ANR-11-EQPX-0026 - EQPX - VALID
Subjects: Cancer Research, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Renal oxidative, Revascularization, positron-emission-tomography, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, renal blood-flow, In vivo, TRACER, medicine, Renal functional parameters, Radiology, Nuclear Medicine and imaging, validation, Kidney, medicine.diagnostic_test, carbon-11-acetate, Chemistry, business.industry, Acetate, Blood flow, 3. Good health, Cardiovascular physiology, [SDV] Life Sciences [q-bio], Nuclear Medicine & Medical Imaging, medicine.anatomical_structure, Positron emission tomography, 030220 oncology & carcinogenesis, PET-MRI, Molecular Medicine, Nuclear medicine, business, Radiology, Perfusion, metabolism, oxidative-metabolism, Renal perfusion
Abstract: International audience; Rationale: Renal positron emission tomography (PET) functional imaging allows non-invasive and dynamic measurements of functional and metabolic parameters. [O-15]H2O is used as a perfusion tracer, and [C-11]acetate as an oxidative metabolism in this purpose, requiring two injections to assess those fundamental parameters. Yet, in cardiac physiology study, the high first-pass myocardial extraction fraction of [C-11]acetate allowed to use its influx rate as a blood flow marker too. Since [C-11]acetate has been characterized by a 20-25% single pass renal extraction in dogs, it could be used as a potential tracer for renal perfusion. The aim of this study was to determine whether [C-11]acetate influx rate can be used as quantitative in vivo marker of kidney perfusion in human. Methods: In 10 healthy subjects, dynamic PET acquisitions were performed after [O-15]H2O and [C-11]acetate injections spaced by a 15-minute interval. As previously validated, with compartmental modeling of kinetics, renal perfusion and oxidative metabolism were estimated respectively with influx rate of [O-15]H2O and efflux rate of [C-11]acetate. Additionally, influx rate of [C-11]acetate was regressed to influx rate of [O-15]H2O. Results: Renal time activity curves of [C-11]-acetate was best fitted with a mono compartmental model compared to a bi-compartmental model (p \textless 0.0001). [C-11]acetate influx rate was significantly correlated with perfusion quantified with [O-15]H2O (r(2) = 0.37, p \textless 0.001) at baseline. This regression allowed the computation of a renal [C-11]acetate extraction fraction (EF), and further the computation of renal blood flow from its influx rate. Conclusion: In healthy subjects, over a wide range of renal perfusion, direct estimates of renal oxygen consumption as well as tissue perfusion can be obtained by PET with a single tracer [C-11]acetate. This approach needs to be validated in CKD patients, and would be of great interest to design clinical protocol aiming at evaluating ischemic nephropathies candidate to revascularization. (C) 2019 Elsevier Inc. All rights reserved.
Published: 2019

32. Twin pregnancy in a patient on chronic haemodialysis who already had three pregnancies

Author: Anne Jolivot, Pascaline M Alix, Flora Brunner, Muriel Doret, Laurent Juillard, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Adult, Male, Polyhydramnios, medicine.medical_specialty, Twin pregnancy, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Twins, 030232 urology & nephrology, Gestational Age, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Renal Dialysis, Intensive care, Diseases in Twins, medicine, Humans, Twin Pregnancy, Dialysis, Respiratory distress, Cesarean Section, business.industry, Obstetrics, Infant, Newborn, Four pregnancies, medicine.disease, 3. Good health, Pregnancy Complications, Nephrology, Pregnancy, Twin, Kidney Failure, Chronic, Gestation, Female, Hemodialysis, business, Chronic hemodialysis, Daily hemodialysis
Abstract: International audience; Pregnancy in women with end-stage renal disease is rare. Multiple pregnancies carry a high risk of complications even in healthy individuals. We report the case of a 36-year-old woman who had four pregnancies while she was on dialysis, including one twin pregnancy. The last pregnancy occurred while in the 14th year of hemodialysis. At 8 weeks of gestation (WG), ultrasonography diagnosed a dichorionic diamniotic twin pregnancy. The frequency of dialysis was increased from 3 to 6 times a week and each session lasted 4 h. At 22 WG, polyhydramnios was diagnosed. At 25 WG, the patient presented respiratory distress and was transferred to intensive care where continuous hemodialysis, non-invasive ventilation, antibiotic and tocolysis were initiated. Because of tocolysis failure, a cesarean section was performed and she delivered male twins. The two newborns weighed 790 and 870 g, respectively. To our knowledge, this is the first report of four pregnancies in hemodialysis including one twin pregnancy. The incidence of pregnancy and a better outcome in patients on hemodialysis has increased in recent years but a tight coordination between nephrologists and obstetricians is essential.
Published: 2019

33. Insuffisance rénale aiguë en périopératoire et en réanimation (à l’exclusion des techniques d’épuration extrarénale)

Author: Nicolas Lerolle, Jean-Michel Constantin, Bertrand Souweine, Laurent Jacob, Olivier Joannes-Boyau, Arnaud Garnier, Carole Ichai, Jacques Duranteau, Eric Rondeau, Emmanuel Canet, Théophille Gaillot, Christophe Clec’h, Yannick Walrave, Fabienne Tamion, Christophe Vinsonneau, Lionel Velly, Alexandre Lautrette, Laurent Muller, Didier Journois, Thomas Rimmelé, Groupe francophone de réanimation et urgences pédiatriques, Société française d'anesthésie et de réanimation, Laurent Juillard, Société française de néphrologie, Michael Darmon, Matthieu Legrand, and Fabien Armando
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, business.industry, Medicine, 030208 emergency & critical care medicine, 030204 cardiovascular system & hematology, business
Published: 2016

34. Determinants and prognostic value of kidney disease in pulmonary arterial hypertension

Author: Julie Traclet, Florence Sens, Laurent Juillard, Cécile Payet, Sabrina Zeghmar, Laurent Bitker, Ségolène Turquier, Kais Ahmad, Jean-François Mornex, Vincent Cottin, and Antoine Duclos
Subjects: medicine.medical_specialty, business.industry, Internal medicine, Cardiology, medicine, business, medicine.disease, Value (mathematics), Kidney disease
Published: 2018

35. Proteomic Characterization of High-Density Lipoprotein Particles from Non-Diabetic Hemodialysis Patients

Author: Frédéric Delolme, Christophe O. Soulage, Adeline Page, Fitsum Guebre Egziabher, Catherine Calzada, Nans Florens, Laurent Juillard, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France (Service de néphrologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France), SFR Biosciences, École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), grant 'Annee Recherche' from Agence Regionale de Sante (ARS) Hospices Civils de Lyon grant 'IRCT-Dialyse' from The French Society of Nephrology (Societe Francaise Nephrologie Dialyse et Transplantation, SFNDT) Institut National de la Sante et de la Recherche Medicale (Inserm)Institut National des Sciences Appliquees de Lyon (INSA-Lyon) ITMO Cancer AVIESAN (Alliance Nationale pour les Sciences de la Vie et de la Sante, National Alliance for Life Sciences and Health), Florens, Nans, Soulage, Christophe, Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), CALZADA, Catherine, and École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL)
Subjects: Proteomics, [SDV]Life Sciences [q-bio], Health, Toxicology and Mutagenesis, medicine.medical_treatment, lcsh:Medicine, Apoptosis, 030204 cardiovascular system & hematology, Toxicology, medicine.disease_cause, chemistry.chemical_compound, 0302 clinical medicine, High-density lipoprotein, spectrométrie de masse, HDL cholesterol, hémodialyse chronique, protéomique, ComputingMilieux_MISCELLANEOUS, proteomic, mass spectrometry, 0303 health sciences, education.field_of_study, lipoprotéine, hemodialysis, cholestérol, Up-Regulation, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.TOX] Life Sciences [q-bio]/Toxicology, risque cardiovasculaire, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Alimentation et Nutrition, Proteome, Hemodialysis, Lipoproteins, HDL, cardiovascular risk, medicine.medical_specialty, Population, Down-Regulation, Article, 03 medical and health sciences, Renal Dialysis, Internal medicine, medicine, Humans, Food and Nutrition, education, Toxicologie, 030304 developmental biology, Hemostasis, Wound Healing, lipoproteins, business.industry, lcsh:R, Lipid metabolism, Lipid Metabolism, medicine.disease, Oxidative Stress, Endocrinology, chemistry, Case-Control Studies, business, Oxidative stress, Kidney disease
Abstract: Chronic kidney disease is associated with an increased cardiovascular risk, and altered biological properties of high-density lipoproteins (HDL) may play a role in these events. This study aimed to describe the HDL proteome from non-diabetic hemodialysis patients and identify potential pathways affected by the dysregulated expression of HDL proteins. HDL were sampled from nine non-diabetic hemodialysis (HD) and eight control patients. Samples were analyzed using a nano-RSLC coupled with a Q-Orbitrap. Data were processed by database searching using SequestHT against a human Swissprot database and quantified with a label-free quantification approach. Proteins that were in at least five of the eight control and six of the nine HD patients were analyzed. Analysis was based on pairwise ratios and the ANOVA hypothesis test. Among 522 potential proteins, 326 proteins were identified to be in the HDL proteome from HD and control patients, among which 10 were significantly upregulated and nine downregulated in HD patients compared to the control patients (p &lt, 0.05). Up and downregulated proteins were involved in lipid metabolism, hemostasis, wound healing, oxidative stress, and apoptosis pathways. This difference in composition could partly explain HDL dysfunction in the chronic kidney disease (CKD) population and participate in the higher cardiovascular risk observed in this population.
Published: 2019

36. AGE Content of a Protein Load Is Responsible for Renal Performances: A Pilot Study

Author: Zacharie Irace, Thomas Troalen, Marjorie Villien, Nicolas Costes, Sandrine Lemoine, Laurent Juillard, Gabrielle Normand, Inés Mérida, Didier Le Bars, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Siemens Healthcare [France], Siemens AG [Munich], Hôpital de la Croix-Rousse [CHU - HCL], Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Glycation End Products, Advanced, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], 030209 endocrinology & metabolism, Pilot Projects, restriction, 030204 cardiovascular system & hematology, Kidney, Gastroenterology, Diabetic nephropathy, 03 medical and health sciences, Young Adult, Endocrinology & Metabolism, 0302 clinical medicine, Oxygen Consumption, Glycation, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, Diabetic Nephropathies, Prospective Studies, Renal Insufficiency, Chronic, Prospective cohort study, 2. Zero hunger, Advanced and Specialized Nursing, Meal, disease, glomerular-filtration-rate, Cross-Over Studies, business.industry, reserve, Kidney metabolism, Middle Aged, medicine.disease, Crossover study, 3. Good health, Oxygen, glycation end-products, Female, Dietary Proteins, business, diet, Kidney disease
Abstract: OBJECTIVE Chronic kidney disease is associated with higher morbidity and mortality in patients with diabetes. A low-protein diet is recommended to slow diabetic nephropathy progression because each protein load leads to renal hemodynamic variations. The aim of our study was to evaluate whether the advanced glycation end products (AGE) content of a protein load is responsible for the protein-induced renal hemodynamic variations in humans. RESEARCH DESIGN AND METHODS Ten healthy subjects were assigned to a high-protein (1 g/kg) low-AGE (3,000 kU AGE) versus high-AGE (30,000 kU AGE) meal. Renal perfusion, oxygen consumption, and oxygen content were measured before and 120 min after each meal. RESULTS Renal perfusion (3.2 ± 0.5 vs. 3.8 ± 0.4 mL/min/g; P = 0.0002) and oxygen consumption (0.3 ± 0.04 vs. 0.4 ± 0.08 min−1; P = 0.005) increased significantly after the high-AGE meal compared with the low-AGE meal. CONCLUSIONS Our results suggest that the AGE content of a protein load is responsible for renal hemodynamic modifications. Therefore, prevention of diabetic nephropathy progression could aim predominantly at reducing food AGE content.
Published: 2018

37. Renal Involvement in Neuropathy, Ataxia, Retinitis Pigmentosa (NARP) Syndrome: A Case Report

Author: Laurent Juillard, Maud Rabeyrin, Marine Panaye, Fitsum Guebre-Egziabher, Philippe Petiot, Sandrine Lemoine, Elisabeth Errazuriz-Cerda, Bénédicte Mousson de Camaret, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Service Néphrologie Dialyse, Hypertension Arterielle, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Service des Maladies Héréditaires du Métabolisme, Centre de Biologie et de pathologie Est-Hospices Civils de Lyon (HCL), Hôpital de la Croix-Rousse [CHU - HCL], Centre Hospitalier Universitaire [Grenoble] (CHU), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Hospices Civils de Lyon (HCL)-Centre de Biologie et de pathologie Est
Subjects: Male, Pathology, medicine.medical_specialty, Ataxia, Adolescent, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Kearns-Sayre Syndrome, Gene mutation, Young Adult, 03 medical and health sciences, Rare Diseases, 0302 clinical medicine, Renal Dialysis, Retinitis pigmentosa, medicine, Humans, Genetic Predisposition to Disease, Child, Myopathy, Dialysis, ComputingMilieux_MISCELLANEOUS, Kidney, Psychomotor retardation, medicine.diagnostic_test, business.industry, Biopsy, Needle, Mitochondrial Myopathies, Mitochondrial Proton-Translocating ATPases, medicine.disease, Immunohistochemistry, 3. Good health, Treatment Outcome, medicine.anatomical_structure, Nephrology, Disease Progression, Kidney Diseases, Renal biopsy, medicine.symptom, business, Retinitis Pigmentosa, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: We report a case of a patient who had the mitochondrial cytopathy complex of neuropathy, ataxia, and retinitis pigmentosa (NARP) syndrome diagnosed at age 11 years with a biopsy-proven kidney involvement that progressed to end-stage renal disease at age 21 years. Mutations of mitochondrial DNA (mtDNA) are maternally inherited and lead to mitochondrial cytopathies with predominant neurologic manifestations: psychomotor retardation, epilepsy, ataxia, neuropathy, and myopathy. Given the ubiquitous nature of mitochondria, cellular dysfunction can also appear in tissues with high metabolic turnover; thus, there can be cardiac, digestive, ophthalmologic, and kidney complications. Mutations in the MT-ATP6 gene of mtDNA have been shown to cause NARP syndrome without renal involvement. We report a patient who had NARP syndrome diagnosed at age 11 years in whom glomerular proteinuria was present very early after diagnosis. Although neurologic manifestations were stable over time, he developed worsening proteinuria and kidney function. He started dialysis therapy at age 21 years. Kidney biopsy confirmed the mitochondrial cytopathy histologically, with abnormal mitochondria seen on electron microscopy. The MT-ATP6 gene mutation was detected in the kidney biopsy specimen.
Published: 2018

38. Pregnancy Outcomes in French Hemodialysis Patients

Author: Fitsum Guebre-Egziabher, Sylvie Bin, Evelyne Decullier, Anne Jolivot, Marine Panaye, Gabrielle Normand, Laurent Juillard, Muriel Doret, Xiaoli Xu, Sandrine Lemoine, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: trends, Adult, medicine.medical_specialty, dialysis patients, renal-transplant recipients, medicine.medical_treatment, Birth weight, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Gestational Age, 030204 cardiovascular system & hematology, registry, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Renal Dialysis, Risk Factors, medicine, Birth Weight, Humans, Pregnancy outcomes, Dialysis, Retrospective Studies, Fetus, business.industry, Obstetrics, Cesarean Section, Infant, Newborn, Pregnancy Outcome, Gestational age, cohort, Urology & Nephrology, medicine.disease, Chronic renal insufficiency, 3. Good health, Pregnancy Complications, Catheter, Nephrology, Kidney Failure, Chronic, Female, Hemodialysis, women, France, business
Abstract: Background: Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal complications. Scarcity of available data from large cohorts impedes fair medical counseling. Methods: This is a descriptive, retrospective, multi-centric study. Pregnant women on HD during the period from 1985 to 2015 in France were included. The primary outcome was a living infant discharged from hospital, while secondary outcomes included gestational age and birth weight. Results: We identified 100 pregnancies in 84 women on HD, from 41 centers. Chronic HD was initiated during pregnancy for 17.7% (14/79) of patients explaining a 19.8% prevalence of catheter (19/96) and a preserved residual diuresis for 50% of pregnancy (43/86). Seventy-six (89.4%) women performed daily dialysis during the third trimester (6 times per week). Our primary outcome was met for 78% of newborns with a mean gestational age of 33.2 ± 3.9 weeks and a mean birth weight of 1,719 ± 730 g. Conclusions: Our study is one of the largest series of pregnancies in HD patients. Despite recent progresses, these pregnancies remain at high risk, reinforcing the need for an early nephrologist-obstetrician skilled team co-management.
Published: 2018

39. Presence of Kidney Disease as an Outcome Predictor in Patients with Pulmonary Arterial Hypertension

Author: Laurent Juillard, Vincent Cottin, Florence Sens, Cécile Payet, Laurent Bitker, Antoine Duclos, Ségolène Turquier, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre de Recherche Cardio-Thoracique, Partenaires INRAE, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Université de Lyon (COMUE), Hôpital Louis Pradel [CHU - HCL], Infections Virales et Pathologie Comparée - UMR 754 (IVPC), Institut National de la Recherche Agronomique (INRA)-École pratique des hautes études (EPHE), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Claude Bernard Lyon 1 (UCBL)
Subjects: Male, Physiology, [SDV]Life Sciences [q-bio], Hemodynamics, 030204 cardiovascular system & hematology, urologic and male genital diseases, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 0302 clinical medicine, blood-pressure, Chronic kidney disease, 030212 general & internal medicine, Aged, 80 and over, glomerular-filtration-rate, Hazard ratio, Central venous pressure, Middle Aged, Urology & Nephrology, female genital diseases and pregnancy complications, 3. Good health, Nephrology, Cardiology, Female, France, Mortality/Survival, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Hypertension, Pulmonary, Cardiorenal syndrome, Renal function, equation, Heart failure, survival, serum creatinine, Pulmonary hypertension, 03 medical and health sciences, Internal medicine, medicine, Humans, Renal Insufficiency, Chronic, renal-function, Aged, business.industry, heart-failure, association, medicine.disease, mortality, business, Kidney disease
Abstract: Background: Pulmonary arterial hypertension (PAH) may lead to right heart failure and subsequently alter glomerular filtration rates (GFR). Chronic kidney disease (CKD, GFR 2) may also adversely affect PAH prognosis. This study aimed to assess how right heart hemodynamics was associated with reduced estimated GFR (eGFR) and the association of CKD with survival in PAH patients. Methods: In a prospective PAH cohort (2003–2012), invasive hemodynamics and eGFR were collected at diagnosis (179 patients) and during follow-up (159 patients). The prevalence of CKD was assessed at PAH diagnosis. Variables, including hemodynamics, associated with reduced eGFR at diagnosis and during follow-up were tested in multivariate analysis. The association of CKD with survival was evaluated using a multivariate Cox regression model. Results: At diagnosis, mean age was 60.4 ± 16.5 years, mean pulmonary arterial pressure was 43 ± 12 mm Hg, and eGFR was 74.4 ± 26.4 mL/min/1.73 m2. CKD was observed in 52 incident patients (29%). Independent determinants of reduced eGFR at diagnosis were age, systemic hypertension, and decreased cardiac index. Independent determinants of reduced eGFR during follow-up were age, female gender, PAH etiology, systemic hypertension, decreased cardiac index, and increased right atrial pressure. Age ≥60 years, female gender, NYHA 4, and CKD at diagnosis were independently associated with decreased survival. The adjusted hazards ratio for death associated with CKD was 1.81 (95% confidence interval [1.01–3.25]). Conclusion: CKD is frequent at PAH diagnosis and is independently associated with increased mortality. Right heart failure may induce renal hypoperfusion and congestion, and is associated with eGFR decrease.
Published: 2018

40. Expanded haemodialysis: news from the field

Author: Laurent Juillard, Nans Florens, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Hospices Civils de Lyon (HCL), Baxter Healthcare Corporation, ProdInra, Migration, Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, 030232 urology & nephrology, Tissue membrane, Reviews, Hemodiafiltration, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Rhabdomyolysis, 03 medical and health sciences, Dialysis solutions, 0302 clinical medicine, Renal Dialysis, Dialysis Solutions, Restless Legs Syndrome, haemodialysis membrane, Medicine, Humans, Adverse effect, Intensive care medicine, Transplantation, business.industry, chronic haemodialysis, medium cut-off, Membranes, Artificial, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 3. Good health, Molecular Weight, Nephrology, HDx, business, Multiple Myeloma, uraemic toxins
Abstract: International audience; Expanded haemodialysis (HDx) has emerged as a promising solution to improve haemodialysis effectiveness. A medium cutoff membrane allows the removal of a wider range of uraemic toxins. However, little is known about the potential interesting applications of HDx therapy. Feedback from the first routine use of HDx therapy under real-life conditions in European facilities was excellent for priming and rinse back. There was no adverse event after 5191 HDx treatments. Patients suffering from itching, restless legs syndrome, persistent asthenia or malnourishment could benefit from HDx therapy. Moreover, we discuss here the promising applications in which HDx could be valuable (myeloma, rhabdomyolysis or cardiovascular diseases). This enthusiastic message is mitigated by reminding why and how prudence should be taken in the design of future HDx studies.
Published: 2018

41. Une nouvelle étiologie dans la lithiase calcique récidivante : la mutation hétérozygote du gène de la 24 hydroxylase

Author: N. Abid, Lionel Badet, A. Molin, Laurence Dubourg, A. Bertholet-Thomas, Laurent Juillard, J Bacchetta, S. Lemoine, and G. Normand
Subjects: business.industry, Urology, Medicine, business, Molecular biology
Abstract: Objectifs L’hypercalciurie est une cause frequente de calculs renaux. Des mutations perte de fonction biallelique de cyp24a1, gene codant pour la vitamine d 24-hydroxylase, et identifiees dans des formes d’hypercalcemie idiopathie neonatale, ont ete egalement identifiees chez des patients avec lithiase renale et/ou nephrocalcinose. Decouverte d’hypercalciurie chez des patients lithiasiques avec mutation heterozygote de la cyp24a1, theoriquement non symptomatiques. Methodes Trois patients, (âge 32 ± 8 ans), ont consulte pour maladie lithiasique active. Les calculs etaient constitues de weddellite ou de brushite. Le bilan phosphocalcique montrait : calcemie normale a 2,34 ± 0,06 mmol/L, pth a 41 ± 13 ng/L (normes 15–65) ; 25-oh vit d a 76 ± 7 nmol/L et 1,25-(oh)2 vit d a 225 ± 98 pmol/L. La calciurie moyenne etait de 5,33 mmol/24 h, soit 0,09 ± 0,01 mmol/kg/j. La consommation sodee et proteique etait normale. Une charge calcique a ete realisee devant l’activite lithiasique importante et/ou l’hypercalciurie avec une absence d’hypercalciurie resorptive et une hypercalciurie absorptive (delta ca/creat a 0,73 n Resultats L’association d’une 1,25-(oh)2 vit d elevee, d’une hypercalcemie a h2 et h4 de la charge calcique avec une pth freinee a motive la recherche de mutation de la 24-hydroxylase. Il a ete identifie une mutation a l’etat heterozygote chez ces 3 patients (c.1124c > t/p.(pro375leu), c1226t > c/p.(leu409ser) et c.1348t > a/p.(phe450ile). Il serait interessant de doser la 24-25ohd2 chez ces patients ( Tableau 1 ). Conclusion Les mutations heterozygotes de cyp24a1 peuvent etre identifiees chez des patients lithiasiques hypercalciuriques avec une 1,25-(oh)2 vit d elevee. Une charge calcique avec hypercalciurie absorptive et freination majeure de la pth peut orienter la recherche d’une mutation de cyp24a1.
Published: 2018

42. Grossesse en insuffisance rénale terminale : épidémiologie, prise en charge et pronostic

Author: Fitsum Guebre-Egziabher, Laurent Juillard, Marine Panaye, Anne Jolivot, Sandrine Lemoine, Muriel Doret, and Emmanuel Morelon
Subjects: Pregnancy, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Eclampsia, business.industry, Obstetrics, medicine.medical_treatment, 030232 urology & nephrology, Intrauterine growth restriction, medicine.disease, 3. Good health, Peritoneal dialysis, 03 medical and health sciences, 0302 clinical medicine, Nephrology, medicine, Hemodialysis, business, Kidney transplantation, Dialysis, Kidney disease
Abstract: Pregnancy in patients presenting end-stage renal disease is rare and there are currently no recommendations for the management of these patients. In hemodialysis patients, reduced fertility and medical reluctance limit the frequency of pregnancies. Although the prognosis has significantly improved, a significant risk for unfavorable maternal (pre-eclampsia, eclampsia) and fetal (pre-term birth, intrauterine growth restriction, still death) outcome still remains. Increasing dialysis dose with the initiation of daily dialysis sessions, early adaptation of medications to limit teratogenicity and management of chronic kidney disease complications (anemia, hypertension) are required. A tight coordination between nephrologists and obstetricians remains the central pillar of the care. In peritoneal dialysis, pregnancy is also possible with modification of the exchange protocol and reducing volumes.
Published: 2014

43. Dose and timing of injections for effective cyclosporine A pretreatment before renal ischemia reperfusion in mice

Author: Laurent Juillard, Maud Rabeyrin, Michel Ovize, Lionel Augeul, Delphine Baetz, Gabrielle Normand, Sandrine Lemoine, Annie Varennes, Bruno Pillot, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL), Bibliotheque Scientifique de l'Internat de LyonHospices Civils de Lyon, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hôpital Edouard Herriot [CHU - HCL], Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Male, 0301 basic medicine, Critical Care and Emergency Medicine, [SDV]Life Sciences [q-bio], Drug Evaluation, Preclinical, 030232 urology & nephrology, lcsh:Medicine, Pharmacology, Kidney, Biochemistry, Vascular Medicine, Mitochondrial Membrane Transport Proteins, chemistry.chemical_compound, 0302 clinical medicine, Ischemia, Medicine and Health Sciences, lcsh:Science, Energy-Producing Organelles, ComputingMilieux_MISCELLANEOUS, Multidisciplinary, Acute Kidney Injury, Mitochondria, 3. Good health, Dose–response relationship, medicine.anatomical_structure, Creatinine, Reperfusion Injury, Cyclosporine, Cellular Structures and Organelles, Anatomy, Renal Ischemia, Research Article, Histology, Calcineurin Inhibitors, Renal function, Bioenergetics, Drug Administration Schedule, 03 medical and health sciences, medicine, Animals, Calcium Signaling, Dose-Response Relationship, Drug, Renal ischemia, Mitochondrial Permeability Transition Pore, business.industry, lcsh:R, Biology and Life Sciences, Kidneys, Cell Biology, Renal System, medicine.disease, Mice, Inbred C57BL, 030104 developmental biology, chemistry, Mitochondrial permeability transition pore, Reperfusion, lcsh:Q, Calcium, business, Reperfusion injury, Biomarkers
Abstract: International audience; BackgroundThere is experimental evidence that lethal ischemia-reperfusion injury (IRI) is largely due to mitochondrial permeability transition pore (mPTP) opening, which can be prevented by cyclosporine A (CsA). The aim of our study is to show that a higher dose of CsA (10 mg/kg) injected just before ischemia or a lower dose of CsA (3 mg/kg) injected further in advance of ischemia (1 h) protects the kidneys and improves mitochondrial function.MethodsAll mice underwent a right unilateral nephrectomy followed by 30 min clamping of the left renal artery. Mice in the control group did not receive any pharmacological treatment. Mice in the three groups treated by CsA were injected at different times and with different doses, namely 3 mg/kg 1 h or 10 min before ischemia or 10 mg/kg 10 min before ischemia. After 24 h of reperfusion, the plasma creatinine level were measured, the histological score was assessed and mitochondria were isolated to calculate the calcium retention capacity (CRC) and level of oxidative phosphorylation.ResultsMortality and renal function was significantly higher in the CsA 10 mg/kg-10 min and CsA 3mg/kg-1 h groups than in the CsA 3mg/kg-10 min group. Likewise, the CRC was significantly higher in the former two groups than in the latter, suggesting that the improved renal function was due to a longer delay in the opening of the mPTP. Oxidative phosphorylation levels were also higher 24 h after reperfusion in the protected groups.ConclusionsOur results suggest that the protection afforded by CsA is likely limited by its availability. The dose and timing of the injections are therefore crucial to ensure that the treatment is effective, but these findings may prove challenging to apply in practice.
Published: 2017

44. Chronic Lyme borreliosis associated with minimal change glomerular disease: a case report

Author: Maud Rabeyrin, Fitsum Guebre-Egziabher, J. Kanitakis, Sandrine Lemoine, Nans Florens, Florent Valour, Laurent Juillard, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Department of Infectious Diseases and Tropical Medicine, Hospices Civils de Lyon (HCL), Departement det Dermatologie, Departement de Pathologie, Centre médical universitaire de Genève (CMU), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Nephrology, Pathology, lésion cutanée, Nephrotic Syndrome, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Case Report, examen clinique, Kidney, 0302 clinical medicine, Lyme disease, Minimal change disease, 030212 general & internal medicine, Borreliosis, pathogénèse, Skin, Lyme Disease, medicine.diagnostic_test, diagnostic techniques, pathogenesis, Ceftriaxone, 3. Good health, LYME, Anti-Bacterial Agents, Renal pathology, Female, Renal biopsy, Chronic atrophic acrodematitis, medicine.medical_specialty, lyme, borreliosis, minimal change disease, chronic atrophic acrodematitis, Prednisolone, 03 medical and health sciences, Internal medicine, corticostéroïde, medicine, Humans, Glucocorticoids, Aged, business.industry, Nephrosis, Lipoid, Acrodermatitis, maladie de lyme, medicine.disease, Dermatology, Skin biopsy, Chronic Disease, Lyme, business, Nephrotic syndrome
Abstract: Background: There are only few cases of renal pathology induced by Lyme borreliosis in the literature, as this damage is rare and uncommon in humans. This patient is the first case of minimal change glomerular disease associated with chronic Lyme borreliosis. Case presentation: A 65-year-old Caucasian woman was admitted for an acute edematous syndrome related to a nephrotic syndrome. Clinical examination revealed violaceous skin lesions of the right calf and the gluteal region that occurred 2 years ago. Serological tests were positive for Lyme borreliosis and skin biopsy revealed lesions of chronic atrophic acrodermatitis. Renal biopsy showed minimal change glomerular disease. The skin lesions and the nephrotic syndrome resolved with a sequential treatment with first ceftriaxone and then corticosteroids. Conclusion: We report here the first case of minimal change disease associated with Lyme borreliosis. The pathogenesis of minimal change disease in the setting of Lyme disease is discussed but the association of Lyme and minimal change disease may imply a synergistic effect of phenotypic and bacterial factors. Regression of proteinuria after a sequential treatment with ceftriaxone and corticosteroids seems to strengthen this conceivable association.
Published: 2017

45. Cystatin C Versus Creatinine for GFR Estimation in CKD Due to Heart Failure

Author: Eric Bonnefoy, Sandrine Lemoine, Laurent Sebbag, Laurence Dubourg, Fitsum Guebre-Egziabher, Laurent Juillard, Delphine Kervella, Florence Sens, Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Urology, Renal function, 030204 cardiovascular system & hematology, 03 medical and health sciences, chemistry.chemical_compound, Young Adult, 0302 clinical medicine, medicine, Humans, Prospective Studies, Young adult, Cystatin C, Renal Insufficiency, Chronic, Prospective cohort study, ComputingMilieux_MISCELLANEOUS, Aged, Aged, 80 and over, Heart Failure, Creatinine, biology, business.industry, Follow up studies, Middle Aged, medicine.disease, chemistry, Nephrology, Heart failure, biology.protein, Female, business, Biomarkers, Follow-Up Studies, Glomerular Filtration Rate
Abstract: International audience
Published: 2017

46. Large Middle Molecule and Albumin Removal: Why Should We Not Rest on Our Laurels?

Author: Laurent Juillard and Nans Florens
Subjects: Membrane permeability, business.industry, medicine.medical_treatment, 030232 urology & nephrology, Albumin, 030204 cardiovascular system & hematology, Pharmacology, medicine.disease, Highly sensitive, 03 medical and health sciences, 0302 clinical medicine, Uremic toxins, medicine, Lack of knowledge, Hemodialysis, business, Middle molecule, Kidney disease
Abstract: Large middle molecules (LMM) are an important subclass of uremic toxins. Many of them have been linked with poor outcomes in hemodialysis (HD) patients. The onset of high-flux membranes and convective techniques allowed to dramatically improve their clearance but without a clear and undebatable reduction of mortality in HD patients. Despite the real effect on the removal of selected toxins, little is known about the influence of modern HD techniques on the global removal of uremic toxins. Mostly explained by a lack of knowledge and selective assays, LMM removal is not evaluated appropriately. The development of highly sensitive and widespread detection techniques such as mass spectrometry could increase our knowledge about the real state of their removal in HD. Nevertheless, these techniques remain cost effective and are difficult to handle. On the contrary, the improvement of LMM removal raises the question of a tolerable albumin removal. Indeed, increasing membrane permeability can significantly increase LMM removal accompanied by a higher albumin loss. However, in chronic kidney disease and particularly in HD patients, albumin can be modified, and it subsequently exerts detrimental effects. This could be avoided by the clearance of the modified forms in HD, but future efforts should be done to investigate the real impact of their removal.
Published: 2017

47. Adenine rich diet Is not a surrogate of 5/6 nephrectomy in rabbits

Author: Nans Florens, Caroline C. Pelletier, Sandrine Lemoine, Laurent Juillard, Maud Rabeyrin, Christophe O. Soulage, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Département de Néphrologie, Université Bordeaux Segalen - Bordeaux 2, Département de Pathologie, Université Libre de Bruxelles [Bruxelles] (ULB)-Institut Jules Bordet, INSERM, INSA-Lyon, ARS, Hospices Civils de Lyon, Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Université libre de Bruxelles (ULB)-Institut Jules Bordet [Bruxelles], Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, 0301 basic medicine, Pathology, medicine.medical_specialty, fasting, medicine.medical_treatment, rabbit, Renal function, Disease, Kidney, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, chronic diseases, Mice, 03 medical and health sciences, Animal model, Species Specificity, chemical nephrectomy, adénine, mental disorders, medicine, Animals, Urea, lapin, Renal Insufficiency, Chronic, business.industry, Adenine, animal model, maladie chronique, Kidney pathology, Diet, Rats, jeûne alimentaire, Disease Models, Animal, 030104 developmental biology, Creatinine, Urea blood, vitamin b 4, Rabbits, maladie rénale, Creatinine blood, business, chronic kidney disease, Glomerular Filtration Rate
Abstract: Background: Animal models are important tools needed to understand the mechanisms underlying the progression of renal disease and to implement new therapeutic approaches. A non-surgical model of chronic kidney disease (CKD) developed by chemical nephrectomy using an adenine-enriched diet has been shown to be a robust model to induce kidney failure in mice and rats. The purpose of this study was to implement an adenine diet to induce CKD in rabbits. Methods: Male New Zealand rabbits were fed for 4 weeks with a diet containing 0.75% (w/w) adenine, and renal function was assessed by measuring plasma urea and creatinine concentrations. The glomerular filtration rate (GFR) was measured using the plasmatic clearance of Iohexol. Kidney histology was performed with haematoxylin erythrosine saffron and Sirius red staining. Results: In contrast to what was observed in rodents, adenine diet failed to induce kidney failure in rabbits as is evident in the plasma concentrations of creatinine and urea and the direct measurement of GFR or histopathological studies. Conclusion: Adenine diet is not a surrogate of subtotal nephrectomy to induce kidney failure in rabbits. Several interspecies differences in metabolism and renal physiology could account for this observation.
Published: 2017

48. Contents Vol. 135, 2017

Author: David Ternant, Gianluca Villa, Ben Parker, Yongxing Xu, Jianjun Gao, Troels Krarup Hansen, Druckerei Stückle, Alessandra Brocca, Alessandra Brendolan, Maud Rabeyrin, Béatrice Birmelé, Crystal C. Tyson, Maud François, Elodie Chasseuil, Loreto Gesualdo, Claudio Ronco, Nolwenn Rabot, Gilles Paintaud, Christophe O. Soulage, Emile de Heer, M. Yvonne Alexander, Boran Liang, Sandrine Lemoine, Laurent Juillard, Morten Fog-Tonnesen, Francesco Ramponi, Amaya García de Vinuesa, Philip A. Kalra, Alexander Rosendahl, Sarah Skeoch, Yuehua Gao, Jenny Norlin, Caroline C. Pelletier, Jean-Michel Halimi, Alessandra Spinelli, Lise Høj Thomsen, François Darrouzain, Giuseppe Castellano, Matthias Büchler, Jiamei Wei, Nans Florens, Sara Samoni, Thomas M. Coffman, Zhaoyan Gu, Yu Na, Min Li, Peter ten Dijke, Darren Green, Stefano Chiaramonte, Aashish Sharma, Lisbeth Nielsen Fink, and Lila Ghouti-terki
Subjects: Traditional medicine, business.industry, Medicine, business
Published: 2017

49. Course of chronic kidney disease in French patients

Author: P. Nicoud, Nicolas Janus, Philippe Vanhille, Stéphane Burtey, Thierry Hannedouche, Myriam Isnard-Rouchon, Gilbert Deray, Malik Touam, Gérard Janin, Maurice Laville, Vincent Launay-Vacher, Laurent Juillard, J.-P. Ortiz, Service ICAR, Néphrologie, Hôpital La Pitie Salpetriere, Service de Néphrologie, Centre Hospitalier de l'Université de Montréal (CHUM), AURA Chamalières, Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION )-Assistance Publique - Hôpitaux de Marseille (APHM), Polyclinique de St Roch, Service de Néphologie, Hôpital des Chanaux, Hôpitaux du Pays du Mont-Banc, AURA Paris, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Montréal (UdeM)-Université de Montréal (UdeM), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION )
Subjects: Nephrology, insuffisance rénale, medicine.medical_specialty, Pediatrics, médicament, medicine, Referral, medicine.medical_treatment, dialyse, 030232 urology & nephrology, Esrd Management, Dialysis patients, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, dosage, renal insufficiency, 03 medical and health sciences, Patient referral, 0302 clinical medicine, Internal medicine, Urology and Nephrology, Dialysis, Urologie et Néphrologie, Transplantation, chronic renal insufficiency, business.industry, 030503 health policy & services, Retrospective cohort study, drug dosage management, medicine.disease, 3. Good health, Chronic dialysis, mechanical kidney, dialysis, patient, France, 0305 other medical science, business, Kidney disease
Abstract: Background: In 1998, a French survey showed that the referral of patients with chronic kidney disease to a nephrologist was delayed, resulting in many emergency initiations of dialysis. In 2009, the ORACLE study aimed to describe the renal course of dialysis patients from their first nephrology visit to their first dialysis session. Methods: The ORACLE study was a multicentre retrospective study of all patients who started chronic dialysis. Data were collected at the first nephrology visit and at the first dialysis session. Results: In total, 720 patients were included (69 centres). At the first nephrology visit, the mean Cockcroft-Gault (CG) indicator was 31.8 mL/min (22.7 in 1998) and 52.4% of patients (73% in 1998) had a CG
Published: 2017

50. Accuracy of GFR Estimation in Obese Patients

Author: Laurent Juillard, Marie-Sophie Nguyen-Tu, Sandrine Lemoine, Fitsum Guebre-Egziabher, Aoumeur Hadj-Aissa, Florence Sens, Laurence Dubourg, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Subjects: Male, Body Surface Area, Epidemiology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Contrast Media, Kidney, Critical Care and Intensive Care Medicine, Severity of Illness Index, Body Mass Index, Hospitals, University, 0302 clinical medicine, 80 and over, Renal Insufficiency, 030212 general & internal medicine, Glomerular Filtration Rate, Aged, 80 and over, 2. Zero hunger, Body surface area, Inulin, Middle Aged, Hospitals, Nephrology, Obesity/*complications/diagnosis, Predictive value of tests, Cohort, Kidney/*physiopathology, Female, France, medicine.drug, Adult, medicine.medical_specialty, Models, Iohexol, Urology, Renal function, Models, Biological, Young Adult, 03 medical and health sciences, Predictive Value of Tests, medicine, Humans, Obesity, Renal Insufficiency, Chronic, Bland–Altman plot, Aged, University, Transplantation, business.industry, Body Weight, Chronic/complications/*diagnosis/physiopathology, Original Articles, Biological, medicine.disease, Surgery, business, Body mass index, Kidney disease
Abstract: International audience; BACKGROUND AND OBJECTIVES: Adequate estimation of renal function in obese patients is essential for the classification of patients in CKD category as well as the dose adjustment of drugs. However, the body size descriptor for GFR indexation is still debatable, and formulas are not validated in patients with extreme variations of weight. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study included 209 stages 1-5 CKD obese patients referred to the Department of Renal Function Study at the University Hospital in Lyon between 2010 and 2013 because of suspected renal dysfunction. GFR was estimated with the Chronic Kidney Disease and Epidemiology equation (CKD-EPI) and measured with a gold standard method (inulin or iohexol) not indexed (mGFR) or indexed to body surface area determined by the Dubois and Dubois formula with either real (mGFRr) or ideal (mGFRi) body weight. Mean bias (eGFR-mGFR), precision, and accuracy of mGFR were compared with the results obtained for nonobese participants (body mass index between 18.5 and 24.9) who had a GFR measurement during the same period of time. RESULTS: Mean mGFRr (51.6 +/- 24.2 ml/min per 1.73 m(2)) was significantly lower than mGFR, mGFRi, and eGFRCKD-EPI. eGFRCKD-EPI had less bias with mGFR (0.29; -1.7 to 2.3) and mGFRi (-1.62; -3.1 to 0.45) compared with mGFRr (8.7; 7 to 10). This result was confirmed with better accuracy for the whole cohort (78% for mGFR, 84% for mGFRi, and 72% for mGFRr) and participants with CKD stages 3-5. Moreover, the Bland Altman plot showed better agreement between mGFR and eGFRCKD-EPI. The bias between eGFRCKD-EPI and mGFRr was greater in obese than nonobese participants (8.7 versus 0.58, P\textless0.001). CONCLUSIONS: This study shows that, in obese CKD patients, the performance of eGFRCKD-EPI is good for GFR \textless/= 60 ml/min per 1.73 m(2). Indexation of mGFR with body surface area using ideal body weight gives less bias than mGFR scaled with body surface area using real body weight.
Published: 2014

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