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201. Soin nutritionnel et amélioration clinique dans un service de néphrologie : une approche pilote multidisciplinaire

Author: Emilie Kalbacher, Denis Fouque, Fitsum Guebre-Egziabher, Christine Pommerol, and Céline Pasian
Subjects: 03 medical and health sciences, 0302 clinical medicine, Nephrology, 030232 urology & nephrology, 030204 cardiovascular system & hematology, 3. Good health
Abstract: Resume Introduction La denutrition est un facteur independant aggravant la mortalite et la morbidite dans les pathologies renales chroniques. Elle est particulierement frequente et accentuee au cours d’une hospitalisation. Objectifs Il s’agit de mesurer l’evolution nutritionnelle et musculaire (masse et force), ainsi que l’autonomie des patients au cours d’une hospitalisation dans un service de nephrologie. Le but est egalement de pouvoir adapter les traitements en fonction des differents diagnostics (soin nutritionnel, composition corporelle, forme physique) avec une approche multimodale, et de mesurer l’impact de cette prise en charge sur l’etat nutritionnel du patient. Methodes Quel que soit leur profil nutritionnel et leur pathologie renale (insuffisance renale aigue, chronique ou hemodialyse chronique), les patients inclus sont hospitalises depuis moins de 48 heures (j0). Les interventions nutritionnelles et les mesures sont repetees a j7, j14 et j21. L’etude a ete conduite chez 48 patients, de decembre 2011 a juin 2012. Resultats Les apports nutritionnels sont insuffisants a l’entree dans le service (20,9 ± 8,6 kcal/kg/j). Cependant, il est possible de les augmenter grâce a une intervention dietetique (28,1 ± 6,5 kcal/kg/j a 2 semaines d’hospitalisation, 29 ± 6,1 kcal/kg/j a 3 semaines et 29 ± 8,4 kcal/kg/j a 4 semaines). Ainsi, 73 % des patients hospitalises sont denutris et parmi eux, 91 % presentent une hypo-albuminemie a leur admission (26,8 ± 6,6 g/L). L’augmentation des apports calorico-azotes associee a la reeducation physique permet d’ameliorer leur statut nutritionnel. Le poids et la masse musculaire (mesuree par bio-impedancemetrie) ont ete maintenus, la pre-albumine (transthyretine) a augmente de 16,5 mg/L a 2 semaines (n = 48 ; p = 0,61) ; 27,8 mg/L a 3 semaines (n = 31 ; p = 0,018) ; 52,3 mg/L a 4 semaines (n = 13 ; p = 0,002). En revanche, l’albuminemie n’a augmente que de 1,8 g/L (n = 13 patients suivis 4 semaines ; p = 0,13). L’autonomie evaluee avec le test moteur minimum ainsi que la force de pression musculaire ont ete significativement ameliorees. Conclusion Un depistage systematique de la denutrition et une prise en charge pluridisciplinaire ameliorent l’etat nutritionnel et la capacite physique des patients hospitalises en nephrologie.
Published: 2014

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

Author: Jean-Claude Souberbielle, Claude Laurent Benhamou, Bernard Cortet, Mickael Rousière, Christian Roux, Vered Abitbol, Cédric Annweiler, Maurice Audran, Justine Bacchetta, Pierre Bataille, Olivier Beauchet, Rémi Bardet, Alexandra Benachi, Francis Berenbaum, Hubert Blain, Françoise Borson-Chazot, Véronique Breuil, Karine Briot, Philippe Brunet, Jean-Claude Carel, Philippe Caron, Olivier Chabre, Philippe Chanson, Roland Chapurlat, Pierre Cochat, Régis Coutant, Sophie Christin-Maitre, Martine Cohen-Solal, Christian Combe, Catherine Cormier, Marie Courbebaisse, Grégory Debrus, Brigitte Delemer, Georges Deschenes, Marc Duquenne, Patrice Fardellone, Denis Fouque, Gérard Friedlander, Jean-Bernard Gauvain, Lionel Groussin, Pascal Guggenbuhl, Pascal Houillier, Thierry Hannedouche, William Jacot, Rose-Marie Javier, Guillaume Jean, Claude Jeandel, Dominique Joly, Peter Kamenicky, Bertrand Knebelmann, Marie-Hélène Lafage-Proust, Yves LeBouc, Erick Legrand, Florence Levy-Weil, Agnès Linglart, Laurent Machet, Emmanuel Maheu, Eric Mallet, Christian Marcelli, Pierre Marès, Christophe Mariat, Gérard Maruani, Yves Maugars, France Montagnon, Bruno Moulin, Philippe Orcel, Henri Partouche, Virginie Personne, Charles Pierrot-Deseilligny, Michel Polak, Claire Pouteil-Noble, Dominique Prié, Agathe Raynaud-Simon, Yves Rolland, Jean-Louis Sadoul, Bernard Salle, Corinne Sault, Anne-Marie Schott, Isabelle Sermet-Gaudelus, Martin Soubrier, Ivan Tack, Éric Thervet, Isabelle Tostivint, Philippe Touraine, Florence Tremollières, Pablo Urena-Torres, Jean-Paul Viard, Jean-Louis Wemeau, Georges Weryha, Norbert Winer, Jacques Young, Thierry Thomas, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional d'Orléans (CHRO), Service de rhumatologie[Lille], Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Cochin [AP-HP], Service de médecine interne et gérontologie clinique [Angers], Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Centre Hospitalier Boulogne-sur-mer, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de gynécologie-obstétrique, médecine de la reproduction [Béclère], Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Euromov (EuroMov), Université de Montpellier (UM), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de rhumatologie, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Neuroprotection du Cerveau en Développement / Promoting Research Oriented Towards Early Cns Therapies (PROTECT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7), Service Endocrinologie, maladies métaboliques et nutrition [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Biologie du Cancer et de l'Infection (BCI ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Récepteurs stéroïdiens : physiopathologie endocrinienne et métabolique, Université Paris-Sud - Paris 11 (UP11)-IFR93-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie, diagnostic et traitements des maladies osseuses / Pathophysiology, Diagnosis & Treatments of Bone Diseases (LYOS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Endocrinologie pédiatrique[CHU Angers], Physiopathologie des maladies génétiques d'expression pédiatrique, Os et articulations, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fibrose hépatique et cancer du foie, Université Bordeaux Segalen - Bordeaux 2-IFR66-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Néphrologie-transplantation-dialyse [Bordeaux], CHU Bordeaux [Bordeaux], Centre de recherche Croissance et signalisation (UMR_S 845), 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), Nutrition [Cergy] (N - cabinet libéral ), Service d'Endocrinologie - Diabète - Nutrition [Reims], Université de Reims Champagne-Ardenne (URCA)-Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Hôpital Robert Debré, Centre Hospitalier Le Mans (CH Le Mans), Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Service de Physiologie [Georges-Pompidou], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5), CHU Strasbourg, Institut de recherche en cancérologie de Montpellier (IRCM - U896 Inserm - UM1), Université Montpellier 1 (UM1)-CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre de Rein Artificiel [Tassin la demi-lune] (CRA), Université Montpellier 1 (UM1), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Tissu Osseux et Contraintes Mecaniques (LBTO), Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Trousseau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Victor Dupouy, Immunologie et génétique du diabète de type 1, génétique multifactorielle en endocrinologie pédiatrique (U986), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Rouen, Normandie Université (NU), Service de Rhumatologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Service de Rhumatologie, Hôtel-Dieu, Cabinet de Rhumatologie [Saint-Etienne] (CdR), Hôpital Lariboisière-Fernand-Widal [APHP], Département de Médecine Générale, Université Paris Cité (UPCité), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Hôpital Edouard Herriot [CHU - HCL], CIC Hôpital Bichat, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine, Gérontopôle, 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)-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)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service d'Endocrinologie (NICE - Endocrino), Centre Hospitalier Universitaire de Nice (CHU Nice), Académie nationale de médecine, Eurofins Biomnis, CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [AP-HP], Université Pierre et Marie Curie - Paris 6 (UPMC), Service Obstétrique [CHU Toulouse], Pôle Femme-Mère-Couple [CHU Toulouse], Clinique du Landy [Saint-Ouen] (CL), Hôpital Hôtel-Dieu [Paris], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Endocrinologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Gynécologie Obstétrique (NANTES - Gynéco Obstétrique), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Gustave Roussy (IGR), Service d'endocrinologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, and Jonchère, Laurent
Subjects: medicine.medical_specialty, Malabsorption, [SDV]Life Sciences [q-bio], MathematicsofComputing_GENERAL, [SDV.CAN]Life Sciences [q-bio]/Cancer, Phosphorus metabolism disorder, GeneralLiterature_MISCELLANEOUS, Phosphorus metabolism, InformationSystems_GENERAL, [SDV.CAN] Life Sciences [q-bio]/Cancer, Malabsorption Syndromes, Calcium Metabolism Disorders, Internal medicine, medicine, Serum vitamin D measurement, Vitamin D and neurology, Humans, Renal Insufficiency, Chronic, Renal Insufficiency, Chronic, Vitamin D, ComputingMilieux_MISCELLANEOUS, MESH: Bone Diseases / blood, Calcium Metabolism Disorders / blood, Malabsorption Syndromes / blood, Phosphorus Metabolism Disorders / blood, Renal Insufficiency, Chronic / blood, Vitamin D / blood, business.industry, Phosphorus Metabolism Disorders, General Medicine, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Endocrinology, Malabsorption syndromes, Bone Diseases, business, Kidney disease
Abstract: La mesure de la concentration serique de 25-hydroxy vitamines D (25OHD) permet d’evaluer le statut vitaminique D d’un individu. Ceci ne signifie pas qu’il faille doser ce parametre biologique chez tous les patients. Le nombre de prescriptions de dosages de 25OHD a pourtant decuple en France entre 2005 et 2013 generant un cout important de remboursement pour la Caisse nationale de l’assurance-maladie des travailleurs salaries (CNAMTS) ce qui l’a conduit, logiquement, a la saisine [...]
Published: 2014

203. MANAGEMENT OF HYPERPHOSPHATAEMIA: PRACTICES AND PERSPECTIVES AMONGST THE RENAL CARE COMMUNITY

Author: Denis Fouque, Susan Rogers, Maria Cruz Casal, Christina Johanna Maria Nagel, Jennifer Kernc, Jitka Pancířová, J. Brian Copley, and Elizabeth Lindley
Subjects: Advanced and Specialized Nursing, medicine.medical_specialty, medicine.drug_class, business.industry, medicine.medical_treatment, Renal care, medicine.disease, Protein intake, 3. Good health, Peritoneal dialysis, Phosphate binder, Nephrology, Internal medicine, medicine, Intensive care medicine, business, Management practices, Dietary protein intake, Kidney disease, Dietary Phosphorus
Abstract: SUMMARY Background Protein-rich foods are a major source of dietary phosphorus; therefore, helping patients to increase their dietary protein intake, while simultaneously managing their hyperphosphataemia, poses a significant challenge for renal care professionals. Objectives To examine the clinical recommendations and practice perceptions of renal care professionals providing nutrition and phosphate control advice to patients with chronic kidney disease (CKD). Methods Renal care professionals from four European countries completed an online survey on the clinical management of hyperphosphataemia. Results The majority of responders recommended a protein intake of less than 1.0 g/kg/day for pre-dialysis patients, 1.2 g/kg/day for patients undergoing peritoneal dialysis (PD) and 1.1–1.2 g/kg/day for patients undergoing haemodialysis (HD). The most common perception was that maintaining dietary protein intake and reducing dietary phosphorus intake are equally important for hyperphosphataemia management. For patients in the pre-dialysis stage, the majority of responders (59%) reported that their first-line management recommendation would be reduction of dietary phosphorus. For patients undergoing PD and HD, the majority of responders (53% and 59%, respectively) reported a first-line management recommendation of both reduction of dietary phosphorus and phosphate binder therapy. More renal nurses than dietitians perceived reducing dietary phosphorus to be more important than maintaining protein intake (for patients undergoing PD, 23% vs. 0%, respectively; for patients undergoing HD, 34% vs. 0%, respectively). Conclusion This renal care community followed professionally accepted guidelines for patient nutrition and management of hyperphosphataemia. There was disparity in the perceptions and recommendations between nurses and dietitians, highlighting the need to standardise management practices amongst renal care professionals.
Published: 2014

204. Role of altered intestinal microbiota in systemic inflammation and cardiovascular disease in chronic kidney disease

Author: Laetitia Koppe, Julie Calixto Lobo, Denise Mafra, Denis Fouque, Amanda F. Barros, Nosratola D. Vaziri, 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)-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: Lipopolysaccharides, intestinal microbiota, Male, Kidney Disease, endotoxins, [SDV]Life Sciences [q-bio], medicine.medical_treatment, uremic toxins, Inflammation/*etiology, 030232 urology & nephrology, Cardiovascular Diseases/*etiology, Disease, Cardiovascular, Systemic inflammation, Oral and gastrointestinal, Fats, Pathogenesis, 0302 clinical medicine, cardiovascular disease, Pregnancy, 2.1 Biological and endogenous factors, oxidative stress, Renal Insufficiency, Aetiology, Chronic, Intestinal Mucosa, Fats/metabolism, 0303 health sciences, Microbiota, Chronic/*complications/metabolism/*microbiology, 3. Good health, Intestines, Cardiovascular Diseases, Medical Microbiology, prebiotic, Carbohydrate Metabolism, Proteins/metabolism, Female, medicine.symptom, Intestines/metabolism/*microbiology, Microbiology (medical), Renal and urogenital, Inflammation, Biology, Microbiology, 03 medical and health sciences, Insulin resistance, nutrients, medicine, Humans, Animals, Microbiome, Renal Insufficiency, Chronic, 030304 developmental biology, Prevention, Probiotics, Prebiotic, Proteins, medicine.disease, Good Health and Well Being, Prebiotics, Immunology, Digestive Diseases, chronic kidney disease, Lipopolysaccharides/metabolism, Kidney disease
Abstract: ABSTRACT: The normal intestinal microbiota plays a major role in the maintenance of health and disease prevention. In fact, the alteration of the intestinal microbiota has been shown to contribute to the pathogenesis of several pathological conditions, including obesity and insulin resistance, among others. Recent studies have revealed profound alterations of the gut microbial flora in patients and animals with chronic kidney disease (CKD). Alterations in the composition of the microbiome in CKD may contribute to the systemic inflammation and accumulation of gut-derived uremic toxins, which play a central role in the pathogenesis of accelerated cardiovascular disease and numerous other CKD-associated complications. This review is intended to provide a concise description of the potential role of the CKD-associated changes in the gut microbiome and its potential role the pathogenesis of inflammation and uremic toxicity. In addition, the potential efficacy of pre- and pro-biotics in the restoration of the microbiome is briefly described.
Published: 2014

205. Rapport de la HAS sur les dosages de vitamine D : ne passons pas d’une situation extrême à une autre situation tout aussi extrême

Author: Jean-Claude Souberbielle, Claude Laurent Benhamou, Bernard Cortet, Mickael Rousière, Christian Roux, Vered Abitbol, Maurice Audran, Justine Bachetta, Olivier Beauchet, Hubert Blain, Véronique Breuil, Karine Briot, Philippe Brunet, Philippe Chanson, Catherine Cormier, Marie Courbebaisse, Patrice Fardellone, Denis Fouque, Gérard Friedlander, Jean-Bernard Gauvain, Lionel Groussin, Pascal Houillier, William Jacot, Guillaume Jean, Peter Kamenicky, Marie-Hélène Lafage-Proust, Erick Legrand, Florence Levy-Weil, Agnès Linglart, Eric Mallet, Christian Marcelli, Gérard Maruani, France Montagnon, Virginie Personne, Dominique Prié, Agathe Raynaud-Simon, Yves Rolland, Bernard Salle, Corinne Sault, Anne-Marie Schott, Eric Thervet, Pablo Urena-Torres, Jean-Paul Viard, Georges Weryha, Charles Pierrot-Deseilligny, Jacques Young, and Thierry Thomas
Subjects: business.industry, Medicine, General Medicine, business, Humanities
Published: 2014

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

Author: Guillaume, Jean, Éric, Daugas, Hubert, Roth, Tilman, Drueke, Jean-Louis, Bouchet, Thierry, Hannedouche, Gérard, London, and Denis, Fouque
Subjects: Aged, 80 and over, Chronic Kidney Disease-Mineral and Bone Disorder, Male, Phosphorus, Middle Aged, Parathyroid Hormone, Renal Dialysis, Surveys and Questionnaires, Humans, Calcium, Female, France, Renal Insufficiency, Chronic, Vitamin D, Aged
Abstract: Only limited data is available on the management of the chronic kidney disease-associated bone and mineral metabolism disorder (CKD-MBD) in the pre-dialysis stages of CKD in France. A better knowledge of current management habits could lead to an improvement in the implementation of international recommendations (KDIGO). The 3rd version of the French Phosphorus and Calcium Survey Photo-Graphe (Sanofi) included a cohort of CKD stages 4 and 5 patients, whose aim was to examine the prevalence of CKD-MBD and the quality of its management in patients under the care of 62 nephrologists from over 20 geographical regions in France. The study started in October 2011, i.e. one year after patient enrollment. We examined in particular the percentage of patients presenting with laboratory parameter abnormalities indicative of CKD-MBD who were not receiving adequate treatment. A total of 456 patients with CKD stage 4 and 154 with CKD stage 5 were studied. Their mean age was 72.9±14.2 years, and male/female ratio was 58/42. KDIGO targets of serum PTH for CKD stages 4 and 5 were not achieved in respectively 80 and 84% of the patients, for serum calcium in 8 and 22% and for serum phosphate in 12 and 46%. As a potential explanation, insufficient therapy was estimated to account for respectively 45 and 60% of insufficiently controlled secondary hyperparathyroidism, and for 36% of persistent hyperphosphatemia in stage 5. It should be noted that 55.5 and 57.5% of patients were receiving native vitamin D. In this national observatory, the management of CKD-MBD stages 4 and 5 appears suboptimal, especially as regards the control of secondary hyperparathyroidism, which remained untreated in nearly 50% of the patients. Hyperphosphatemia was also common and inadequately controlled in CKD stage 5. To improve the management of CKD-MBD, nephrologists need to be more aware of the importance of aiming for recommended laboratory targets and how this can be achieved.
Published: 2016

207. Validity and reproducibility of a short food frequency questionnaire among patients with chronic kidney disease

Author: Bénédicte Stengel, Aurélie Affret, Sandra Wagner, Françoise Clavel-Chapelon, M. Niravong, Denis Fouque, Douae El Fatouhi, Julie De Chefdebien, Courtney Dow, Emmanuelle Correia, Marie-Christine Boutron-Ruault, Guy Fagherazzi, 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) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), French-Clinical Research Infrastructure Network [Lyon] (Cardiovascular & Renal Clinical Trialists - INI-CRCT ), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RH), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-CHU Saint-Etienne-Hospices Civils de Lyon (HCL)-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-CHU Saint-Etienne-Hospices Civils de Lyon (HCL)-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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), Mode de vie, génétique et santé : études intégratives et transgénérationnelles (U1018 (Équipe 9)), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Gustave Roussy (IGR), The CKD-REIN cohort is funded by the Agence Nationale de la Recherche (ANR-10-COHO-01-05) through the 2010 ‘Cohortes-Investissements d’Avenir’ programme and by the 2010 national Programme Hospitalier de Recherche Clinique. CKD-REIN is also supported through partnership agreements with Amgen, Baxter, Fresenius Medical Care, GlaxoSmithKline, Lilly, Merck Sharp and Dohme-Chibret (MSD France), and Otsuka. This present work was supported by a grant from the French Research Institute in Public Health (IReSP) and the French multi-organism thematic Institutes in Public Health (ITMO Santé Publique). AA is supported by a doctoral grant from the French National Cancer Institute. SW is funded by the F-CRIN INI-CRCT network. GF is supported by the French Research Agency (ANR, Agence Nationale de la Recherche) via an 'Investissement d’Avenir' grant (investment for the future grant, ANR-10-COHO-0006) that supports the E4N study., ANR-10-COHO-05-01/10-COHO-0005,i-SHARE,Etude de cohorte sur la santé des étudiants(2010), ANR-10-COHO-0006/10-COHO-0006,E4N,Etude Epidémiologique des Enfants de femmes de l'Education Nationale(2010), 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), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-CHU Saint-Etienne-Hospices Civils de Lyon (HCL)-CHU Grenoble-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-CHU Saint-Etienne-Hospices Civils de Lyon (HCL)-CHU Grenoble-Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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), 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)-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)-Institut Gustave Roussy (IGR), ANR-10-COHO-0005,i-SHARE,Etude de cohorte sur la santé des étudiants(2010), ANR-10-COHO-0006,E4N,Etude Epidémiologique des Enfants de femmes de l'Education Nationale(2010), 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), French-Clinical Research Infrastructure Network / F-CRIN [Lyon] (Cardiovascular & Renal Clinical Trialists - INI-CRCT ), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL)-Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), 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)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Grenoble Alpes (UGA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-CHU Grenoble-CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Grenoble Alpes (UGA), 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-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)-Institut Gustave Roussy (IGR), BMC, BMC, Cohortes - Etude de cohorte sur la santé des étudiants - - i-SHARE2010 - ANR-10-COHO-0005 - COHO - VALID, and Cohortes - Etude Epidémiologique des Enfants de femmes de l'Education Nationale - - E4N2010 - ANR-10-COHO-0006 - COHO - VALID
Subjects: Nephrology, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, lcsh:RC870-923, Validity, Food group, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Surveys and Questionnaires, Chronic kidney disease, Epidemiology, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Renal Insufficiency, Chronic, Prospective cohort study, Aged, Reproducibility, Short food frequency questionnaire, business.industry, Food frequency questionnaire, Reproducibility of Results, Middle Aged, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Diet Records, 3. Good health, Diet, [SDV] Life Sciences [q-bio], Nutrition Assessment, Dietary assessment, Cohort, Female, business, Energy Intake, Kidney disease, Research Article
Abstract: Background A balanced diet is essential to slowing the progression of chronic kidney disease (CKD) and managing the symptoms. Currently, no tool is available to easily and quickly assess energy and macronutrient intake in patients with non end-stage CKD. We aimed to develop and evaluate the validity and reproducibility of a new short 49-item food frequency questionnaire (SFFQ) adapted to patients with CKD. Methods The CKD-REIN study is a prospective cohort that enrolled 3033 patients with moderate or advanced CKD from a national sample of nephrology clinics. A sub-sample of 201 patients completed the SFFQ twice, at a one-year interval and were included in the reproducibility study. During this interval, 127 patients also completed six 24-h recalls and were included in the validity study. Main nutrient and dietary intakes were computed. Validity was evaluated by calculating crude, energy-adjusted and de-attenuated correlation coefficients (CC) between FFQ and the mean of the 24-h recall results. Bland-Altman plots were performed and cross-classification into quintiles of consumption of each nutrient and food group was computed. Reproducibility between the two SFFQs was evaluated by intraclass CC (ICC). Results Regarding validity, CC ranged from 0.05 to 0.79 (unadjusted CC, median: 0.40) and 0.10 to 0.59 (de-attenuated CC, median: 0.35) for food group and nutrient intakes, respectively. Five of the most important nutrients of interest in CKD, i.e. protein, calcium, phosphorus, potassium, and sodium had de-attenuated CC of 0.46, 0.43, 0.39, 0.32, and 0.12, respectively. The median of classification into the same or adjacent quintiles was 68% and 65% for food and nutrient intakes, respectively, and ranged from 63% to 69% for the five nutrients mentioned before. Bland-Altman plots showed good agreement across the range of intakes. ICC ranged from 0.18 to 0.66 (median: 0.46). Conclusions The CKD-REIN SFFQ showed acceptable validity and reproducibility in a sample of patients with CKD, notably for CKD nutrients of importance. It can now be used in large-scale epidemiological studies to easily assess the relations between diet and CKD outcomes as well as in clinical routine. It may also serve as a basis for the development of FFQs in international CKD cohort networks. Electronic supplementary material The online version of this article (10.1186/s12882-017-0695-2) contains supplementary material, which is available to authorized users.
Published: 2016

208. French law: what about a reasoned reimbursement of serum vitamin D assays?

Author: Jean-Claude Souberbielle, Claude Laurent Benhamou, Bernard Cortet, Mickael Rousière, Christian Roux, Vered Abitbol, Cédric Annweiler, Maurice Audran, Justine Bacchetta, Pierre Bataille, Olivier Beauchet, Rémi Bardet, Alexandra Benachi, Francis Berenbaum, Hubert Blain, Françoise Borson-Chazot, Véronique Breuil, Karine Briot, Philippe Brunet, Jean-Claude Carel, Philippe Caron, Olivier Chabre, Philippe Chanson, Roland Chapurlat, Pierre Cochat, Régis Coutant, Sophie Christin-Maitre, Martine Cohen-Solal, Christian Combe, Catherine Cormier, Marie Courbebaisse, Grégory Debrus, Brigitte Delemer, Georges Deschenes, Marc Duquenne, Guillaume Duval, Patrice Fardellone, Denis Fouque, Gérard Friedlander, Jean-Bernard Gauvain, Lionel Groussin, Pascal Guggenbuhl, Pascal Houillier, Thierry Hannedouche, William Jacot, Rose-Marie Javier, Guillaume Jean, Claude Jeandel, Dominique Joly, Peter Kamenicky, Bertrand Knebelmann, Marie-Hélène Lafage-Proust, Yves LeBouc, Erick Legrand, Florence Levy-Weil, Agnès Linglart, Laurent Machet, Emmanuel Maheu, Eric Mallet, Christian Marcelli, Pierre Marès, Christophe Mariat, Gérard Maruani, Yves Maugars, France Montagnon, Bruno Moulin, Philippe Orcel, Henri Partouche, Virginie Personne, Charles Pierrot-Deseilligny, Michel Polak, Claire Pouteil-Noble, Dominique Prié, Agathe Raynaud-Simon, Yves Rolland, Jean-Louis Sadoul, Bernard Salle, Corinne Sault, Anne-Marie Schott, Isabelle Sermet-Gaudelus, Martin Soubrier, Ivan Tack, Eric Thervet, Isabelle Tostivint, Philippe Touraine, Florence Tremollières, Pablo Urena-Torres, Jean-Paul Viard, Jean-Louis Wemeau, Georges Weryha, Norbert Winer, Jacques Young, Thierry Thomas, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire d'Informatique de Nantes Atlantique (LINA), Mines Nantes (Mines Nantes)-Université de Nantes (UN)-Centre National de la Recherche Scientifique (CNRS), Service de rhumatologie[Lille], Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Laboratoire d'aérologie (LAERO), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Observatoire Midi-Pyrénées (OMP), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Centre National de la Recherche Scientifique (CNRS), Laboratoire des Matériels Électriques (EDF R&D LME), EDF R&D (EDF R&D), EDF (EDF)-EDF (EDF), Centre d'Analyse et d'Intervention Sociologiques (CADIS), École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS), Département de Médecine Interne et Gérontologie clinique, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service de gynécologie-obstétrique, médecine de la reproduction [Béclère], Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Department of Geriatrics - Efficiency and Deficiency Laboratory, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de rhumatologie, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Vascular research center of Marseille (VRCM), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Trigone-CIREL, Centre Interuniversitaire de Recherche en Education de Lille - ULR 4354 (CIREL), Université de Lille-Université de Lille, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Biologie de l'Os et du Cartilage : Régulations et Ciblages Thérapeutiques (BIOSCAR (UMR_S_1132 / U1132)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Rhumatologie [CHU Lariboisière], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité Expérimentale Recherches Intégrées - Gotheron (UERI), Institut National de la Recherche Agronomique (INRA), 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), Unité de Néphrologie Pédiatrique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré, Université de Bordeaux (UB), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Motricité - Plasticité, Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Necker Enfants-Malades (INEM - UM 111 (UMR 8253 / U1151)), Centre de recherche sur le développement territorial (CRDT), Centre de recherche sur le développement territorial, CHU Pontchaillou [Rennes], Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut Pascal (IP), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-SIGMA Clermont (SIGMA Clermont)-Centre National de la Recherche Scientifique (CNRS), Service de rhumatologie [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Information – Technologies – Analyse Environnementale – Procédés Agricoles (UMR ITAP), Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Centre de Physique Théorique [Palaiseau] (CPHT), École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS), Département de Médecine Générale, Université Paris Descartes - Paris 5 (UPD5), CHU Pitié-Salpêtrière [AP-HP], Service de néphrologie et transplantation, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de recherche Croissance et signalisation (UMR_S 845), Service d'Endocrinologie (NICE - Endocrino), Centre Hospitalier Universitaire de Nice (CHU Nice), CIC Cochin Pasteur (CIC 1417), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôtel-Dieu-Université Paris Descartes - Paris 5 (UPD5)-Groupe hospitalier Broca-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, CPMF2 - Flemish Cluster Predictive Microbiology in Foods - www.cpmf2.be BioTeC - Chemical and Biochemical Process Technology and Control Department of Chemical Engineering, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Université Pierre et Marie Curie - Paris 6 (UPMC), Centre de ménopause, Centre de Diagnostic et de Thérapeutique, Hôpital de l’Hôtel-Dieu [Paris], Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Service d'Endocrinologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service d'obstétrique-gynécologie [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Institut für Kernphysik der Universität zu Köln, Universität zu Köln = University of Cologne, Centre National de la Recherche Scientifique (CNRS)-Mines Nantes (Mines Nantes)-Université de Nantes (UN), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Observatoire Midi-Pyrénées (OMP), Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS), Service de rhumatologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Eq 4, Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Groupement Hospitalier Lyon-Est (GHE), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL)-Centre de médecine nucléaire, Fédération d'endocrinologie-Groupement hospitalier Lyon-Est-Fédération d'endocrinologie-Groupement hospitalier Lyon-Est, Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X), Service de neurologie 1 [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre des Pathologies gynécologiques Rares [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), Institut E3M [CHU Pitié-Salpêtrière], Hôpital Paule de Viguier, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Universität zu Köln, Hôpital Roger Salengro-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Laboratoire d'aérologie (LA), Centre National de la Recherche Scientifique (CNRS)-Observatoire Midi-Pyrénées (OMP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Antoine Béclère, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Service de rhumatologie, inflammation-immunopathologie- biothérapie [CHU Saint-Antoine] (DHU i2B ), CHU Saint-Antoine [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Centre de Recherche en Cancérologie de Lyon (CRCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Groupement Hospitalier Lyon-Est (GHE), Centre Interuniversitaire de Recherche en Education de Lille (CIREL) - EA 4354 (CIREL), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Hôpital Lariboisière, Unité de Recherches Intégrées - Gotheron (GOTH RI UERI), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Robert Debré, Laboratoire de génie chimique [ancien site de Basso-Cambo] (LGC), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Sigma CLERMONT (Sigma CLERMONT)-Centre National de la Recherche Scientifique (CNRS), Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP]-Hôtel-Dieu-Université Paris Descartes - Paris 5 (UPD5)-Groupe hospitalier Broca-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Gabriel Montpied (CHU), CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Institut für Kernphysik - Universität zu Köln, Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Météo-France -Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Centre National de la Recherche Scientifique (CNRS), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11), Laboratoire d'Informatique de Nantes Atlantique ( LINA ), Centre National de la Recherche Scientifique ( CNRS ) -Mines Nantes ( Mines Nantes ) -Université de Nantes ( UN ), Hôpital Roger Salengro-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Laboratoire d'aérologie - LA ( LA ), Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut national des sciences de l'Univers ( INSU - CNRS ) -Observatoire Midi-Pyrénées ( OMP ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire des Matériels Électriques ( EDF R&D LME ), EDF R&D ( EDF R&D ), EDF ( EDF ) -EDF ( EDF ), Centre d'Analyse et d'Intervention Sociologiques ( CADIS ), École des hautes études en sciences sociales ( EHESS ) -Centre National de la Recherche Scientifique ( CNRS ), CHU Angers, Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Antoine Béclère, Centre de Recherche Saint-Antoine ( CR Saint-Antoine ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ), Service de rhumatologie, inflammation-immunopathologie- biothérapie [CHU Saint-Antoine] ( DHU i2B ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Centre de Recherche en Cancérologie de Lyon ( CRCL ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Groupement Hospitalier Lyon-Est ( GHE ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ) -Centre de médecine nucléaire, CHU Nice-Hôpital l'Archet, Vascular research center of Marseille ( VRCM ), Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Interuniversitaire de Recherche en Education de Lille (CIREL) - EA 4354 ( CIREL ), Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Biologie de l'Os et du Cartilage : Régulations et Ciblages Thérapeutiques ( BIOSCAR ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Unité de Recherches Intégrées - Gotheron ( GOTH RI UERI ), Institut National de la Recherche Agronomique ( INRA ), Institut Cochin ( 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 ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Robert Debré, Laboratoire de génie chimique ( LGC ), Institut National Polytechnique [Toulouse] ( INP ) -Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique ( CNRS ), Université de Bordeaux ( UB ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Necker Enfants-Malades (INEM) ( INEM - UM 111 (UMR 8253 / U1151) ), Centre de recherche sur le développement territorial ( CRDT ), Institut Pascal ( IP ), Université Blaise Pascal - Clermont-Ferrand 2 ( UBP ) -Sigma CLERMONT ( Sigma CLERMONT ) -Centre National de la Recherche Scientifique ( CNRS ), Université de Nantes ( UN ) -Hôtel-Dieu-Centre hospitalier universitaire de Nantes ( CHU Nantes ), Information – Technologies – Analyse Environnementale – Procédés Agricoles ( UMR ITAP ), Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture ( IRSTEA ) -Institut national d’études supérieures agronomiques de Montpellier ( Montpellier SupAgro ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Lariboisière, Centre de Physique Théorique [Palaiseau] ( CPHT ), École polytechnique ( X ) -Centre National de la Recherche Scientifique ( CNRS ), Université Paris Descartes - Paris 5 ( UPD5 ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Université de Lyon-Université de Lyon-Hospices Civils de Lyon ( HCL ) -Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ), Centre de recherche Croissance et signalisation ( UMR_S 845 ), Service d'Endocrinologie ( NICE - Endocrino ), CHU Nice, CIC Cochin Pasteur ( CIC 1417 ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP]-Hôtel-Dieu-Université Paris Descartes - Paris 5 ( UPD5 ) -Groupe hospitalier Broca-Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU Gabriel Montpied ( CHU ), Katholieke Universiteit Leuven ( KU Leuven ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Assistance publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes - Faculté de Médecine ( UPD5 Médecine ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), and CRLCC Val d'Aurelle - Paul Lamarque-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, recommendation, Pediatrics, medicine.medical_specialty, Malabsorption, Legislation, Medical, [SDV]Life Sciences [q-bio], Osteoporosis, 030209 endocrinology & metabolism, Rickets, vitamin D, osteomalacia, vitamin D deficiency, 03 medical and health sciences, 0302 clinical medicine, rickets, medicine, Vitamin D and neurology, Humans, 030212 general & internal medicine, Biological Psychiatry, Reimbursement, Aged, Aged, 80 and over, Osteomalacia, Hematologic Tests, [ SDV ] Life Sciences [q-bio], business.industry, Hydroxycholecalciferols, assay, medicine.disease, Obesity, reimbursement, osteoporosis, 3. Good health, Surgery, clinical practice, Neuropsychology and Physiological Psychology, Insurance, Health, Reimbursement, Female, Neurology (clinical), France, Geriatrics and Gerontology, business, calcium phosphorus evaluation, chronic kidney disease
Abstract: International audience; The number of serum 25-hydroxyvitamin D (25OHD) assays has increased tenfold in France in less than 10 years, sometimes for invalidated reasons. In 2013, the French National Authority for Health (Haute autorité de santé, or HAS) limited the indications for serum 25OHD measurements to rickets/osteomalacia, older adults with recurrent falls, monitoring of kidney transplant in adults, and surgical treatment of obesity in adults. Our aim here was to note that other indications for serum 25OHD measurements are supported by previous literature and by a number of national and international recommendations, in particular the following: any situation of bone fragility, any chronic renal failure
Published: 2016

209. Distinguishing Between Cachexia, Sarcopenia and Protein Energy Wasting in End-Stage Renal Disease Patients on Dialysis

Author: Adrian Slee, Samuel Porter, Helen Noble, Alexander P. Maxwell, David S. Seres, Miles D. Witham, Ken Farrington, Joanne Reid, Kamyar Kalantar-Zadeh, Denis Fouque, and Andrew Davenport
Subjects: medicine.medical_specialty, education.field_of_study, business.industry, medicine.medical_treatment, Population, medicine.disease, musculoskeletal system, End stage renal disease, Cachexia, Malnutrition, Endocrinology, Weight loss, Sarcopenia, Internal medicine, medicine, medicine.symptom, Intensive care medicine, education, business, Wasting, Dialysis
Abstract: Patients with end-stage renal disease (ESRD) receiving dialysis can have altered nutritional status and body composition due to dietary restrictions, level of physical activity, co-morbidities, metabolic alterations and inflammation.1 As such, weight loss or wasting is common among this population with up to 75% of adults with ESRD undergoing maintenance dialysis displaying some evidence of wasting.2 There are several forms of loss of lean muscle mass or wasting in ESRD, including ‘protein energy wasting’, ‘cachexia’, and ‘age-related sarcopenia’ and these terms are often used interchangeably alongside ‘malnutrition’ in current care. Limited understanding of the differences between such terms is arguably a barrier to accurate recognition and management of these disorders in patients with ESRD. For instance, a recent European study of over 700 dietetic participants concluded that only 13% of health care professionals who could differentiate between malnutrition, starvation, cachexia and sarcopenia.3 Such knowledge is pertinent as for example, loss of muscle mass is a key feature in both sarcopenia and cachexia, but most patients with sarcopenia are not cachectic,4 as muscle wasting occurs with aging
Published: 2016

210. Protein-Bound Uremic Toxins from Gut Microbiota and Inflammatory Markers in Chronic Kidney Disease

Author: Denis Fouque, Lia S. Nakao, Natália A. Borges, Carla J. Dolenga, Amanda F. Barros, Denise Mafra, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Medicine (miscellaneous), Renal function, Inflammation, 030204 cardiovascular system & hematology, Gut flora, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Internal medicine, medicine, Humans, Renal Insufficiency, Chronic, Interleukin 6, Dialysis, Aged, Nutrition and Dietetics, biology, Interleukin-6, business.industry, Middle Aged, medicine.disease, biology.organism_classification, Gastrointestinal Microbiome, 3. Good health, Cross-Sectional Studies, Endocrinology, Nephrology, biology.protein, Female, Hemodialysis, medicine.symptom, Calprotectin, business, Kidney disease
Abstract: International audience; OBJECTIVE: Protein-bound uremic toxins from gut microbiota tend to accumulate in chronic kidney disease (CKD) patients and are poorly removed by current dialysis techniques. These toxins induce inflammation and are associated with cardiovascular disease (CVD). The aim of this study was to report the relationship between uremic toxins and inflammatory and cardiovascular markers in CKD patients. DESIGN: This was a cross sectional study. SUBJECTS: Twenty-one nondialysis patients were included (43% men, 63.0 +/- 7.8 years, glomerular filtration rate: 34.4 +/- 12.5 mL/min) as well as 29 hemodialysis (HD) patients [58% men, 52.7 +/- 10.3 years, time on dialysis 54 (31-94.5 months)]. MAIN OUTCOME MEASURE: Total levels of uremic toxins (IS, p-CS, and IAA) were assessed by high-performance liquid chromatography with fluorescence detection. C-reactive protein, Interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and calprotectin plasma levels were determined by immunometric assays. RESULTS: HD patients presented higher inflammatory markers and uremic toxins levels than nondialysis patients. IL-6 levels were positively correlated with IS (r = 0.49; P = .03), p-CS (r = 0.35; P = .04) and IAA (r = 0.36; P = .03). A positive correlation was also observed between MCP-1 levels with IS (r = 0.72; P = .001), p-CS (r = 0.48; P = .001) and IAA (r = 0.75; P = .0001). Linear regression showed that IS was an independent predictor for IL-6 and MCP-1 levels after adjustment. CONCLUSION: Plasma uremic toxins were associated with higher IL-6 and MCP-1 levels in CKD patients, potentially playing a role in the development of CVD.
Published: 2016

211. Évaluation de la prévalence des prescriptions médicamenteuses non adaptées à la fonction rénale selon la prise en compte de la surface corporelle pour estimer le DFG

Author: Sophie Liabeuf, Ziad A. Massy, B. Stengel, L. Frimat, Solène M. Laville, Denis Fouque, Marie Metzger, Christian Jacquelinet, C. Combe, and Maurice Laville
Subjects: Nephrology
Abstract: Introduction Adapter les doses de medicaments au debit de filtration glomerulaire estime (DFGe) par equation est difficile, notamment chez les personnes obeses. Nous avons evalue la prevalence de prescriptions non adaptees chez des patients atteints de maladie renale chronique (MRC), en estimant le DFG par l’equation CKD-EPI, indexee ou non a la surface corporelle (SC). Patients/Materiels et methodes Dans une cohorte incluant 3033 patients suivis en nephrologie pour une MRC avec un DFGe entre 15 et 60 mL/min/1,73 m2, nous avons examine les doses journalieres de principe actif prescrites dans les 3 mois precedant l’inclusion dans l’etude. Une prescription non adaptee a la fonction renale (fondee sur les recommandations des resumes des caracteristiques des produits) a ete definie comme la prescription declaree d’un medicament contre-indique ou a une dose trop elevee pour le DFGe du patient. Observation/Resultats L’âge median [ecart interquartile] des patients etait de 69 [61–76] ans ; 66 % etaient des hommes, 43 % avaient un diabete et 36 %, un indice de masse corporelle ≥ 30 kg/m2. La SC moyenne etait de 1,90 ± 0,22 m2. Le DFGe moyen etait respectivement de 33 mL/min/1,73 m2 et 36 mL/min, selon que l’equation etait indexee ou non a la SC. Le nombre median de medicaments prescrits etait de 8 [5–10] par jour. La proportion de patients avec au moins une prescription non adaptee au DFGe etait de 52 % avec, et de 47 % sans indexation a la SC. Les hypouricemiants, les antidiabetiques et les medicaments a visee cardiovasculaire etaient les principales classes de medicaments incriminees. Les patients diabetiques avaient avec une SC moyenne de 1,97 ± 0,21 m2 et un DFGe moyen, respectivement, de 33 mL/min/1,73 m2 et 37 mL/min avec et sans indexation a la SC. En consequence, chez les 273 patients sous metformine (seule ou en association), la prescription etait apparemment contre-indiquee chez 53 patients (19 %) avec un DFGe indexe a la SC Discussion/Conclusion La prevalence globale des prescriptions non adaptees a la fonction renale touche pres d’un patient sur deux avec une MRC moderee ou avancee. La prise en compte de la SC pour estimer le DFG induit des variations dans l’evaluation de cette prevalence qui sont d’autant plus importantes que la SC moyenne s’ecarte de la valeur standard de 1,73 m2. Il reste cependant a determiner si la desindexation de l’equation CKD-EPI modifie l’estimation de l’effet de ces prescriptions apparemment non adaptees sur les risques d’evenements iatrogenes, d’hospitalisations et de mortalite.
Published: 2018

212. Une biopsie osseuse (BO) de 4 mm de diamètre est-elle aussi performante qu’une BO de 7,5 mm de diamètre pour le diagnostic de l’ostéodystrophie rénale (ODR) ?

Author: E. Novel, Roland Chapurlat, M.H. Lafage Proust, Solenne Pelletier, Jean-Paul Roux, and Denis Fouque
Subjects: 03 medical and health sciences, 0302 clinical medicine, Nephrology, 030232 urology & nephrology, 030204 cardiovascular system & hematology
Abstract: Introduction La biopsie osseuse (BO) transiliaque reste le gold standard pour le diagnostic des troubles mineraux et osseux de la maladie renale chronique (TMO-MRC). Ce geste realise avec le trocart de Meunier de 7,5 mm de diametre interne est invasif et peu pratique actuellement, et tend a etre realise avec des trocarts de plus petit calibres type Jamshidi jetable (4 mm de diametre interne) [1] . Cependant cette methode n’a jamais ete evaluee. L’objectif de notre etude est de valider la reproductibilite du diagnostic des lesions d’osteodystrophie renale sur des biopsies de petit calibre. Patients/materiels et methodes Cinquante et une biopsies osseuses transiliaques completes de 8 mm de diametre de notre registre realisees dans l’indication TMO-MRC ont ete incluses dans l’etude. Chaque coupe montee sur une lame a ete orientee (haut/bas) puis divisee en deux parties egales dans le sens de la longueur. Une analyse histomorphometrique de chaque hemi-biopsie a ensuite ete realisee en aveugle de l’analyse de l’autre hemi-biopsie et de l’analyse initiale de la piece complete. Les parametres volume osseux, de formation osseuse, et de mineralisation osseuse ont ete mesures. La correlation de chaque parametre a ete etudiee grâce a un test de Pearson. La concordance des diagnostics finaux en termes de turnover osseux estimee par le Bone Formation Rate (BFR) a ete verifiee. Resultats Cinquante et une BO completes separees en 102 hemi-biopsies ont ete analysees. Le diagnostic initial etait une hyperparathyroidie secondaire dans 83 % des cas. La correlation entre hemi-biopsie superieure et inferieure etait excellente pour les parametres de volume osseux (BV/TV, n = 51, r = 0,94 [0,91–0,96], p Conclusion Une biopsie osseuse de taille reduite (4 mm de diametre interne) permet une reproductibilite satisfaisante du diagnostic d’ODR au prix d’une moindre invasivite.
Published: 2018

213. Une glomérulonéphrite extramembraneuse révélatrice d’un syndrome d’hyper-IgG4

Author: M. Nouvier, Denis Fouque, G. Wehrlen, A. Deeb, and A. Bouchara
Subjects: Nephrology
Abstract: Introduction Le syndrome d’hyper-IgG4 designe une maladie systemique classiquement caracterisee en histologie par des infiltrats inflammatoires avec predominance de plasmocytes IgG4+ et un taux eleve d’IgG4 seriques. Les principaux organes atteints sont le pancreas, le foie et la thyroide. L’atteinte renale caracteristique est une nephrite tubulo-interstitielle avec une fibrose importante. Cependant, des cas d’atteintes glomerulaires sont egalement rapportes dans la litterature. Observation Nous rapportons le cas d’un patient de 77 ans presentant un syndrome nephrotique avec une fonction renale conservee, s’inscrivant dans un tableau d’alteration de l’etat general depuis 4 mois, associe a une insuffisance pancreatique exocrine responsable d’un amaigrissement de 18 kg, des adenopathies profondes sus-diaphragmatiques et une cholestase anicterique. La ponction biopsie renale retrouve une glomerulonephrite extramembraneuse (GEM) avec depots diffus et globaux d’IgG2 et d’IgG4. Les anticorps anti-PLA2R seriques sont negatifs. Le dosage des IgG4 seriques est de 1,39 g/L. Nous retenons le diagnostic de GEM secondaire a un syndrome d’hyper-IgG4, associee a une pancreatite auto-immune et une cholangite sclerosante. Nous debutons une corticotherapie permettant une amelioration rapide clinique et biologique du patient. Conclusion Quelques cas de GEM secondaires a un syndrome d’hyper-IgG4 ont ete rapportes dans la litterature. Il est important d’evoquer ce diagnostic devant une GEM secondaire lorsque le tableau clinique associe d’autres atteintes d’organes car le pronostic de cette maladie est excellent apres corticotherapie, surtout quand la prise en charge est precoce.
Published: 2018

214. Colique néphrétique secondaire à un calcul composé de chaînes légères d’immunoglobuline : une présentation atypique d’atteinte rénale du myélome

Author: P. Rousset, A. Bouchet, A. Lazareth, M. Nouvier, C. Lombard, Denis Fouque, Vincent Javaugue, and C. Teuma
Subjects: Nephrology
Abstract: Introduction Nous rapportons le premier cas de calcul renal proteique constitue de chaines legeres libres (CLL) Kappa, ayant revele un myelome multiple (MM). Patients/materiels et methodes/Observation Un patient de 74 ans est hospitalise pour une crise de colique nephretique et une insuffisance renale aigue (IRA) grade 3, persistante apres expulsion du calcul. Il presente une proteinurie de Bence Jones Kappa estimee a 1,6 g/24 h, une anemie et une hypogammaglobulinemie sans pic monoclonal. Les CLL seriques Kappa sont elevees a 2560 mg/L. Le myelogramme confirme le diagnostic de MM. L’analyse par spectrophotometrie infrarouge a identifie un calcul constitue entierement de proteines. L’etude par electrophorese et immunofixation a confirme qu’il s’agit de CLL Kappa. Le sequencage de cette chaine legere, realise apres extraction de l’ARN d’un prelevement de moelle osseuse, a montre plusieurs caracteristiques moleculaires proches des chaines legeres decrites au cours du syndrome de Fanconi. Elle appartient au sous-groupe de variabilite VK1-33 et presente des mutations responsables d’une modification de sa polarite pouvant potentiellement expliquer sa forte capacite de cristallisation. Un traitement par hydratation alcaline, corticotherapie puis chimiotherapie par bortezomib, cyclophosphamide et dexamethasone a permis une remission hematologique et une recuperation de la fonction renale partielles, sans recidive de colique nephretique. Discussion L’IRA est un mode de revelation frequent du MM, par atteinte tubulaire, glomerulaire ou secondaire a l’hypercalcemie et aux lithiases calciques associees. Les tubulopathies proximales par cristallisation immunoglobulinique sont favorisees par des mutations du domaine variable de la CLL Kappa, egalement retrouve chez notre patient. Conclusion Il s’agit du premier calcul proteique urinaire forme de CLL Kappa menant au diagnostic de MM.
Published: 2018

215. P270 Aminoglycoside exposure and renal function before lung transplantation in adult cystic fibrosis patients

Author: R. Nove Josserand, Isabelle Durieu, Stéphane Durupt, Denis Fouque, E. Novel Catin, Solenne Pelletier, Laurence Dubourg, and Quitterie Reynaud
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, medicine.medical_treatment, Aminoglycoside, Renal function, medicine.disease, Cystic fibrosis, Gastroenterology, Internal medicine, Pediatrics, Perinatology and Child Health, medicine, Lung transplantation, business
Published: 2018

216. SP660HIGH-VOLUME ON-LINE HEMODIAFILTRATION MAY PREVENT PROTEIN-ENERGY WASTING IN HEMODIALYSIS PATIENTS: A 1-YEAR PROSPECTIVE CONTROLLED STUDY

Author: Antonio Mora, Cristina Castro-Alonso, José Luis Górriz, Mercedes González-Moya, Luis M Pallardó, Ana Ávila, Mariola D Molina, Sandra Beltrán, Denis Fouque, Pablo Molina, Julia Kanter, J. J. Carrero, Nuria Estañ, and Belén Vizcaíno
Subjects: Transplantation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Urology, Protein energy wasting, medicine.disease, Cachexia, Volume (thermodynamics), Nephrology, On line hemodiafiltration, medicine, Hemodialysis, business
Published: 2018

217. FO047REAL-WORLD EFFECTIVENESS OF SUCROFERRIC OXYHYDROXIDE FOR SERUM PHOSPHORUS CONTROL IN DIALYSIS PATIENTS: AN INTERIM SUBGROUP ANALYSIS OF THE VERIFIE STUDY

Author: Marc G. Vervloet, Denis Fouque, Philip A. Kalra, Anja Derlet, Piergiorgio Messa, Markus Ketteler, Viatcheslav Rakov, Jacques Rottembourg, Jorge B. Cannata-Andía, Christoph Wanner, Amandine Perrin, Linda H. Ficociello, Sebastian Walpen, Ioannis Boletis, Manuela Stauss-Grabo, and Angel L.M. de Francisco
Subjects: Transplantation, medicine.medical_specialty, business.industry, Phosphorus, chemistry.chemical_element, Subgroup analysis, Dialysis patients, Gastroenterology, chemistry, Nephrology, Internal medicine, Interim, Medicine, Serum phosphorus, business
Published: 2018

218. Premier cas de fièvre hémorragique avec syndrome rénal causé par le virus Dobrava–Belgrade en France

Author: J.M. Reynes, M.E. Langlois, A. Deeb, M. Rabeyrin, J.C. Lega, E. Bres, Denis Fouque, and M. Antoine
Subjects: Nephrology
Abstract: Introduction Trois especes d’Hantavirus sont observees en France : les virus Puumala, Seoul et Toula. En moyenne 100 cas sont recenses chaque annee principalement dus au virus Puumala. Nous rapportons le cas d’un patient bulgare presentant une insuffisance renale aigue rapidement progressive causee par le virus Dobrava–Belgrade (DOBV). Methodes Homme de 48 ans, plombier, expose aux canalisations d’eaux usees et ayant voyage en Bulgarie un mois auparavant presente une hyperthermie associee a des douleurs abdominales diffuses, nausees et vomissements. Le bilan biologique montre une cytolyse hepatique a trois fois la normale sans cholestase. Il n’y a pas de syndrome inflammatoire biologique. Il existe une thrombopenie associee a une anemie regenerative sans hemolyse. L’evolution est marquee par une insuffisance renale aigue avec augmentation rapide de la creatinine de 51 μmol/l a 680 μmol/l en trois jours. Il existe une proteinurie massive a 16 g/24 h et une hematurie extra-glomerulaire. Il n’y a pas de stigmates d’auto-immunite. Les bilans virologique et bacteriologique sont negatifs. Une biopsie renale est rapidement realisee. L’aspect macroscopiquement de la medulla etait hemorragique. L’histologie renale montre une nephrite interstitielle hemorragique aigue. Il existe une phase oligurique de 5 jours suivie d’un episode polyurique. L’evolution est favorable sans necessiter de dialyse. La serologie evoque une infection par le virus Seoul. Cependant la nested RT-PCR est positive a une souche du DOBV. Conclusion Il s’agit du 1er cas d’infection par le virus DOBV rapporte en France. Des enquetes epidemiologiques et virologiques sont en cours pour confirmer l’importation du virus de Bulgarie ou son caractere autochtone (le rongeur Apodemus flavicollis, l’un des reservoirs du virus, est signale dans la region Lyonnaise). L’aspect macroscopique hemorragique de la biopsie renale est caracteristique de cette infection et doit faire suggerer le diagnostic d’infection a Hantavirus au moment de la biopsie. Ce diagnostic reste un challenge.
Published: 2019

219. Un régime appauvri en acides aminés aromatiques freine la progression de l’insuffisance rénale chronique chez la souris

Author: Christophe Barba, Griet Glorieux, Laetitia Koppe, Denis Fouque, Christophe O. Soulage, and Cécile Picard
Subjects: Nephrology
Abstract: Introduction L’interet des regimes pauvres en proteines au cours de la maladie renale chronique (MRC) est toujours discute car leur action reste mal comprise. Une diminution de la production de toxines uremiques pourrait expliquer le benefice de ces regimes. Les acides amines aromatiques etant les precurseurs de nombreuses toxines uremiques telles que le p-cresyl sulfate (PCS) et l’indoxyl-sulfate (IS), nous avons teste si un regime normoproteique mais appauvri en acides amines aromatiques (tyrosine, tryptophane, phenylalanine) pourrait s’averer aussi efficace qu’un regime pauvre en proteines, en limitant la production des toxines uremiques. Methodes La MRC a ete induite chez des souris C57Bl/6 JRj par nephrectomie chimique via un regime adenine (0,25 %, 4 semaines). Elles ont ensuite recu 3 differents regimes sur une periode de 6 semaines. Regime standard (normoproteique, NPD : 14,7 % de proteines, AA aromatiques 0,019 %), regime pauvre en proteine (LPD, proteines 5 %, AA aromatiques 0,007 %) ou regime pauvre en acides amines aromatiques (LAA : proteines 14 %, AA aromatiques 0,007 %). Resultats obtenus ou attendus La creatininemie etait significativement plus basse dans le groupe LPD et LAA que dans le groupe NPD (71,6 ± 4,2 et 73 ± 3,8 μmol/L vs. 127 ± 6,3 μmol/L, p Conclusion Un regime normoproteique appauvri en acides amines aromatiques est aussi nephroprotecteur qu’un regime pauvre en proteines au cours de la maladie renale chronique, sans exposer au risque de denutrition.
Published: 2019

220. La néphroprotection en médecine générale : pratiques médicales et limites

Author: J. Fernoux, A. Deeb, and Denis Fouque
Subjects: Nephrology
Abstract: Introduction La maladie renale chronique (MRC) est une pathologie chronique frequente aux enjeux humains et economiques importants. La nephroprotection vise a retarder son evolution et a en eviter les aggravations aigues. L’objectif de notre etude etait de determiner les pratiques de nephroprotection menees en ambulatoire par les medecins generalistes (MG) aupres de leurs patients porteurs d’une MRC stade 3. Methodes Nous avons mene une etude epidemiologique prospective observationnelle aupres de 374 maitres de stage universitaire (MSU) appartenant aux UFR de medecine de Lyon. Un questionnaire en ligne, prealablement construit et teste, a ete diffuse par mail par le college de medecine generale. Resultats obtenus ou attendus Cent quatre MSU ont repondu a l’etude menee en fin d’annee 2017. L’estimation du risque cardiovasculaire et la prise en charge medicamenteuse de la pression arterielle des patients porteurs d’une MRC stade 3 etaient bien effectuees par respectivement 76 % et 69 % des MG ; 94 % etaient soucieux de la fonction renale du patient au moment de leurs prescriptions. Cependant seulement 33 % des MG utilisaient les recommandations 2012 de la HAS (Haute Autorite de sante) ; 36 % effectuaient une prevention dietetique adaptee et 27 % adressaient leurs patients chez un(e) dieteticien(ne). La surveillance biologique n’etait pas optimale et la iatrogenie medicamenteuse etait sous-estimee. Les limites mises en evidence et pouvant expliquer ces defauts de prevention etaient : un manque de sensibilisation sur le sujet de la MRC, des difficultes de coordination et de communication entre professionnels de sante en situation de suivi et d’urgence, des contraintes liees a la consultation elle-meme (manque de temps ou de cooperation du patient). Conclusion La nephroprotection menee en medecine generale aupres des patients porteurs d’une MRC stade 3 n’est pas optimale et majoritairement non menee selon les recommandations HAS. Une sensibilisation des MG et le developpement de parcours de soins ambulatoires dedies semblent necessaires.
Published: 2019

221. The Effect of Sevelamer on Serum Levels of Gut-Derived Uremic Toxins: Results from In Vitro Experiments and A Multicenter, Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Author: Sandra Bodeau, Bertrand Dussol, Sophie Liabeuf, Dimitri Titeca-Beauport, Christian Combe, Najeh El Esper, Gabriel Choukroun, Pablo Ureña, Youssef Bennis, Denis Fouque, Yan Cluet, DIPI (DIPI), ENISE, Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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), CHU Amiens-Picardie, Institut de Neurosciences de la Timone (INT), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Diagnostics et imageries des procédés industriels (ENISE-DIPI), Ecole Nationale d'Ingénieurs de Saint Etienne (ENISE), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre recherche en CardioVasculaire et Nutrition (C2VN), 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 Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)
Subjects: Male, [SDV]Life Sciences [q-bio], Health, Toxicology and Mutagenesis, medicine.medical_treatment, uremic toxins, 030232 urology & nephrology, lcsh:Medicine, Sulfuric Acid Esters, Pharmacology, Toxicology, medicine.disease_cause, Sevelamer, Placebo, Article, Cresols, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Double-Blind Method, medicine, Humans, Chelation, Renal Insufficiency, Chronic, sevelamer, Saline, Aged, Chelating Agents, Toxins, Biological, Uremia, 030304 developmental biology, 0303 health sciences, Indoleacetic Acids, Toxin, Chemistry, lcsh:R, Middle Aged, Phosphate, medicine.disease, 3. Good health, Gastrointestinal Tract, Carbonate, Female, Adsorption, Indican, Kidney disease, medicine.drug
Abstract: High serum levels of gut-derived uremic toxins, especially p-cresyl sulfate (pCS), indoxyl sulfate (IS) and indole acetic acid (IAA), have been linked to adverse outcomes in patients with chronic kidney disease (CKD). Sevelamer carbonate could represent an interesting option to limit the elevation of gut-derived uremic toxins. The aim of the present study was to evaluate the adsorptive effect of sevelamer carbonate on different gut-derived protein-bound uremic toxins or their precursors in vitro, and its impact on the serum levels of pCS, IS and IAA in patients with CKD stage 3b/4. For the in vitro experiments, IAA, p-cresol (precursor of pCS) and indole (precursor of IS), each at a final concentration of 1 or 10 &micro, g/mL, were incubated in centrifugal 30 kDa filter devices with 3 or 15 mg/mL sevelamer carbonate in phosphate-buffered saline at a pH adjusted to 6 or 8. Then, samples were centrifuged and free uremic toxins in the filtrates were analyzed. As a control experiment, the adsorption of phosphate was also evaluated. Additionally, patients with stage 3b/4 CKD (defined as an eGFR between 15 and 45 mL/min per 1.73 m2) were included in a multicenter, double-blind, placebo-controlled, randomized clinical trial. The participants received either placebo or sevelamer carbonate (4.8 g) three times a day for 12 weeks. The concentrations of the toxins and their precursors were measured using a validated high-performance liquid chromatography method with a diode array detector. In vitro, regardless of the pH and concentration tested, sevelamer carbonate did not show adsorption of indole and p-cresol. Conversely, with 10 &micro, g/mL IAA, use of a high concentration of sevelamer carbonate (15 mg/mL) resulted in a significant toxin adsorption both at pH 8 (mean reduction: 26.3 &plusmn, 3.4%) and pH 6 (mean reduction: 38.7 &plusmn, 1.7%). In patients with CKD stage 3b/4, a 12-week course of treatment with sevelamer carbonate was not associated with significant decreases in serum pCS, IS and IAA levels (median difference to baseline levels: &minus, 0.12, 0.26 and &minus, 0.06 &micro, g/mL in the sevelamer group vs. 1.97, 0.38 and 0.05 &micro, g/mL in the placebo group, respectively). Finally, in vitro, sevelamer carbonate was capable of chelating a gut-derived uremic toxin IAA but not p-cresol and indole, the precursors of pCS and IS in the gut. In a well-designed clinical study of patients with stage 3b/4 CKD, a 12-week course of treatment with sevelamer carbonate was not associated with significant changes in the serum concentrations of pCS, IS and IAA.
Published: 2019

222. SGLT-2 inhibitors and GLP-1 receptor agonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease

Author: Enrique Morales, Jose M. Valdivielso, Esteban Porrini, Khaled Khazim, Robert Ekart, Pantelis Sarafidis, Jolanta Malyszko, Andrzej Wiecek, Petro Ruggenenti, Radovan Hojs, Alberto Ortiz, Mads Hornum, Gérard M. London, Francesca Mallamaci, Denis Fouque, Carmine Zoccali, Ziad A. Massy, and Charles J. Ferro
Subjects: Cardioprotection, Transplantation, Nephrology, business.industry, Diabetes mellitus, medicine, In patient, Pharmacology, medicine.disease, business, Glucagon-like peptide 1 receptor, Kidney disease
Published: 2019

223. Ectopic lipid accumulation: A potential cause for metabolic disturbances and a contributor to the alteration of kidney function

Author: Pascaline M. Alix, Christophe O. Soulage, Fitsum Guebre-Egziabher, Emilie Kalbacher, Denis Fouque, Caroline C. Pelletier, and Laetitia Koppe
Subjects: Aging, medicine.medical_specialty, Lipodystrophy, Context (language use), Type 2 diabetes, Biology, Kidney, Biochemistry, Diglycerides, Diabetic nephropathy, Insulin resistance, Internal medicine, medicine, Humans, Insulin, Obesity, Renal Insufficiency, Chronic, Fatty Acids, General Medicine, Lipid Metabolism, medicine.disease, Endocrinology, Diabetes Mellitus, Type 2, Lipotoxicity, Insulin Resistance, Metabolic syndrome, Kidney disease
Abstract: Ectopic lipid accumulation is now known to be a mechanism that contributes to organ injury in the context of metabolic diseases. In muscle and liver, accumulation of lipids impairs insulin signaling. This hypothesis accounts for the mechanism of insulin resistance in obesity, type 2 diabetes, aging and lipodystrophy. Increasing data suggest that lipid accumulation in the kidneys could also contribute to the alteration of kidney function in the context of metabolic syndrome and obesity. Furthermore and more unexpectedly, animal models of kidney disease exhibit a decreased adiposity and ectopic lipid redistribution suggesting that kidney disease may be a state of lipodystrophy. However, whether this abnormal lipid partitioning during chronic kidney disease (CKD) may have any functional impact in these tissues needs to be investigated. Here, we provide a perspective by defining the problem and analyzing the possible causes and consequences. Further human studies are required to strengthen these observations, and provide novel therapeutic approaches.
Published: 2013

224. Complications métaboliques en insuffisance rénale chronique : hyperphosphatémie, hyperkaliémie et anémie

Author: Thierry Hannedouche, Dominique Joly, and Denis Fouque
Subjects: Nephrology, medicine.medical_specialty, Hyperkalemia, business.industry, Anemia, medicine.medical_treatment, 030232 urology & nephrology, Renal function, Iron deficiency, 030204 cardiovascular system & hematology, urologic and male genital diseases, medicine.disease, Gastroenterology, 03 medical and health sciences, Hyperphosphatemia, 0302 clinical medicine, Internal medicine, medicine, medicine.symptom, business, Dialysis, Kidney disease
Abstract: Metabolic complications of chronic kidney disease (CKD) are frequent; the aims of this review are to present a 2018 update for hyperkalemia, hyperphosphatemia and anemia. Hyperkalemia is defined by a plasma level above 5.0 mmol/L, after ruling out pre-analytical problems such as hemolysis. It is frequent in CKD, most often due to drugs and notably renin/ angiotensin blockers. Chronic hyperkalemia is deleterious, with an increased risk of mortality. Therapeutic strategies to decrease the incidence and severity of hyperkalemia are therefore crucial in nephrology: experts recommend to maintain the renin/angiotensin blockers as long as possible, whilst associating diuretics and potassium binders. There are apparent discrepancies between optimal protein intake and decreased phosphate intake in CKD; this is even more important in dialysis since protein decrease is associated with denutrition and subsequent increased risk of mortality. Nutritional phosphate intake from vegetables are less absorbed; in contrast, phosphate additives are almost completely absorbed in the gastro-intestinal tract. These "hidden" intake may increase the total daily phosphate intake by 1 000 mg. As such in addition to optimized dialysis, phosphate binders should be used but compliance may be challenging on the long-term. Educational programs focused on phosphate are also mandatory in CKD patients. "Absolute" iron deficiency is less frequent than "functional" iron deficiency in CKD patients: both require the use of iron supplementation, and the latter may benefit from additional erythropoietin stimulating agents (ESA) when hemoglobin is below 10 g/dL. Intravenous iron is more efficient to correct iron deficiency both in pre-dialysis and dialysis especially in patients with chronic deficiency. Last generation intravenous preparations have largely demonstrated their safety. One indication of iron supplementation one should not forget in nephrology is the patient with moderate CKD and heart failure since the expected benefits are multiple, notably in terms of quality of life, renal function and functional capacity. Cet article fait partie du numero supplement Innovations en Nephrologie realise avec le soutien institutionnel de Vifor Fresenius Medical Care Renal Pharma.
Published: 2018

225. Évolution de l’alimentation du paléolithique à nos jours : progression ou régression ?

Author: Michel Aparicio, Philippe Chauveau, Christian Combe, and Denis Fouque
Subjects: Value (ethics), Gerontology, High prevalence, Feeding behavior, History, Nephrology, medicine, Paleolithic diet, Comparative historical research, Nutrition research, medicine.disease_cause, Eating habits, Decreased Physical Activity
Abstract: The changes in eating habits and decreased physical activity have been responsible for part of the high prevalence of chronic diseases such as hypertension or diabetes, currently observed in the so-called civilized societies. These diseases are less prevalent in previous civilizations and several decades of nutrition research have enabled better understanding of the eating habits of our ancestors, and have demonstrated the value of diet called "Mediterranean or Paleolithic". This review provides an update on the latest research. What dietary changes since the Paleolithic period, and finally how can we adapt our current diet? Several animal studies or human clinical demonstrate the value of historical research and nutrition.
Published: 2013

226. Clinical nephrology - IgA nephropathy, lupus nephritis, vasculitis

Author: Piero Stratta, David Jayne, Fabio Sallustio, Alina Casian, Jingyuan Xie, Cristiane B. Dias, Serena Simeone, John Feehally, Hong Ren, Patrícia Cotovio, Derya Özmen, Byung Yoon Yang, Harin Rhee, Xiangmei Chen, Rosanna Coppo, Rachel B Jones, Jean Pierre Fauvel, Derya Guler, Hee Yeon Jung, Grazia Serino, Isao Ohsawa, George Efstratiadis, Claire Kennedy, Afroditi Pantzaki, Claudia Yuste, I. De Simone, Jadwiga Małdyk, Michael R. Clarkson, G. B. Visciano, Wenhu Liu, Krzysztof Kiryluk, Shubha Bellur, Beata Bienias, Jing Xu, Carlos Botelho, Özlem Yilmaz, Yuansheng Xie, François Berthoux, Rui Toledo Barros, Ali G. Gharavi, Emilie Kalbacher, Manuel Praga, Wenge Li, Shuwei Duan, Christos Bantis, Chunhua Zhou, Soo Bong Lee, Ligia C. Battaini, F. Ferrario, Noshaba Naz, George Toulkeridis, Cristina Silva, Stratis Kasimatis, Ying Zheng, Kyung Hoon Kim, Owen Kwon, Dóra Bajcsi, Weiming Wang, Viktoria Woronik, Pedro Maia, György Ábrahám, Kálmán Polner, Denis Fouque, Katarzyna Gadomska-Prokop, Yoshio Shimizu, Chan-Duck Kim, Federico Mecacci, Brigitte MacGregor, Sun-Hee Park, Dong Won Lee, Karina Lopes, Shanmai Guo, Rona M Smith, Aikaterini Papagianni, Leticia Jorge, Xiaoxia Pan, Guangyan Cai, Roman Stankiewicz, Il Young Kim, Yavuz Doǧan, Cristina Izzo, Ian Roberts, Hesham Mohey, A. Pani, Zhi-Qiang Huang, Jan Novak, Benedek Ronaszeki, Anindya Banerjee, Mark Canney, Haner Direskeneli, Lide Lun, Michel Ducher, Hakki Arikan, G. Fogazzi, Rui Toledo-Barros, Francesco Paolo Schena, Norella C T Kong, Armando Carreira, Denise Malheiro, Cristina Jironda, Yasuhiko Tomino, Anna Wasilewska, Xuemei Li, Francois Combarnous, Yong-Xi Chen, Myrthes Toledo-Barros, Halim Abdul Gafor, Philip H. Bredin, Ekaterina S Stolyarevich, Bruce A. Julian, Elena Romoli, Eun Young Seong, Jianrong Zhang, Salih Kavukçu, Ryszard Grenda, V. Terraneo, Maria Roszkowska-Blaim, Jie Wu, Koshi Yamada, Maria Júlia Correia Lima Nepomuceno Araújo, Colin Reily, Péter Légrády, Hitoshi Suzuki, Małgorzata Mizerska-Wasiak, Peter A. Merkel, Ihm Soo Kwak, Arzu Velioglu, Serdar Nalcaci, Nan Chen, Elisa Lazzarich, Yusuke Suzuki, Ga Young Park, Giorgio Mello, C. Sarcina, Shamsul Azhar Shah, Elena Zakharova, Sabah Mohamed Alharazy, Roberta Camilla, Satoshi Horikoshi, Marlyn Mohammad, Jin Lee, Yaping Wang, Cristiane Bitencourt Dias, Mehmet Koc, Lectícia Barbosa Jorge, Gurdal Birdal, Mário Campos, Terence Cook, Francisco Ferrer, C. Pozzi, F. Rastelli, Maria Skoularopoulou, Calogero Cirami, Francesco Pesce, Alfons Segarra, Agnieszka Rybi-Szumińska, Pingyan Shen, Luca Vergano, Cetin Ozener, Mrityunjay Hiremath, Jang-Hee Cho, Zsolt Balla, Roberta Fenoglio, Shuwen Liu, Maria Stangou, Hiyori Suzuki, Mamiko Shimamoto, Yeşim Öztürk, Serhan Tuglular, Elisabetta Radin, Małgorzata Zajaczkowska, Liam Plant, Enrico Eugenio Minetti, Rivera F, Marco Quaglia, Zhao-Hui Wang, Stéphan Troyanov, Arbaiyah Bain, Daniel C. Cattran, Yaser Shah, Ya Li, Blandine Laurent, Christophe Mariat, Maria Guedes Marques, Wen Zhang, Béla Iványi, Sharon Cox, Alper Soylu, Min Ji Shin, Laura Morando, Yong-Lim Kim, Xiaoyan Zhang, Seiji Nagamachi, Vivian L. Onusic, Michelle Lewin, Zoltán Rakonczay, Andrea Airoldi, Agnieszka Firszt-Adamczyk, Pamela Gallo, Zina Moldoveanu, Ágnes Haris, Milan Raska, Ji-Young Choi, and Sandor Sonkodi
Subjects: Transplantation, medicine.medical_specialty, Nephrology, business.industry, medicine, Lupus nephritis, Clinical nephrology, medicine.disease, Vasculitis, business, Dermatology, Nephropathy
Published: 2013

227. Acute Renal Infarction

Author: Eric Daugas, Jean-Jacques Boffa, Hassan Izzedine, Vincent Audard, Pauline Bernadet-Monrozies, Marie Bourgault, Zahir Amoura, Jacques Pourrat, Florence Canoui-Poitrine, Noémie Jourde-Chiche, Aurélie Hummel, Catherine Verret, Michel Hérody, Philippe Grimbert, Philippe Lang, Denis Fouque, Jean-Michel Halimi, Alexandre Karras, and Hélène François
Subjects: Male, Abdominal pain, Time Factors, Epidemiology, medicine.medical_treatment, Infarction, Kidney, Critical Care and Intensive Care Medicine, Risk Factors, Thrombophilia, Aged, 80 and over, biology, Age Factors, Middle Aged, Prognosis, C-Reactive Protein, medicine.anatomical_structure, Nephrology, Hypertension, Cardiology, Female, Kidney Diseases, France, Hemodialysis, medicine.symptom, Adult, medicine.medical_specialty, Heart Diseases, Flank Pain, Risk Assessment, Sex Factors, Renal Dialysis, Internal medicine, medicine, Humans, Blood Coagulation, Aged, Retrospective Studies, Transplantation, Chi-Square Distribution, L-Lactate Dehydrogenase, business.industry, C-reactive protein, Retrospective cohort study, Original Articles, medicine.disease, Abdominal Pain, Surgery, Logistic Models, Relative risk, Multivariate Analysis, biology.protein, business, Biomarkers
Abstract: Summary Background and objectives Renal infarction is an arterial vascular event that may cause irreversible damage to kidney tissues. This study describes the clinical characteristics of patients with renal infarction according to underlying mechanism of vascular injury. Design, setting, participants, & measurements This study retrospectively identified 94 patients with renal infarction diagnosed between 1989 and 2011 with the aim of highlighting potential correlations between demographic, clinical, and biologic characteristics and the etiology of renal infarction. Four groups were identified: renal infarction of cardiac origin (cardiac group, n=23), renal infarction associated with renal artery injury (renal injury group, n=29), renal infarction associated with hypercoagulability disorders (hypercoagulable group, n=15), and apparently idiopathic renal infarction (idiopathic group, n=27). Results Clinical symptoms included abdominal and/or flank pain in 96.8% of cases; 46 patients had uncontrolled hypertension at diagnosis. Laboratory findings included increase of lactate dehydrogenase level (90.5%), increase in C-reactive protein level (77.6%), and renal impairment (40.4%). Compared with renal injury group patients, this study found that cardiac group patients were older (relative risk for 1 year increase=1.21, P=0.001) and displayed a lower diastolic BP (relative risk per 1 mmHg=0.94, P=0.05). Patients in the hypercoagulable group had a significantly lower diastolic BP (relative risk=0.86, P=0.005). Patients in the idiopathic group were older (relative risk=1.13, P=0.01) and less frequently men (relative risk=0.11, P=0.02). Seven patients required hemodialysis at the first evaluation, and zero patients died during the first 30 days. Conclusions This study suggests that the clinical and biologic characteristics of patients can provide valuable information about the causal mechanism involved in renal infarction occurrence.
Published: 2013

228. Comparison of a Bayesian Network with a Logistic Regression Model to Forecast IgA Nephropathy

Author: Michel Ducher, Jean Pierre Fauvel, Jérome Finaz de Vilaine, François Combarnous, Emilie Kalbacher, Denis Fouque, and Brigitte McGregor
Subjects: Adult, Male, Article Subject, Biopsy, lcsh:Medicine, Logistic regression, General Biochemistry, Genetics and Molecular Biology, Nephropathy, Bayes' theorem, Statistics, medicine, Humans, Aged, Mathematics, General Immunology and Microbiology, Receiver operating characteristic, lcsh:R, Bayesian network, Bayes Theorem, Glomerulonephritis, IGA, General Medicine, Middle Aged, Prognosis, medicine.disease, Immunoglobulin A, Clinical Practice, Logistic Models, ROC Curve, Clinical Study, Female, Neural Networks, Computer, Glomerulonephritis iga
Abstract: Models are increasingly used in clinical practice to improve the accuracy of diagnosis. The aim of our work was to compare a Bayesian network to logistic regression to forecast IgA nephropathy (IgAN) from simple clinical and biological criteria. Retrospectively, we pooled the results of all biopsies performed by nephrologists in a specialist clinical facility between 2002 and 2009. Two groups were constituted at random. The first subgroup was used to determine the parameters of the models adjusted to data by logistic regression or Bayesian network, and the second was used to compare the performances of the models using receiver operating characteristics (ROC) curves. IgAN was found (on pathology) in 44 patients. Areas under the ROC curves provided by both methods were highly significant but not different from each other. Based on the highest Youden indices, sensitivity reached (100% versus 67%) and specificity (73% versus 95%) using the Bayesian network and logistic regression, respectively. A Bayesian network is at least as efficient as logistic regression to estimate the probability of a patient suffering IgAN, using simple clinical and biological data obtained during consultation.
Published: 2013

229. Efficacité du cinacalcet en pratique clinique chez les patients dialysés présentant une hyperparathyroïdie secondaire : observatoire ECHO – Expérience française

Author: J.-C. Réglier, P. Ureña, P. Brunet, Denis Fouque, and M. Touam
Subjects: Gynecology, medicine.medical_specialty, Hyperparathyroidism, Cinacalcet, business.industry, medicine.disease, Sevelamer, Clinical Practice, Multicenter study, Nephrology, Medicine, Secondary hyperparathyroidism, business, medicine.drug
Abstract: Resume Chez les patients presentant une hyperparathyroidie secondaire (HPTS) a une insuffisance renale chronique, les concentrations seriques cibles recommandees K/DOQI™ d’hormone parathyroidienne (PTH), de calcium (Ca) et de phosphate (P) sont difficiles a atteindre et a maintenir. Nous presentons les resultats du groupe francais ayant participe a l’observatoire ECHO etudiant le cinacalcet en pratique courante. Methodes Etude observationnelle de la prise en charge de patients dialyses, presentant une HPTS, pour part retrospective, six mois avant l’introduction du cinacalcet et pour part prospective, pendant 12 mois de traitement par cinacalcet. Resultats Quarante-quatre centres ont inclus 485 patients. Le cinacalcet a ete associe au traitement par vitamine D active (39 %) et par chelateurs du phosphate (87 %). Apres 12 mois de traitement, la proportion de patients atteignant les cibles recommandees K/DOQI™ est passee de 2,5 % a 28,8 % pour la PTH, de 46,8 % a 50,1 % pour le Ca, de 40,0 % a 49,9 % pour le P et de 54,8 % a 77,7 % pour le produit CaxP. La proportion de patients recevant de la vitamine D active a diminue de 6 % et celle de patients traites par sevelamer de 20 %. Des evenements indesirables ont ete rapportes chez 37 (7,6 %) patients principalement a type de nausees (2,1 %), vomissements (2,1 %) et dyspepsies (1,2 %). Conclusions Les resultats observes sont comparables en termes d’efficacite aux donnees issues des etudes controlees, randomisees. Dans la pratique courante, le traitement de l’HPTS par cinacalcet augmente la proportion de patients atteignant les cibles recommandees K/DOQI™ de PTH et des parametres phosphocalciques.
Published: 2012

230. Control of mineral metabolism and bone disease in haemodialysis patients: which optimal targets?

Author: Solenne Pelletier, Tilman B. Drüeke, Jean-Louis Bouchet, Gérard M. London, Hubert Roth, Thierry Hannedouche, Guillaume Jean, and Denis Fouque
Subjects: Male, medicine.medical_specialty, Bone disease, medicine.medical_treatment, chemistry.chemical_element, Guidelines as Topic, Calcium, Phosphates, Cohort Studies, Renal Dialysis, Internal medicine, medicine, Humans, Mineral metabolism, Chronic hemodialysis, Prospective Studies, Renal Insufficiency, Chronic, Aged, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, Transplantation, business.industry, Middle Aged, medicine.disease, Surgery, Clinical trial, chemistry, Parathyroid Hormone, Nephrology, Female, Observational study, France, Guideline Adherence, Hemodialysis, Bone Diseases, business, Kidney disease
Abstract: There is a high drug treatment burden on patients receiving long-term dialysis therapy. Abnormalities of calcium and phosphate metabolism are associated with increased mortality, and attempts to correct these disturbances may improve survival.We prospectively evaluated the targets of the currently used Kidney Disease: Improving Global Outcomes (KDIGO) guidelines in 8377 prevalent patients receiving intermittent haemodialysis therapy in France from July 2007 to December 2009.Adjusted Cox analyses showed that only one among six targets was predictive of mortality, i.e. a serum intact parathyroid hormone (iPTH)130 pg/mL. A continuous risk analysis using fractional polynomials showed a 10% increase in hazard ratio (HR) for mortality for a serum phosphate0.71 (2.2) and1.98 (6.14) mmol/L (mg/dL), a non-corrected serum calcium1.59 (6.37) and2.41 (9.66) mmol/L (mg/dL) and a serum iPTH100 and1090 pg/mL.The findings of our observational study confirm the existence of a grey zone, in which precise biochemical targets are difficult to define, with the exception of avoiding extreme values. Given the absence of intervention trials proving the clinical usefulness of phosphorus control, and pending the results of large clinical trials on the effect of optimal PTH and calcium control on hard outcomes, the present findings may help to refine future recommendations for the treatment of chronic haemodialysis patients.
Published: 2012

231. The Relationship Between Body Composition and Bone Quality Measured with HR-pQCT in Peritoneal Dialysis Patients

Author: Roland Chapurlat, Jocelyne Drai, Coralie Fournie, Justine Bacchetta, Fitsum Guebre-Egziabher, Walid Arkouche, Denis Fouque, Solenne Pelletier, Stephanie Boutroy, and Cyrille B. Confavreux
Subjects: 0301 basic medicine, Male, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Dialysis patients, Bone health, Bone and Bones, Peritoneal dialysis, Fat mass, 03 medical and health sciences, 0302 clinical medicine, Absorptiometry, Photon, Adipokines, Bone Density, Internal medicine, Bone quality, medicine, Humans, Prospective Studies, Aged, business.industry, Leptin, General Medicine, Middle Aged, medicine.disease, 030104 developmental biology, Endocrinology, Nephrology, Lean body mass, Body Composition, Female, business, Tomography, X-Ray Computed, Peritoneal Dialysis, Biomarkers, Kidney disease
Abstract: BackgroundBone is known to be impaired in chronic kidney disease and dialysis patients. Recent studies have shown that body composition (fat mass and lean mass) may impact bone health. Some of these effects may be related to mediators that are secreted by adipose tissue.MethodsThe aim of this study was to evaluate the association between body composition (dual x-ray absorptiometry [DEXA]) and adipokines (leptin, adiponectin), with bone density and microarchitecture assessed with high-resolution peripheral quantitative computed tomography (HR-pQCT) in chronic peritoneal dialysis (PD) patients in a single-center prospective study.ResultsTwenty-three patients with a median age of 61 years and body mass index (BMI) of 27 kg/m2were recruited. On univariate analysis, age was negatively associated with total volumetric bone mineral density (vBMD) ( r = -0.75, p < 0.01), cortical vBMD ( r = -0.85, p < 0.01), and cortical thickness ( r = -0.71, p < 0.01). There was a negative association between leptin and cortical thickness ( r = -0.48, p = 0.021). Fat mass (FM) was negatively correlated with cortical thickness ( r = -0.52, p = 0.012). No association was found between bone parameters and dialysis duration, serum insulin, intact parathyroid hormone, osteocalcin, and adiponectin. The short dialysis vintage could in part explain the lack of correlation with bone parameters. In multivariate analysis, FM was significantly and negatively correlated with total vBMD, cortical and trabecular thickness.ConclusionsThese data suggest that FM is negatively associated with bone quality in PD patients, supporting a relation between body composition and bone that is independent from other dialysis-associated complications. The relative contribution of the different fat deposits (visceral versus subcutaneous) needs to be assessed in future studies.
Published: 2016

232. In Hemodialysis Patients, Intradialytic Resistance Exercise Improves Osteoblast Function: A Pilot Study

Author: Denise Mafra, Sandra Mara Marinho, José Carlos Carraro Eduardo, Valerie Hage, Cécile Teuma, Maurice Laville, Denis Fouque, Solenne Pelletier, 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), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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: Vitamin D/analogs & derivatives, Male, medicine.medical_specialty, medicine.medical_treatment, Health Status, [SDV]Life Sciences [q-bio], Population, 030232 urology & nephrology, Medicine (miscellaneous), Physical exercise, Pilot Projects, Bone remodeling, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Osteogenesis, Renal Dialysis, Internal medicine, medicine, Humans, Vitamin D, education, Exercise, Osteoblasts/*physiology, Exercise Therapy, Bone mineral, education.field_of_study, Nutrition and Dietetics, Osteoblasts, business.industry, Leptin, 030229 sport sciences, medicine.disease, 3. Good health, Endocrinology, chemistry, Nephrology, Sclerostin, Hemodialysis, business, Kidney disease
Abstract: International audience; OBJECTIVE: Abnormalities in mineral and bone metabolism are frequent in chronic kidney disease patients. Physical exercise can improve many indicators of physical functioning, and recent studies showed beneficial effects on bone mineral density in the general population. The aim of this study was to evaluate the effects of resistance exercise training on bone markers and body composition in hemodialysis (HD) patients. DESIGN: This was a randomized controlled trial. SUBJECTS: The study included 13 HD patients (46.2% men). INTERVENTION: Patients were divided into a control group and an exercise group, which performed 8 weeks of intradialytic resistance exercise. Serum sclerostin, bone alkaline phosphatase (BAP), insulin, leptin, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and body composition were measured before and after the exercise period. RESULTS: In the exercise group, BAP levels increased from 11.4 +/- 6.5 to 14.6 +/- 6.4 U/L (P \textless .05) and serum 1,25-dihydroxyvitamin D levels from 46.0 +/- 23.5 to 87.2 +/- 31.8 ng/mL (P \textless .05). After exercise, serum BAP levels were inversely correlated with serum sclerostin (r = -0.96, P \textless .05). There was no change in body composition in either group. CONCLUSION: Resistance exercise training appears to be an interesting approach for stimulating BAP production in HD patients and may prevent bone loss and stimulate bone formation.
Published: 2016

233. Adherence to ketoacids/essential amino acids-supplemented low protein diets and new indications for patients with chronic kidney disease

Author: Shang-Jyh Hwang, Joel D. Kopple, Philippe Chauveau, William E. Mitch, Wei Chen, Denis Fouque, Liliana Garneata, Jing Chen, Kamyar Kalantar-Zadeh, Vladimír Teplan, Giorgina Barbara Piccoli, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
Subjects: Nephrology, Ketoacid, medicine.medical_specialty, Low protein, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030232 urology & nephrology, Physiology, Review, 030204 cardiovascular system & hematology, Keto-analog, 03 medical and health sciences, 0302 clinical medicine, Low-protein diet, Internal medicine, Diet, Protein-Restricted, Humans, Medicine, Amino Acids, Renal Insufficiency, Chronic, Wasting, Dialysis, chemistry.chemical_classification, Pregnancy, business.industry, Protein, Patient Selection, Kidney disease, medicine.disease, Keto Acids, 3. Good health, Amino acid, Low protein diet, Endocrinology, chemistry, Dietary Supplements, Patient Compliance, medicine.symptom, business
Abstract: International audience; BACKGROUND: Low protein diets (LPD) have long been prescribed to chronic kidney disease patients with the goals of improving metabolic abnormalities and postpone the start of maintenance dialysis. METHODS: We reviewed the recent literature addressing low protein diets supplemented with ketoacids/essential aminoacids prescribed during chronic kidney disease and their effects on metabolic, nutritional and renal parameters since 2013. RESULTS: We show new information on how to improve adherence to these diets, on metabolic improvement and delay of the dialysis needs, and preliminary data in chronic kidney disease associated pregnancy. In addition, data on incremental dialysis have been reviewed, as well as potential strategies to reverse protein energy wasting in patients undergoing maintenance dialysis. CONCLUSION: These recent data help to better identify the use of low protein diets supplemented with ketoacids/essential aminoacids during chronic kidney disease.
Published: 2016

234. Serum sclerostin: relation with mortality and impact of hemodiafiltration

Author: Marc G. Vervloet, Solenne Pelletier, Michiel L. Bots, Menso J. Nubé, Marinus A. van den Dorpel, Camiel L.M. de Roij van Zuijdewijn, Lotte Lips, Peter J. Blankestijn, Denis Fouque, Muriel P.C. Grooteman, Renate T. de Jongh, Piet M. ter Wee, Nephrology, ICaR - Circulation and metabolism, Internal medicine, IOO, ACS - Diabetes & metabolism, Endocrinology, Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands., Institute for cardiovascular research, VU University Medical Center [Amsterdam], Julius Center for Health Sciences and Primary Care, Maasstad Hospital, 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), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030232 urology & nephrology, sclerostin, 030204 cardiovascular system & hematology, Gastroenterology, Kidney Failure, 0302 clinical medicine, Bone Morphogenetic Proteins/blood, ComputingMilieux_MISCELLANEOUS, Hazard ratio, Adaptor Proteins, Kidney Failure, Chronic/blood, Middle Aged, Mortality/trends, Prognosis, 3. Good health, haemodialysis, Survival Rate, Quartile, Chronic/blood, Nephrology, Bone Morphogenetic Proteins, Female, Hemodialysis, Hemodiafiltration/adverse effects, Genetic Markers, medicine.medical_specialty, Hemodiafiltration, haemodiafiltration, Convection, convection volume, 03 medical and health sciences, Internal medicine, medicine, Humans, Mortality, Survival rate, Dialysis, Adaptor Proteins, Signal Transducing, Aged, Transplantation, Proportional hazards model, business.industry, Signal Transducing, mortality, Confidence interval, Surgery, Kidney Failure, Chronic, business, Biomarkers/blood, Biomarkers
Abstract: BACKGROUND: The glycoprotein sclerostin (Scl; 22 kDa), which is involved in bone metabolism, may play a role in vascular calcification in haemodialysis (HD) patients. In the present study, we investigated the relation between serum Scl (sScl) and mortality. The effects of dialysis modality and the magnitude of the convection volume in haemodiafiltration (HDF) on sScl were also investigated.METHODS: In a subset of patients from the CONTRAST study, a randomized controlled trial comparing HDF with HD, sScl was measured at baseline and at intervals of 6, 12, 24 and 36 months. Patients were divided into quartiles, according to their baseline sScl. The relation between time-varying sScl and mortality with a 4-year follow-up period was investigated using crude and adjusted Cox regression models. Linear mixed models were used for longitudinal measurements of sScl.RESULTS: The mean (±standard deviation) age of 396 test subjects was 63.6 (±13.9 years), 61.6% were male and the median follow-up was 2.9 years. Subjects with the highest sScl had a lower mortality risk than those with the lowest concentrations [adjusted hazard ratio 0.51 (95% confidence interval, CI, 0.31-0.86, P = 0.01)]. Stratified models showed a stable sScl in patients treated with HD (Δ +2.9 pmol/L/year, 95% CI -0.5 to +6.3, P = 0.09) and a decreasing concentration in those treated with HDF (Δ -4.5 pmol/L/year, 95% CI -8.0 to -0.9, P = 0.02). The relative change in the latter group was related to the magnitude of the convection volume.CONCLUSIONS: (i) A high sScl is associated with a lower mortality risk in patients with end-stage kidney disease; (ii) treatment with HDF causes sScl to fall; and (iii) the relative decline in patients treated with HDF is dependent on the magnitude of the convection volume.
Published: 2016

235. No apparent link between serum Klotho and phosphate in human chronic kidney disease

Author: Solenne Pelletier, Denis Fouque, Valerie Hage, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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), Université de Lyon-Institut National de la Recherche Agronomique (INRA), 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, business.industry, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, 030204 cardiovascular system & hematology, Phosphate, medicine.disease, 3. Good health, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, chemistry, Nephrology, Internal medicine, medicine, business, Klotho, ComputingMilieux_MISCELLANEOUS, Kidney disease
Abstract: International audience
Published: 2016

236. Association Between Protein Intake and Mortality in Hypertensive Patients Without Chronic Kidney Disease in the OLD-HTA Cohort

Author: Chloé Lesiuk, Alice Defforges, Denis Fouque, Brahim Harbaoui, Hugues Milon, Pierre-Yves Courand, Pierre Lantelme, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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), 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), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon
Subjects: Male, Low protein, [SDV]Life Sciences [q-bio], Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Severity of Illness Index, Cohort Studies, 0302 clinical medicine, Cause of Death, Urea, 030212 general & internal medicine, Stroke, ComputingMilieux_MISCELLANEOUS, education.field_of_study, Hazard ratio, Middle Aged, 3. Good health, Hospitalization, Cardiovascular Diseases, Cohort, Hypertension, Cardiology, Female, Dietary Proteins, France, Adult, medicine.medical_specialty, Population, Renal function, Risk Assessment, 03 medical and health sciences, Internal medicine, Internal Medicine, medicine, Humans, Renal Insufficiency, Chronic, education, Antihypertensive Agents, Aged, Proportional Hazards Models, Retrospective Studies, business.industry, Blood Pressure Determination, medicine.disease, Survival Analysis, Blood pressure, Endocrinology, Multivariate Analysis, business, Kidney disease
Abstract: Protein intake may have some benefits on reducing blood pressure and cardiovascular events, but their effects are still debated. The objective of this study was to test the prognostic value of protein intake assessed by 24-hour urinary urea in a cohort of hypertensive patients with preserved renal function. A total of 1128 hypertensive patients were followed according to tertile of protein intake adjusted for ideal body weight: 0.93 g/kg. Baseline characteristics (mean±standard deviation) were age 45.1±13.2 years, systolic/diastolic blood pressure 185±32/107±20 mm Hg, and estimated glomerular filtration rate 82±32 mL/min. After 10 years of follow-up, 289 deaths occurred, 202 of which were of cardiovascular cause. After adjustment for major cardiovascular risk factors, patients in the second and third tertiles of protein intake had a decreased risk of all-cause death (hazard ratio [95% confidence interval], 0.71 [0.56–0.91]) and cardiovascular death (0.72 [0.54–0.96]), but not of stroke death (0.72 [0.41–1.28]) in comparison to patients in the low protein intake tertile. Normal–high protein intake was associated with a better outcome in a subset of the population: younger patients, low salt intake, without aortic atherosclerosis, or previous cardiovascular events ( P interaction 0.7 g/kg ideal body weight, particularly those at low risk, had lower all-cause and cardiovascular mortality rates. Physicians may encourage hyper tensive patients to have normal or high protein diet in addition to low salt consumption, moderate alcohol consumption, and regular physical activity.
Published: 2016

237. Determination of the binding properties of the uremic toxin phenylacetic acid to human serum albumin

Author: Hédi Soula, Dan Yi, Milena B. Stockler-Pinto, Christophe O. Soulage, Denise Mafra, Stéphane Chambert, Juliana F. Saldanha, Denis Fouque, Graduate Program in Medical Science, Fluminense Federal University, 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), Cardiovascular Sciences Collaborative Program, Centre National de la Recherche Scientifique (CNRS), Chimie Organique et Bioorganique (COB), Institut de Chimie et Biochimie Moléculaires et Supramoléculaires (ICBMS), 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-Centre National de la Recherche Scientifique (CNRS)-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-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Institut National de la Sante et de la Recherche Medicale (INSERM), Institut National des Sciences Appliquees de Lyon (INSA-Lyon), Chinese Scolarship Council (CSC), Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES), Comite Francais d'Evaluation de la Cooperation Universitaire avec le Bresil (COFECUB) Me 759-12, 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-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 0301 basic medicine, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Serum albumin, uremic toxin, Plasma protein binding, protein binding, Phenylacetic acid, Biochemistry, Cell Line, phenylacetic acid, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Protein Domains, medicine, Humans, albumine, Binding site, Renal Insufficiency, Chronic, Serum Albumin, uremic syndrome, Phenylacetates, Chromatography, biology, Chemistry, Albumin, ovalbumin, General Medicine, biochemical phenomena, metabolism, and nutrition, Human serum albumin, Binding constant, 3. Good health, Ultrafiltration (renal), 030104 developmental biology, human serum albumin, biology.protein, site de liaison protéique, maladie rénale, chronic kidney disease, syndrome uremique hemolytique, medicine.drug
Abstract: Uremic toxins are compounds normally excreted in urine that accumulate in patients with chronic kidney disease as a result of decreased renal clearance. Phenylacetic acid (PAA) has been identified as a new protein bound uremic toxin. The purpose of this study was to investigate in vitro the interaction between PAA and human serum albumin (HSA) at physiological and pathological concentrations. We used ultrafiltration to show that there is a single high-affinity binding site for PAA on HSA, with a binding constant on the order of 3.4 x 10(4) M-1 and a maximal stoichiometry of 1.61 mol per mole. The PAA, at the concentration reported in end-stage renal patients, was 26% bound to albumin. Fluorescent probe competition experiments demonstrated that PAA did not bind to Sudlow's site I (in subdomain IIA) and only weakly bind to Sudlow's site II (in subdomain IIIA). The PAA showed no competition with other protein-bound uremic toxins such as p-cresyl-sulfate or indoxyl sulfate for binding to serum albumin. Our results provide evidence that human serum albumin can act as carrier protein for phenylacetic acid. (C) 2016 Elsevier B.V. and Societe Francaise de Biochimie et Biologie Moleculaire (SFBBM).
Published: 2016

238. NF-κB expression and its association with nutritional status in hemodialysis patients

Author: Najla E. Farage, Viviane O. Leal, José Carlos Carraro-Eduardo, Ludmila Lmf Cardozo, Denis Fouque, Milena B. Stockler-Pinto, Denise Mafra, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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: Nephrology, Male, Pathology, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Statistics as Topic, 030232 urology & nephrology, 030204 cardiovascular system & hematology, Gastroenterology, chemistry.chemical_compound, 0302 clinical medicine, 2. Zero hunger, biology, Anthropometry, NF-kappa B, Middle Aged, 3. Good health, Creatinine, Body Composition, Female, Hemodialysis, medicine.symptom, Brazil, Signal Transduction, Adult, medicine.medical_specialty, NF-E2-Related Factor 2, Urology, Serum albumin, Nutritional Status, Inflammation, Peripheral blood mononuclear cell, 03 medical and health sciences, Renal Dialysis, Internal medicine, medicine, Humans, Serum Albumin, business.industry, NF-κB, Cross-Sectional Studies, Nutrition Assessment, chemistry, biology.protein, Leukocytes, Mononuclear, Kidney Failure, Chronic, business, Biomarkers
Abstract: International audience; PURPOSE: This study aimed to evaluate the association among the expressions of pro- and anti-inflammatory nuclear factors (nuclear factor-kappaB, NF-kappaB and nuclear erythroid 2-related factor 2, Nrf2) and nutritional status in HD patients. METHODS: This cross-sectional study included eighty-three HD patients. The peripheral blood mononuclear cells were isolated and processed for the evaluation of NF-kappaB and Nrf2 RNAm expression by quantitative real-time polymerase chain reaction. Muscle mass was estimated by creatinine index (CI) and percentage of body fat (%BF) by anthropometry. Seven-point subjective global assessment was also used to evaluate the nutritional status. RESULTS: The NF-kappaB expression was negatively correlated with CI (r = -0.54, p = 0.0001), serum albumin (r = -0.32, p = 0.02) and %BF (r = -0.61, p = 0.001). Multiple linear regression analysis revealed that NF-kappaB expression was independently associated with CI (beta: -0.8, p = 0.013) and %BF (beta: -0.42, p = 0.04). There was no correlation among Nrf2 and anthropometric and biochemical variables. CONCLUSION: The classical NF-kappaB activation seems to be associated with poor nutritional status in HD patients; however, the exact underlying mechanisms deserve further studies.
Published: 2016

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

Author: Bénédicte, Stengel, Christian, Combe, Christian, Jacquelinet, Serge, Briançon, Denis, Fouque, Maurice, Laville, Luc, Frimat, Christophe, Pascal, Yves-Édouard, Herpe, Pascal, Morel, Jean-François, Deleuze, Joost P, Schanstra, Ron L, Pisoni, Bruce M, Robinson, and Ziad A, Massy
Subjects: Aged, 80 and over, Information Services, Male, Middle Aged, Cohort Studies, Renal Replacement Therapy, Disease Progression, Quality of Life, Humans, Kidney Failure, Chronic, Female, France, Renal Insufficiency, Chronic, Aged, Follow-Up Studies
Abstract: Preserving kidney function and improving the transition from chronic kidney disease to end stage is a research and healthcare challenge. The national Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort was established to identify the determinants, biomarkers and practice patterns associated with chronic kidney disease outcomes.The study will include more than 3000 adult patients with moderate to advanced chronic kidney disease from a representative sample of 40 nephrology clinics with respect to regions and legal status, public or private. Patients are recruited during a routine visit and followed for 5 years, before and after starting renal replacement therapy. Patient-level clinical, biological, and lifestyle data are collected annually, as well as provider-level data on clinical practices, coordinated with the International Chronic Kidney Disease Outcomes and Practice Pattern Study. Blood and urine samples are stored in a biobank. Major studied outcomes include survival, patient-reported outcomes, disease progression and hospitalizations.More than 13,000 eligible patients with chronic kidney disease were identified, 60% with stage 3 and 40% with stage 4. Their median age is 72 years [interquartile range, 62-80 years], 60% are men and 38% have diabetes. By the end of December 2015, 2885 patients were included.The CKD-REIN cohort will serve to improve our understanding of chronic kidney disease and provide evidence to improve patient survival and quality of life as well as health care system performances.
Published: 2016

240. Exercise Training Alters the Bone Mineral Density of Hemodialysis Patients

Author: Denise Mafra, Jorge Eduardo dos Santos Monteiro Barbosa, Solenne Pelletier, Cristiane Moraes, Denis Fouque, José Carlos Carraro Eduardo, and Sandra Mara Marinho
Subjects: Adult, Male, medicine.medical_specialty, Bone density, medicine.medical_treatment, Osteoporosis, 030232 urology & nephrology, Urology, Physical Therapy, Sports Therapy and Rehabilitation, 03 medical and health sciences, 0302 clinical medicine, Absorptiometry, Photon, Bone Density, Renal Dialysis, medicine, Humans, Orthopedics and Sports Medicine, Femoral neck, Bone mineral, business.industry, Resistance Training, 030229 sport sciences, General Medicine, Middle Aged, medicine.disease, Osteopenia, medicine.anatomical_structure, Physical therapy, Lean body mass, Female, Hemodialysis, business, Kidney disease
Abstract: Marinho, SM, Moraes, C, Barbosa, JEdSM, Eduardo, JCC, Fouqe, D, Pelletier, S, and Mafra, D. Exercise training alters the bone mineral density of hemodialysis patients. J Strength Cond Res 30(10): 2918-2923, 2016-Patients with chronic kidney disease undergoing hemodialysis (HD) frequently present low bone mineral density (BMD), and exercise may be useful for treating bone loss. This study aimed to assess the effects of an intradialytic resistance exercise training program (RETP) on BMD in HD patients. Twenty-one patients were enrolled into 2 groups; 10 patients performed exercise (80.0% men; 46.9 ± 12.1 years; 27.0 ± 3.4 kg·m) and 11 patients were in the control group (54.5% men; 50.5 ± 11.5 years; 24.1 ± 8.7 kg·m). Dual-energy x-ray absorptiometry was used to measure the BMD, lean mass, and body fat before and after the supervised RETP (performed with elastic bands and ankle cuffs in both lower limbs 3 times a week for 24 weeks-72 sessions). In the exercise group, 30.0% of patients presented with osteopenia and 20.0% osteoporosis and in the control group, 45.5% osteopenia and 36.4% osteoporosis. Only in the exercise group, the osteoporosis percentage was reduced to 10.0% and the femoral neck BMD and T-score improved from 0.89 ± 0.1 to 0.93 ± 0.1 g·cm and from -1.3 ± 0.8 to -1.0 ± 0.8 g·cm (p ≤ 0.05), respectively, after the intervention. In contrast, these parameters were reduced in the control group. The results suggest that resistance exercise may be useful for improving the BMD in HD patients. In summary, 24 weeks of the supervised RETP played a role in improving the BMD of HD patients.
Published: 2016

241. [Wasting in chronic kidney disease: Refeeding techniques and artificial nutrition practices]

Author: Céline, Pasian, Raymond, Azar, and Denis, Fouque
Subjects: Parenteral Nutrition, Enteral Nutrition, Treatment Outcome, Renal Dialysis, Humans, Nutritional Status, Nutrition Therapy, Renal Insufficiency, Chronic, Protein-Energy Malnutrition, Survival Analysis, Body Mass Index
Abstract: Protein energy wasting (PEW) is an independent factor associated with morbi-mortality in chronic kidney disease. Wasting is particularly common in chronic diseases of organs such as kidney disease with a major impact at the stage of dialysis. It covers 20 to 70% of patients diagnosed with chronic kidney disease according to the degree of evolution of the disease and the diagnostic method used patients. Mechanisms of PEW are based mainly on anorexia and metabolic abnormalities caused by kidney disease. Nutritional treatment differs depending on the stage of the kidney disease acute or chronic treated whether or not by dialysis. Nutritional monitoring should be regular, individualized and collaborative to detect a risk of PEW or treat installed PEW. Refeeding techniques should allow all the nutritional needs. Their indications depend on the clinic, biochemical assessment and nutrient intake.
Published: 2016

242. Cohorte française Chronic Kidney Disease–Réseau Épidémiologie et Information en Néphrologie (CKD-REIN) : mieux connaître la maladie rénale chronique

Author: Serge Briançon, Bénédicte Stengel, Luc Frimat, Pascal Morel, Joost P. Schanstra, Christian Combe, Ziad A. Massy, Denis Fouque, Christian Jacquelinet, Bruce M. Robinson, Jean-François Deleuze, R. Pisoni, Yves-Edouard Herpe, Maurice Laville, Christophe Pascal, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de Néphrologie-Transplantation-Dialyse, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Bioingénierie tissulaire (BIOTIS), Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence de la biomédecine [Saint-Denis la Plaine], Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Service de Néphrologie [CHRU Nancy], GRAPHOS - IFROSS Recherche, Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon, CHU Amiens-Picardie, Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté]), Centre National de Génotypage (CNG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Etablissement français du sang [Bourgogne-France-Comté] (EFS [Bourgogne-France-Comté]), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Université 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), 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), Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC), and Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: 03 medical and health sciences, 0302 clinical medicine, Nephrology, 030232 urology & nephrology, [SHS.GESTION]Humanities and Social Sciences/Business administration, 030204 cardiovascular system & hematology, ComputingMilieux_MISCELLANEOUS, 3. Good health
Abstract: Resume Introduction Preserver la fonction renale et ameliorer la transition de la maladie renale chronique vers le stade terminal constituent un defi pour la nephrologie. La cohorte nationale Chronic Kidney Disease–Reseau Epidemiologie et Information en Nephrologie (CKD-REIN) a ete mise en place pour identifier les determinants, les biomarqueurs et les profils de pratiques associes au pronostic de la maladie renale chronique. Methodes L’etude vise a inclure plus de 3000 patients adultes avec une maladie renale chronique moderee ou avancee suivis dans 40 consultations de nephrologie representatives du point de vue des regions et du statut public ou prive des etablissements. Les patients sont inclus a l’occasion d’une consultation de routine et suivis pendant 5 ans, avant et apres l’initiation eventuelle d’un traitement de suppleance renale. Des donnees cliniques, biologiques, sur la sante percue et le mode de vie des patients sont recueillies annuellement, ainsi que sur les pratiques, en coordination avec l’etude internationale Chronic Kidney Disease Outcome and Practice Pattern Study. Une biotheque d’echantillons de sang et d’urine est constituee. Les principaux evenements etudies sont la survie, la qualite de vie, la progression de la maladie et les hospitalisations. Resultats Plus de 13 000 patients eligibles ont ete identifies, 60 % au stade 3 et 40 % au stade 4 de la maladie renale, d’âge median 72 ans [interquartile, 62–80 ans], dont 60 % sont de sexe masculin et 38 % ont un diabete. Fin decembre 2015, 2885 patients etaient inclus. Conclusion La cohorte CKD-REIN servira a mieux connaitre la maladie renale chronique et a apporter des donnees probantes pour ameliorer la sante et la qualite de vie des patients ainsi que les performances du systeme de sante dans ce domaine.
Published: 2016

243. Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

Author: Vincenzo Bellizzi, Juan Jesus Carrero, Philippe Chauveau, Mario Cozzolino, Adamasco Cupisti, Claudia D’Alessandro, Luca De Nicola, Enrico Fiaccadori, Lina Johansson, Roberto Minutolo, Pablo Molina, Siren Sezer, Pieter Ter Wee, Daniel Teta, Christoph Wanner, Patrizia Calella, Denis Fouque, European Renal Nutrition Working Group of the European Renal Association-European Dialysis Transplant Association, (ERA-EDTA), ICaR - Circulation and metabolism, and Nephrology
Subjects: Chronic kidney disease, Conservative treatment, Ketoanalogs, Low protein diet, Nutrition, Point of care, Progression, Protein-energy wasting, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, 030204 cardiovascular system & hematology, lcsh:RC870-923, urologic and male genital diseases, 03 medical and health sciences, 0302 clinical medicine, Low-protein diet, Medicine, Intensive care medicine, Dialysis, business.industry, Protein energy wasting, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, business, Kidney disease
Abstract: This is a case report on a patient with non-dialysis chronic kidney disease (CKD) in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2nd International Conference of the European Renal Nutrition working group at ERA-EDTA—“Retarding CKD progression: readily available through comprehensive nutritional management?”— and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections—basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD—linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention. First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD) • What nutritional assessment/monitoring for protein-energy wasting (PEW) should be employed? • Is a body mass index (BMI) of 21 kg/m2 adequate? • What phosphate target should be pursued? • What are the nutritional habits in patients with incident CKD? • What protein needs and amount of dietary protein should be pursued? • Does the quality of protein matter? • What amount of dietary salt should be employed? How should this be obtained? • How should normal serum phosphate be achieved? • What diet should be recommended? Is a vegetarian diet an option? Second visit: Major nutritional targets in non-dialysis CKD • Consequences of unintentional weight loss • What is the role of the renal dietitian in helping the patient adhere to a renal diet? Intermediate visits: Nutritional follow-up in non-dialysis CKD • What treatment for calcium/parathyroid hormone (PTH) will affect CKD progression? Final visits: • Would a dietary recall/intensive dietary education improve adherence with the diet? • Would a very-low-protein diet (VLPD)/ketodiet be indicated for this patient?
Published: 2016

244. Towards a multidisciplinary approach to understand and manage obesity and related diseases

Author: Carmen Gil, Tommy Cederholm, Laurence Genton, Nanette Stroebele-Benschop, Cristina Cuerda, Rocco Barazzoni, Yves Boirie, Nicolaas E. P. Deutz, Stephan C. Bischoff, Raanan Shamir, Arved Weimann, M. Leon-Sanz, Anders Thorell, Berthold Koletzko, Denis Fouque, Nathalie M. Delzenne, Joelle Singer, Michael Chourdakis, Pierre Singer, Department of Nutritional Medicine, University of Hohenheim, Unité de Nutrition Humaine (UNH), Institut National de la Recherche Agronomique (INRA)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université, Deptartment of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Medical Nutrition, School of Medicine, Aristotle University of Thessaloniki, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Metabolism and Nutrition Research Group, Louvain Drug Research Institute, Université Catholique de Louvain = Catholic University of Louvain (UCL), Center for Translational Research in Aging and Longevity, Department Health and Kinesiology, Texas A&M University System, 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), Clinical Nutrition, Geneva University Hospital (HUG), Department of Endocrinology and Nutrition, Hospital Central de la Defensa Gomez Ulla, University of Munich Medical Centre, Ludwig Maximilians University of Munich, Department of Medicine and Hospital Doce de Octubre, Endocrinology and Nutrition, Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University [Tel Aviv], Sackler School of Medicine, General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Department of Nutritional Medicine, Division of Applied Psychology, Department of Clinical Science, Danderyd Hospital and Department of Surgery, Ersta Hospital, Karolinska Institute, Department of General, Visceral and Oncological Surgery, Universität Leipzig [Leipzig], Department of Medical, Surgical and Health Sciences, Università degli studi di Trieste, ESPEN special interest group Obesity, Université Catholique de Louvain, 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), Universidad Complutense de Madrid [Madrid] (UCM), Bischoff, Stephan C, Boirie, Yve, Cederholm, Tommy, Chourdakis, Michael, Cuerda, Cristina, Delzenne, Nathalie M, Deutz, Nicolaas E, Fouque, Deni, Genton, Laurence, Gil, Carmen, Koletzko, Berthold, Leon Sanz, Miguel, Shamir, Raanan, Singer, Joelle, Singer, Pierre, Stroebele Benschop, Nanette, Thorell, Ander, Weimann, Arved, Barazzoni, Rocco, Ludwig-Maximilians University [Munich] (LMU), Tel Aviv University (TAU), Danderyds sjukhus = Danderyd University Hospital, Universität Leipzig, Università degli studi di Trieste = University of Trieste, Clermont Université-Université d'Auvergne - Clermont-Ferrand I (UdA)-Institut National de la Recherche Agronomique (INRA), UCL - SSS/LDRI - Louvain Drug Research Institute, Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Institut National de la Recherche Agronomique (INRA), 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: Pediatric Obesity, Sarcopenia, obesity, liver diseases, Overweight, Critical Care and Intensive Care Medicine, Global Health, Muscle Development, weight control, sarcopenic obesity, Body Weight Maintenance, 0302 clinical medicine, Weight loss, Non-alcoholic Fatty Liver Disease, 030212 general & internal medicine, Precision Medicine, Fatty liver disease, Metabolic syndrome, Microbiota, Multidisciplinary, Sarcopenic obesity, Weight maintenance, Child, Geriatrics, ddc:616, Nutrition and Dietetics, Evidence-Based Medicine, syndrome métabolique, contrôle ponderal, metabolic x syndrome, Middle Aged, Prognosis, Combined Modality Therapy, 3. Good health, obésité, nutrition, medicine.symptom, sedentariness, Obesity paradox, medicine.medical_specialty, 030209 endocrinology & metabolism, Models, Biological, metabolic syndrome, 03 medical and health sciences, microbiote, medicine, microbiota, Animals, Humans, Intensive care medicine, Sedentary lifestyle, Patient Care Team, business.industry, sédentarite, medicine.disease, Obesity, approche multidisciplinaire, weight maintenance, Chronic Disease, Physical therapy, Dysbiosis, fatty liver disease, business, maladie du foie, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, multidisciplinary
Abstract: Overnutrition and sedentary lifestyle result in overweight or obesity defined as abnormal or excessive fat accumulation that may impair health. According to the WHO, the worldwide prevalence of obesity nearly doubled between 1980 and 2008. In 2008, over 50% of both men and women in the WHO European Region were overweight, and approximately 23% of women and 20% of men were obese. Comprehensive diagnostic and therapeutic approaches should include nutritional treatment to favor the best metabolic and nutritional outcome, as well as to induce potential disease-specific benefits from selected nutritional regimens. Obesity is usually accompanied by an increased muscle mass. This might explain why obesity, under particular circumstances such as cancer or high age, might have protective effects, a phenomenon named the 'obesity paradox'. However, loss of muscle mass or function can also occur, which is associated with poor prognosis and termed 'sarcopenic obesity'. Therefore, treatment recommendations may need to be individualized and adapted to co-morbidities. Since obesity is a chronic systemic disease it requires a multidisciplinary approach, both at the level of prevention and therapy including weight loss and maintenance. In the present personal review and position paper, authors from different disciplines including endocrinology, gastroenterology, nephrology, pediatrics, surgery, geriatrics, intensive care medicine, psychology and psychiatry, sports medicine and rheumatology, both at the basic science and clinical level, present their view on the topic and underline the necessity to provide a multidisciplinary approach, to address this epidemic.
Published: 2016

245. Is a body mass index of 23 kg/m2 a reliable marker of protein–energy wasting in hemodialysis patients?

Author: Julie Calixto Lobo, Cristiane Moraes, Najla E. Farage, Luis Guillermo Coca Velarde, Denise Mafra, Denis Fouque, Viviane O. Leal, and Milena B. Stockler-Pinto
Subjects: medicine.medical_specialty, Nutrition and Dietetics, Waist, business.industry, Proportional hazards model, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Leptin, Circumference, Endocrinology, Internal medicine, medicine, Hemodialysis, Wasting Syndrome, medicine.symptom, business, Wasting, Body mass index
Abstract: Objective: To evaluate the body composition and inflammatory status in patients on hemodialysis (HD) according to the cutoff of 23 kg/m 2 for the body mass index (BMI). Methods: Forty-seven patients (30 men, 11 diabetics, 53.8 � 12.2 y of age, 58.2 � 50.9 mo on HD) were studied. Anthropometric data and handgrip strength were evaluated. C-reactive protein, tumor necrosis factor-a, leptin, and interleukin-6 were measured. Mortality was assessed after 24 mo of follow-up. Results: Nineteen patients (40.4%) presented BMI values lower than 23 kg/m 2 and leptin levels, midarm muscle area, and free-fat mass were significantly lower in these patients. The prevalence of functional muscle loss according to handgrip strength was not different between the BMI groups. The sum of skinfold thicknesses, the percentage of body fat, fat mass, the fat mass/free-fat mass ratio, and waist circumference were significantly lower in patients with a BMI lower than 23 kg/m 2 , but the mean values did not indicate energy wasting. Patients with a BMI higher than 23 kg/m 2 presented a higher prevalence of inflammation and higher waist circumference and body fat values. The adiposity parameters were correlated with C-reactive protein and leptin. A Cox multivariate regression analysis demonstrated that C-reactive protein, tumor necrosis factor-a, and interleukin-6 predict cardiovascular mortality. Conclusion: Patients on HD with a BMI lower than 23 kg/m 2 did not present signs of energy wasting, whereas those with a BMI higher than 23 kg/m 2 had more inflammation, probably because of a greater adiposity. Thus, the BMI value of 23 kg/m 2 does not seem to be a reliable marker of protein–energy wasting in patients on HD.
Published: 2012

246. Bone microarchitecture is more severely affected in patients on hemodialysis than in those receiving peritoneal dialysis

Author: Roland Chapurlat, Justine Bacchetta, Elisabeth Sornay-Rendu, Denis Fouque, Pawel Szulc, Solenne Pelletier, Walid Arkouche, Fitsum Guebre-Egziabher, Stephanie Boutroy, and Nicolas Vilayphiou
Subjects: high-resolution peripheral quantitative computed tomography, Male, Bone density, medicine.medical_treatment, Severity of Illness Index, Absorptiometry, Photon, Bone Density, Vitamin D, Quantitative computed tomography, Aged, 80 and over, Bone mineral, bone imaging, hemodialysis, medicine.diagnostic_test, Middle Aged, mineral metabolism, Radius, Parathyroid Hormone, Nephrology, Practice Guidelines as Topic, Female, Hip Joint, Hemodialysis, Bone Diseases, Peritoneal Dialysis, bone microarchitecture, Adult, musculoskeletal diseases, medicine.medical_specialty, Bone and Bones, Peritoneal dialysis, Young Adult, Predictive Value of Tests, Renal Dialysis, medicine, Humans, Tibia, Renal Insufficiency, Chronic, Dialysis, Aged, Chi-Square Distribution, business.industry, Vitamin D Deficiency, medicine.disease, Spine, Surgery, Cross-Sectional Studies, Case-Control Studies, Dietary Supplements, Tomography, X-Ray Computed, business, Biomarkers, Kidney disease
Abstract: We used high-resolution quantitative computed tomography to study the microarchitecture of bone in patients with chronic kidney disease on dialysis. We compared bone characteristics in 56 maintenance hemodialysis (21 women, 14 post-menopausal) and 23 peritoneal dialysis patients (9 women, 6 post-menopausal) to 79 healthy men and women from two cohorts matched for age, body mass index, gender, and menopausal status. All underwent dual-energy X-ray absorptiometry of the spine and hip to measure areal bone mineral density, and high-resolution peripheral quantitative computed tomography of the radius and tibia to measure volumetric bone mineral density and microarchitecture. When compared to their matched healthy controls, patients receiving hemodialysis and peritoneal dialysis had a significantly lower areal bone mineral density in the hip. Hemodialysis patients had significantly lower total, cortical, and trabecular volumetric bone mineral density at both sites. Hemodialysis patients had significantly lower trabecular volumetric bone mineral density and microarchitecture at the tibia than the peritoneal dialysis patients. Overall, peritoneal dialysis patients were less affected, their cortical thickness at the distal tibia being the only significant difference versus controls. Thus, we found more severe trabecular damage at the weight-bearing tibia in hemodialysis compared to peritoneal dialysis patients, but this latter finding needs confirmation in larger cohorts.
Published: 2012

247. Zinc-α2-Glycoprotein: Is There Association between This New Adipokine and Body Composition in Hemodialysis Patients?

Author: Maurilo Leite, Guillermo Coca Velarde, Julie Calixto Lobo, Denise Mafra, Najla E. Farage, Viviane O. Leal, Denis Fouque, and Milena B. Stockler-Pinto
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Adipokine, Enzyme-Linked Immunosorbent Assay, Zn-Alpha-2-Glycoprotein, Critical Care and Intensive Care Medicine, Young Adult, Renal Dialysis, Internal medicine, medicine, Humans, Obesity, Renal Insufficiency, Chronic, Wasting, Adiposity, Aged, business.industry, Dietary intake, Seminal Plasma Proteins, Healthy subjects, Lipid metabolism, General Medicine, Middle Aged, Endocrinology, Nephrology, Zinc α2 glycoprotein, Body Composition, Female, Composition (visual arts), Hemodialysis, medicine.symptom, Energy Metabolism, business, Follow-Up Studies
Abstract: Peptides involved in the regulation of body composition are of interest in hemodialysis (HD) patients because protein wasting associated with high fat mass (FM) is present in these patients. Zinc-α2-glycoprotein (ZAG), a new adipokine, is involved in the regulation of lipid metabolism, adiposity, and energy balance. The purpose of this study was to evaluate ZAG levels and its relationship with body composition and dietary intake in HD patients. Forty-nine HD patients (28 men, 53.1 ± 12.5 years, and BMI 24.0 ± 4.3 kg/m2) were studied and compared with 20 healthy subjects (9 men, 49.5 ± 15.2 years, and BMI 25.6 ± 4.1 kg/m(2)). Plasma ZAG levels were measured using the ELISA methods and body composition was evaluated through anthropometric data. Dietary intake was assessed 3 days by 24-hour food recall. Although most of the HD patients (59.2%) were eutrophic according to BMI, 92.3% presented high percentage of body fat (BF), and 43.5%, reduced fat-free mass according to midarm muscle circumference values. ZAG levels were ∼2.5-fold higher in HD patients (135.9 ± 40.9 mg/L) compared with healthy individuals (54.6 ± 23.0 mg/L) (p0.0001). Circulating ZAG was not associated with dietary intake; however, this peptide was negatively correlated with %BF and, for each 1% reduction in BF, ZAG levels increased by 2.4 mg/L (p = 0.02). In summary, circulating ZAG is increased and inversely correlated with adiposity in HD patients; however, in spite of its higher plasma levels, the majority of HD patients did not show low BF.
Published: 2012

248. Statut vitaminique, rôle extra osseux et besoins quotidiens en vitamine D

Author: Alexandre Lapillonne, Pierre Godeau, B.L. Salle, M. Espie, J.-M. Bourre, F. Tron, J.P. Bounhoure, Charles Pierrot-Deseilligny, Denis Fouque, Edgard Delvin, Jean-François Duhamel, Jean-Pierre Nicolas, Jean-Paul Viard, Bernard Salle, Jean-Claude Souberbielle, and Ch.j Menkès
Subjects: General Medicine
Abstract: RESUME La deficience en vitamine D en France dans tous les groupes d'âge est importante car elle synthetisee a partir des UVB au niveau du derme (d'ou ensoleillement obligatoire) et que l'alimentation contient peu de vitamine D (uniquement les poissons gras). La vitamine D joue un role preponderant dans le metabolisme phosphocalcique : absorption intestinale du calcium et fixation du calcium dans l'os. La carence en vitamine D entraine un rachitisme chez l'enfant et l'adolescent et une osteomalacie ou une osteopenie chez l'adulte. La vitamine D aurait egalement d'autres effets : prevention dans le developpement de certaines maladies infectieuses, de certaines maladies auto-immunes ou a composante auto-immnune (Sclerose en plaques, diabete de type 1, polyarthrite rhumatoide et lupus) syndrome metabolique chez l'enfant et chez l'adulte, diabete de type 2 ; eventuel role dans la differentiation cellulaire en relation avec l apparition de certains cancers. Le statut vitaminique D d'un individu est defini par la mesure de la 25(OH)D serique, en accord avec l'ensemble de la communaute scientifique internationale. Le taux de 25OHD serique doit etre superieur a 75 nmol/L (ou 30 ng/ml) pour admettre un statut vitaminique normal selon la majorite des auteurs. La mesure de la 25 OHD serique necessite un immuno-essai valable ou la spectrometrie de masse pour le diagnostic d'une deficience en vitamine D chez l'individu. Les apports quotidiens en vitamine D doivent etre reevalues en France compte tenu de l'âge, de la saison et le deficit en vitamine D doit etre corrige uniquement par une supplementation par voie orale.. Ces recommandations ne tiennent pas compte de la pathologie de l'individu c est-a-dire des maladies hepatiques, renales, intestinales et osseuses.
Published: 2012

249. Trimethylamine N-Oxide From Gut Microbiota in Chronic Kidney Disease Patients: Focus on Diet

Author: Ana Claudia F. Amaral, Denis Fouque, Denise Mafra, Cristiane Moraes, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), 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: medicine.medical_specialty, Eggs, Metabolite, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Medicine (miscellaneous), Trimethylamine, Renal function, Trimethylamine N-oxide, Gut flora, Choline, Methylamines, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Carnitine, Internal medicine, Diet, Protein-Restricted, Animals, Humans, Medicine, Renal Insufficiency, Chronic, Randomized Controlled Trials as Topic, 030304 developmental biology, 0303 health sciences, Nutrition and Dietetics, biology, business.industry, biology.organism_classification, medicine.disease, Gastrointestinal Microbiome, 3. Good health, Disease Models, Animal, Red Meat, Endocrinology, chemistry, Cardiovascular Diseases, Nephrology, Red meat, business, Kidney disease
Abstract: International audience; Low-protein diet is the recommended nutritional intervention for nondialysis chronic kidney disease (CKD) patients because excess protein intake can damage kidney function and produce uremic toxins. Some of these toxins are generated from amino acids breakdown by gut microbiota as p-cresyl sulfate and indoxyl sulfate that have been clearly associated with cardiovascular mortality in CKD patients. Another uremic toxin, trimethylamine N-oxide (TMAO), a degradation product of choline and L-carnitine (which come mainly from animal protein such as red meat and eggs) is now considered as a proatherogenic metabolite. In the present review, we will highlight the relationship between TMAO, diet and cardiovascular aspects, and the potential concerns about TMAO in nondialysis CKD patients.
Published: 2015

250. Syndrome de Fanconi complet secondaire à une tubulopathie proximale à dépôts de chaînes légères au cours d’un myélome multiple

Author: M. Espi, Maurice Laville, A. Vasiljevic, M. Nouvier, K. Lionel, C. Lombard, and Denis Fouque
Subjects: Nephrology
Abstract: Introduction L’insuffisance renale au cours du myelome multiple (MM) survient dans plus de 50 % des cas (nephropathie a cylindres myelomateux, amylose, maladie a depots organises d’immunoglobulines, …). La tubulopathie proximale avec syndrome de Fanconi (FS), secondaire a des depots de chaines legeres sous forme des cristaux dans les cellules tubulaires proximales (LCPT) est rare. Observation Une femme de 61 ans suivie pour un MM IgA kappa depuis 2014 (15 % de plasmocytes dystrophiques, pas d’atteinte osseuse, pic IgA = 15 g/L, chaines legeres kappa = 60 mg/L, rapport kappa/lambda = 6,6) est hospitalisee en nephrologie en septembre 2016 pour insuffisance renale chronique (IRC) (creatininemie = 86 μmol/L ; eDFG = 60 mL/min/1,73m2 [CKD-EPI]) et majoration d’une proteinurie de Bence Jones (de 0,4 a 3 g/24 h). Les explorations complementaires retrouvent : une augmentation pic IgA (22 g/L) et du ratio kappa/lambda (17,5) ; une IRC stade IIIa (clairance du Iohexol = 58 mL/min/1,73m2) et un syndrome de Fanconi complet (glycosurie normoglycemique = 16 mmol/L), acidose metabolique hyperchloremique (HCO3- = 15 mmol/L, Cl = 109 mmol/L), hypophosphoremie avec perte renale de phosphore (taux de reabsorption phosphore = 78 % (normale > 90 %), hypouricemie avec hyperuricurie et aminoacidurie). Une PBR est realisee. En microscopie optique, les cellules tubulaires proximales sont le siege de multiples inclusions granuleuses microcristallins (PAS negatif, verdâtres au trichrome de Masson) intracytoplasmiques et de necrose tubulaire aigue. On note 20 % de fibrose interstitielle, sans lesion glomerulaire. L’immunofluorescence est negative. Une chimiotherapie a base de bortezomib, cyclophosphamide et dexamethasone est realisee avec une reponse hematologique et renale precoce apres 3 cures (pic IgA = 13 g/L, chaine legere kappa = 58 mg/L, eDFG = 66 mL/min/1,73m2 CKD-EPI, proteinurie en baisse a 1,4 g/24 h) Conclusion Nous decrivons une tubulopathie proximale avec depots de chaines legeres responsable d’un syndrome de Fanconi complet apparue pendant le suivi d’un MM. La reponse renale depend de la reponse hematologique au traitement. La collaboration entre nephrologues et hematologues est necessaire pour un diagnostic et un traitement precoce des MGRS.
Published: 2017

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