75 results on '"Michel Vallée"'
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2. Pharmacokinetics of Tobramycin Administered at the Beginning of Intermittent Hemodialysis Session (ESRD Study)
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Marjolaine Giroux, Nicolas Bouchard, Anik Henderson, Lesly Lam, Van Anh Sylvie Tran, Denis Projean, Jean-François Tessier, Laurence Lepage, Paul Gavra, Georges Ouellet, Michel Vallée, and Jean-Philippe Lafrance
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background and Objectives: There is a renewed interest in the successful use of aminoglycosides due to increasing resistance in gram-negative infections. Few studies to date have examined the pharmacokinetics (PK) of intradialytic infusions of tobramycin. This study sought to characterize the pharmacokinetic profile of intradialytically administered tobramycin in infected patients receiving chronic intermittent hemodialysis and to determine whether it is possible to achieve favorable PK targets. Design, Setting, Participants, and Measurements: In this prospective pharmacokinetic study, a single dose (5 mg/kg) of tobramycin was administered intradialytically to 11 noncritically ill patients undergoing chronic intermittent hemodialysis. Blood samples were collected at selected time to determine tobramycin serum concentrations. The PK analysis was performed using Phoenix™ NLME. The efficacy exposure outcome for nonsevere gram-negative infections sensitive to tobramycin with a minimum inhibitory concentration ≤1 were maximum concentration (Cmax ≥ 10 mg/L) and area under the curve (AUC24 h > 30 mg⋅h/L). For toxicity, the goal was to identify plasma trough concentrations
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- 2021
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3. Changes in Urinary and Serum Levels of Novel Biomarkers after Administration of Gadolinium-based Contrast Agents
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Habib Mawad, Louis-Philippe Laurin, Jean-François Naud, François A. Leblond, Nathalie Henley, Michel Vallée, Vincent Pichette, and Martine Leblanc
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Medicine (General) ,R5-920 - Published
- 2016
4. Association of Neutrophil-to-Lymphocyte Ratio With Inflammation and Erythropoietin Resistance in Chronic Dialysis Patients
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Jérôme Pineault, Caroline Lamarche, Robert Bell, Jean-Philippe Lafrance, Georges Ouellet, Martine Leblanc, Vincent Pichette, Sarah Bezzaoucha, and Michel Vallée
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background: Neutrophil-to-lymphocyte ratio (NLR) was widely studied as a prognostic marker in various medical and surgical specialties, but its significance in nephrology is not yet established. Objective: We evaluated its accuracy as an inflammation biomarker in a dialysis population. Design setting: Single-center retrospective study. Patients: The records of all 550 patients who were treated with hemodialysis (HD) or peritoneal dialysis (PD) from September 2008 to March 2011 were included. Measurements: NLR was calculated from the monthly complete blood count. Methods: Association between NLR and markers of inflammation (C-reactive protein [CRP], serum albumin, and erythropoietin resistance index [ERI]) was measured using Spearman coefficient. Results: In total, 120 patients were eligible for the correlation analyses. We found a positive correlation between NLR and CRP (all patients: r = 0.45, P < .001; HD: r = 0.47, P < .001; PD: r = 0.48, P = .13). NLR and albumin were inversely correlated ( r = −0.51, P < .001). Finally, high NLR was associated with a nonsignificant increased ERI, but we have not demonstrated a direct correlation. Limitations: CRP and albumin are not measured routinely and were ordered for a specific clinical reason leading to an indication bias. Also, no relationship with clinical outcome was established. Conclusions: NLR seems to be a good inflammatory biomarker in dialysis in addition to being easily available. However, controlled studies should be conducted to properly assess and validate NLR levels that would be clinically significant and relevant, as well as its prognostic significance and utility in a clinical setting.
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- 2017
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5. Retrospective Study Looking at Cinacalcet in the Management of Hyperparathyroidism after Kidney Transplantation
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Habib Mawad, Hugues Bouchard, Duy Tran, Denis Ouimet, Jean-Philippe Lafrance, Robert Zoël Bell, Sarah Bezzaoucha, Anne Boucher, Suzon Collette, Vincent Pichette, Lynne Senécal, and Michel Vallée
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Surgery ,RD1-811 - Abstract
Objectives. The primary objective of this study is to evaluate the use of cinacalcet in the management of hyperparathyroidism in kidney transplant recipients. The secondary objective is to identify baseline factors that predict cinacalcet use after transplantation. Methods. In this single-center retrospective study, we conducted a chart review of all patients having been transplanted from 2003 to 2012 and having received cinacalcet up to kidney transplantation and/or thereafter. Results. Twenty-seven patients were included with a mean follow-up of 2.9±2.4 years. Twenty-one were already taking cinacalcet at the time of transplantation. Cinacalcet was stopped within the first month in 12 of these patients of which 7 had to restart therapy. The main reason for restarting cinacalcet was hypercalcemia. Length of treatment was 23±26 months. There were only 3 cases of mild hypocalcemia. There was no statistically significant association between baseline factors and cinacalcet status a year later. Conclusions. Discontinuing cinacalcet within the first month of kidney transplantation often leads to hypercalcemia. Cinacalcet appears to be an effective treatment of hypercalcemic hyperparathyroidism in kidney transplant recipients. Further studies are needed to evaluate safety and long-term benefits.
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- 2017
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6. Epilogue
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Michel Vallée and Tullio Caputo
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The family. Marriage. Woman ,HQ1-2044 ,Sociology (General) ,HM401-1281 - Published
- 2010
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7. Overview of Part II
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Michel Vallée and Tullio Caputo
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The family. Marriage. Woman ,HQ1-2044 ,Sociology (General) ,HM401-1281 - Published
- 2010
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8. Creating Safer Communities for Children and Youth: The Role of the Police in Crime Prevention
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Tullio Caputo and Michel Vallée
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crime prevention ,police ,Canada ,children ,youth ,The family. Marriage. Woman ,HQ1-2044 ,Sociology (General) ,HM401-1281 - Abstract
The authors examine the role of the police in crime prevention in the Canadian context, based on in-depth interviews with police officers in six police agencies across the country. They explore core policing functions and consider the role of the police in crime prevention. They discuss three recent studies of crime prevention practices in Canada, and focus in particular on Crime Prevention through Social Development (CPSD). The authors conclude that social development issues are not often seen as part of a core policing function. They argue that the police are in a unique position with respect to CPSD since they are well positioned to facilitate an integrated, multi-agency response to social problems. An alternative role for the police is discussed which would consolidate their law enforcement and crime prevention roles through the facilitation of an integrated problem solving approach based on partnerships with other service agencies.
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- 2010
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9. Introduction
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Michel Vallée and Tullio Caputo
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The family. Marriage. Woman ,HQ1-2044 ,Sociology (General) ,HM401-1281 - Published
- 2010
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10. An Historical Overview of Crime Prevention Initiatives in Canada: A Federal Perspective
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Michel Vallée
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crime prevention ,government ,social development ,Canada ,overview ,The family. Marriage. Woman ,HQ1-2044 ,Sociology (General) ,HM401-1281 - Abstract
The author provides an historical overview of crime prevention activities in Canada that have led to the federal government’s current direction in crime prevention policy. Drawing on more than 30 years experience as a federal public servant with the Ministry of the Solicitor General and Justice Canada, the author traces more than 100 years of Canadian federal crime prevention efforts, with an emphasis on both internal and external government documents and historic material from the Royal Canadian Mounted Police. This brief history of crime prevention efforts in Canada shows a clear trajectory from the mid-1980s onward, towards support for more comprehensive and integrated community-based crime prevention activities. The interventions are increasingly aimed at community safety, health, and well-being while involving the police, other service providers, as well as community members in the process.
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- 2010
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11. Crime Prevention and Community Safety: A Conceptual Overview
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Michel Vallée
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crime prevention ,public opinion ,victimization ,The family. Marriage. Woman ,HQ1-2044 ,Sociology (General) ,HM401-1281 - Abstract
The author explores some of the factors that have influenced the public debate in Canada over issues of crime and victimization, particularly with reference to children and youth as both perpetrators and victims. Focusing specifically on various approaches to crime prevention, he discusses some of the key elements of a comprehensive crime prevention strategy and argues that for such a strategy to be meaningful and effective, it should be a community-based social development approach.
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- 2010
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12. Multidisciplinary Perspectives of Current Approaches and Clinical Gaps in the Management of Hyperphosphatemia
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Michel Vallée, Marisa Battistella, Jordan Weinstein, Roxanne Papineau, Gordon Wong, and Dianne Moseley
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,Review ,law.invention ,Ectopic calcification ,chemistry.chemical_compound ,Hyperphosphatemia ,Randomized controlled trial ,law ,medicine ,phosphate binders ,Intensive care medicine ,education ,Dialysis ,phosphate ,education.field_of_study ,business.industry ,medicine.disease ,Phosphate ,nutrition ,chemistry ,Tolerability ,Nephrology ,business ,chronic kidney disease ,Kidney disease - Abstract
Population-based studies have shown that most patients with advanced chronic kidney disease (CKD) do not have optimal phosphate levels. Meta-analyses suggest that there is a morbidity and mortality benefit associated with the lowering of serum phosphate levels. However, to date there is no conclusive evidence from randomized controlled trials (RCTs) that lowering serum phosphate levels reduces the risk of morbidity and mortality. However, hyperphosphatemia may pose a risk to patients and treatment should be considered. We therefore sought to conduct a multidisciplinary review to help guide clinical decision-making pending results of ongoing RCTs. Restricting dietary phosphate intake is frequently the first step in the management of hyperphosphatemia. Important considerations when proposing dietary restriction include the patient’s socioeconomic status, lifestyle, dietary preferences, comorbidities, and nutritional status. While dietary phosphate restriction may be a valid strategy in certain patients, serum phosphate reductions achieved solely by limiting dietary intake are modest and should be considered in conjunction with other interventions. Conventional dialysis is also typically insufficient; however phosphate removal may be augmented by increased frequency or duration of dialysis, or through enhanced methods such as hemodiafiltration. Phosphate binders have been shown to reduce absorption of dietary phosphate and lower serum phosphate levels. There are several phosphate binders available, and while they all lower phosphate levels to variable degrees, they differ with respect to their pill burden, potential to induce or exacerbate vascular calcification or ectopic calcification, tissue accumulation, safety, and tolerability. The widespread treatment of hyperphosphatemia requires convincing data from RCTs to ascertain whether lowering serum phosphate levels improves patient-important outcomes, as well as the optimal method and degree of phosphate control. In the interim, the decision and approach used to treat hyperphosphatemia should be based on the best available data, as well as patient needs and clinical judgment.
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- 2021
13. Hypertension Canada’s 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children
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Robert A. Hegele, Peter Bolli, Milan Gupta, Steven A. Grover, Swapnil Hiremath, Andrew C. Don-Wauchope, Tabassum Firoz, Evelyne Rey, Simon W. Rabkin, Mike Sharma, Jonathan Y. Gabor, Fady Hannah-Shmouni, Charlotte Jones, Richard E. Gilbert, Janusz Kaczorowski, Vincent Woo, Janis M. Dionne, Alexander A. Leung, Sonia Butalia, Peter Selby, Tavis S. Campbell, Praveena Sivapalan, Ernesto L. Schiffrin, Andrew L. Pipe, André Michaud, Kevin C. Harris, Ruth Sapir-Pichhadze, Michael Roerecke, S. Brian Penner, Donna McLean, Luc Trudeau, Stella S. Daskalopoulou, Alexander G. Logan, Patrice Lindsay, Kim L. Lavoie, Meranda Nakhla, Anne Fournier, Alain Milot, Ellen Burgess, Gordon W. Moe, Jeffrey E. Alfonsi, Birinder K. Mangat, Alan Bell, Kelly B. Zarnke, Simon L. Bacon, Steven E. Gryn, Maxime Lamarre-Cliche, Ally P.H. Prebtani, Philip A. McFarlane, JoAnne Arcand, Nadia A. Khan, Ross T. Tsuyuki, Karen Tran, Michael D. Hill, Marcel Ruzicka, Jean Grégoire, François Audibert, George Honos, Michel Vallée, Kerry McBrien, Jesse Bittman, Laura A. Magee, Sheldon W. Tobe, Sandra M. Dumanski, Jonathan G. Howlett, Anne-Marie Côté, Ross D. Feldman, Geneviève Benoit, Doreen M. Rabi, Richard Lewanczuk, Kara Nerenberg, Laura M. Kuyper, Cedric Edwards, Lyne Cloutier, Raymond R. Townsend, Lawrence A. Leiter, George K. Dresser, Sofia B. Ahmed, Robert J. Herman, Alexandre Y Poppe, Ashkan Shoamanesh, and Gregory L. Hundemer
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Adult ,Canada ,medicine.medical_specialty ,Telemedicine ,Pregnancy Complications, Cardiovascular ,Drug Resistance ,Pharmacy ,Health Promotion ,030204 cardiovascular system & hematology ,Risk Assessment ,Preconception Care ,Medication Adherence ,Diabetes Complications ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Child ,Antihypertensive Agents ,Heart Failure ,business.industry ,Guideline ,Blood Pressure Monitoring, Ambulatory ,Stroke ,Masked Hypertension ,Health promotion ,Cardiovascular Diseases ,Family medicine ,Hypertension ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Algorithms - Abstract
Hypertension Canada's 2020 guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children provide comprehensive, evidence-based guidance for health care professionals and patients. Hypertension Canada develops the guidelines using rigourous methodology, carefully mitigating the risk of bias in our process. All draft recommendations undergo critical review by expert methodologists without conflict to ensure quality. Our guideline panel is diverse, including multiple health professional groups (nurses, pharmacy, academics, and physicians), and worked in concert with experts in primary care and implementation to ensure optimal usability. The 2020 guidelines include new guidance on the management of resistant hypertension and the management of hypertension in women planning pregnancy.
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- 2020
14. A case of secondary hyperparathyroidism in a patient on hemodialysis with parathormone levels within the targets and high total alkaline phosphatase
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Benoit Imbeault, Jessica Kachmar, Marie-Eve Dupuis, Caroline Albert, and Michel Vallée
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,medicine ,Secondary hyperparathyroidism ,General Medicine ,Hemodialysis ,Total alkaline phosphatase ,business ,medicine.disease ,Gastroenterology - Published
- 2021
15. Characterizing Hypertension Specialist Care in Canada: A National Survey
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Samantha Lui, MD, Lisa Dubrofsky, MD, Nadia A. Khan, MD, MSc, Sheldon W. Tobe, MD, Jessica Huynh, MD, MHSc, Laura Kuyper, MD, Anna Mathew, MD, Syed Amin, MD, Ernesto L. Schiffrin, MD, PhD, Paula Harvey, MD, BMBS, PhD, Alexander A. Leung, MD, MPH, Marcel Ruzicka, MD, PhD, Birinder Mangat, MD, MPH, David Reid, MD, John Floras, MD, Jesse Bittman, MD, Lauren Garbutt, MD, Branko Braam, MD, Rita Suri, MD, MSc, Fady Hannah-Shmouni, MD, Ally Prebtani, MD, BScPhm, Sebastien Savard, MD, Thomas E. MacMillan, MD, MSc, Terrence D. Ruddy, MD, Michel Vallee, MD, Apoorva Bollu, MD, Alexander Logan, MD, Raj Padwal, MD, MSc, and Jennifer Ringrose, MD, MSc
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: The hypertension specialist often receives referrals of patients with young-onset, severe, difficult-to-control hypertension, patients with hypertensive emergencies, and patients with secondary causes of hypertension. Specialist hypertension care compliments primary care for these complex patients and contributes to an overall hypertension control strategy. The objective of this study was to characterize hypertension centres and the practice patterns of Canadian hypertension specialists. Methods: Adult hypertension specialists across Canada were surveyed to describe hypertension centres and specialist practice in Canada, including the following: the patient population managed by hypertension specialists; details on how care is provided; practice pattern variations; and differences in access to specialized hypertension resources across the country. Results: The survey response rate was 73.5% from 25 hypertension centres. Most respondents were nephrologists and general internal medicine specialists. Hypertension centres saw between 50 and 2500 patients yearly. A mean of 17% (± 15%) of patients were referred from the emergency department and a mean of 52% (± 24%) were referred from primary care. Most centres had access to specialized testing (adrenal vein sampling, level 1 sleep studies, autonomic testing) and advanced therapies for resistant hypertension (renal denervation). Considerable heterogeneity was present in the target blood pressure in young people with low cardiovascular risk and in the diagnostic algorithms for investigating secondary causes of hypertension. Conclusions: These results summarize the current state of hypertension specialist care and highlight opportunities for further collaboration among hypertension specialists, including standardization of the approach to specialist care for patients with hypertension. Résumé: Contexte: Le spécialiste de l’hypertension reçoit souvent des patients orientés pour une hypertension sévère, d’apparition précoce et difficile à maîtriser, pour une urgence hypertensive ou pour des causes secondaires de l’hypertension. Les soins spécialisés de l’hypertension complètent les soins primaires pour ces cas complexes et font partie d’une stratégie globale de maîtrise de l’hypertension. Cette étude avait pour objectif de caractériser les centres de traitement de l’hypertension et les habitudes de pratique des spécialistes canadiens qui traitent l’hypertension. Méthodologie: Un sondage a été mené auprès de spécialistes de l’hypertension adulte de l’ensemble du Canada afin de décrire les centres de traitement de l’hypertension et la pratique des spécialistes au Canada, notamment les éléments suivants : la population de patients prise en charge par des spécialistes de l’hypertension, les renseignements sur la façon dont les soins sont prodigués, les variations dans les habitudes de pratique ainsi que les différences relatives à l’accès aux ressources spécialisées en hypertension à l’échelle du pays. Résultats: Le taux de réponse au sondage a été de 73,5 % dans 25 centres de l’hypertension. La plupart des répondants étaient des néphrologues et des spécialistes en médecine interne générale. Les centres de l’hypertension recevaient entre 50 et 2500 patients par année. En moyenne, 17 % (± 15 %) des patients provenaient du service des urgences et 52 % (± 24 %) provenaient d’une unité de soins primaires. La plupart des centres avaient accès à des tests spécialisés (prélèvements veineux surrénaliens, études du sommeil de niveau 1, tests autonomes) et à des traitements avancés pour l’hypertension résistante (dénervation rénale). Une hétérogénéité considérable a été constatée en ce qui concerne la pression artérielle cible chez les jeunes présentant un faible risque cardiovasculaire et les algorithmes diagnostiques pour étudier les causes secondaires de l’hypertension. Conclusions: Ces résultats résument la situation actuelle des soins spécialisés de l’hypertension et font ressortir des occasions d’accroître la collaboration entre les spécialistes de l’hypertension, notamment en ce qui concerne une normalisation de l’approche des soins spécialisés pour les patients hypertendus.
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- 2023
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16. Aminoglycosides administration at the end of the hemodialysis session: A pharmacokinetic failure?
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Georges Ouellet, Michel Vallée, Jean-Phillipe Lafrance, Jean-Francois Tessier, Katherine Desforges, and Laurence Lepage
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Pharmacology ,business.industry ,medicine.medical_treatment ,MEDLINE ,Anti-Bacterial Agents ,Aminoglycosides ,Pharmacokinetics ,Renal Dialysis ,Anesthesia ,Medicine ,Humans ,Pharmacology (medical) ,Hemodialysis ,Session (computer science) ,business ,Administration (government) - Published
- 2020
17. The usefulness of thiazide and thiazide-like diuretics in advanced chronic kidney disease
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Pape-Mamadou Sene and Michel Vallée
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Pharmacology ,medicine.medical_specialty ,business.industry ,Urology ,medicine.disease ,Thiazides ,Hypertension ,Medicine ,Humans ,Pharmacology (medical) ,Renal Insufficiency, Chronic ,business ,Diuretics ,Thiazide ,Kidney disease ,medicine.drug - Published
- 2019
18. The 2017 American College of Cardiology/American Heart Association vs Hypertension Canada High Blood Pressure Guidelines and Potential Implications
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Maxime Lamarre-Cliche, Rémi Goupil, and Michel Vallée
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Canada ,medicine.medical_specialty ,business.industry ,Patient Selection ,Cardiology ,MEDLINE ,030204 cardiovascular system & hematology ,United States ,Patient Care Management ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Internal medicine ,Hypertension ,Practice Guidelines as Topic ,Cohort ,medicine ,Humans ,Voluntary Health Agencies ,030212 general & internal medicine ,Hypertension diagnosis ,Cardiology and Cardiovascular Medicine ,business ,health care economics and organizations - Abstract
In this report we examine the differences between the 2017 Hypertension Canada and 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure (BP) guidelines regarding the proportions of individuals with a diagnosis of hypertension, BP above thresholds for treatment initiation, and BP below targets using the CARTaGENE cohort. Compared with the 2017 Canadian guidelines, the 2017 ACC/AHA guidelines would result in increases of 8.7% in hypertension diagnosis and 3.4% of individuals needing treatment, with 17.2% having a different BP target. In conclusion, implementing the 2017 ACC/AHA hypertension guidelines in Canada could result in major effects for millions of Canadians.
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- 2018
19. Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children
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Lyne Cloutier, G. V. Ramesh Prasad, George K. Dresser, Steven E. Gryn, Kara Nerenberg, Sonia Butalia, Alexander A. Leung, Andrew C. Don-Wauchope, Vincent Woo, Karen C. Tran, Simon L. Bacon, Laura M. Kuyper, Andrew L. Pipe, Marcel Ruzicka, George Honos, Milan Gupta, Janusz Feber, Richard Lewanczuk, Pavel Hamet, Gordon W. Moe, Kerry McBrien, Kevin C. Harris, Evelyne Rey, Theodore Wein, Mike Sharma, Donna McLean, Tavis S. Campbell, Ally P.H. Prebtani, Michael Roerecke, Robert A. Hegele, Peter Bolli, Janis M. Dionne, Swapnil Hiremath, Raj Padwal, Geneviève Benoit, Michel Vallée, Simon W. Rabkin, Guy Tremblay, Stella S. Daskalopoulou, S. Brian Penner, Sheldon W. Tobe, Thalia S. Field, Janusz Kaczorowski, Laura A. Magee, Ernesto L. Schiffrin, Meranda Nakhla, Charlotte Jones, Kaberi Dasgupta, Richard E. Gilbert, Anne-Marie Côté, JoAnne Arcand, Ross D. Feldman, Jean Grégoire, Tabassum Firoz, Alexander G. Logan, Michael D. Hill, Steven A. Grover, Alain Milot, Jonathan Y. Gabor, Peter Selby, Luc Trudeau, Philip A. McFarlane, Ellen Burgess, Patrice Lindsay, Maxime Lamarre-Cliche, Ross T. Tsuyuki, Praveena Sivapalan, Norman R.C. Campbell, Jonathan G. Howlett, Kim L. Lavoie, Anne Fournier, Doreen M. Rabi, Kelly B. Zarnke, Lawrence A. Leiter, Paul Oh, Cedric Edwards, Robert J. Herman, Raymond R. Townsend, Mark Gelfer, Gregory A. Kline, Ashkan Shoamanesh, and Luc Poirier
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lifestyle ,medicine.medical_specialty ,hypertension ,Ambulatory blood pressure ,pediatrics ,blood pressure measurement ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Renal artery stenosis ,tobacco ,pharmacotherapy ,03 medical and health sciences ,0302 clinical medicine ,adults ,medicine ,guidelines ,030212 general & internal medicine ,global cardiovascular risk ,automated blood pressure ,renal artery stenosis ,primary aldosteronism ,Ejection fraction ,business.industry ,Guideline ,Thrombolysis ,medicine.disease ,diagnostic algorithm ,pheochromocytoma ,smoking cessation ,home blood pressure monitoring ,ambulatory blood pressure monitoring ,lipid profile ,Blood pressure ,Heart failure ,recommendations ,Emergency medicine ,renovascular disease ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,high blood pressure - Abstract
Hypertension Canada provides annually-updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines were introduced, and one existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke was revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
- Published
- 2018
20. Conversion of oral alfacalcidol to oral calcitriol in the treatment of secondary hyperparathyroidism in chronic hemodialysis patients
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Georges Ouellet, Michel Vallée, Vincent Pichette, Caroline Lamarche, Sarah Bezzaoucha, Robert Bell, Martine Leblanc, Sandrine Rauscher, Laurence Lepage, Katherine Desforges, Denis Ouimet, and Jean-Philippe Lafrance
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Adult ,Male ,Vitamin ,Nephrology ,Canada ,medicine.medical_specialty ,Calcitriol ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Parathyroid hormone ,030204 cardiovascular system & hematology ,Gastroenterology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Drug Substitution ,Hydroxycholecalciferols ,business.industry ,Alfacalcidol ,Phosphorus ,Middle Aged ,medicine.disease ,Uremia ,Patient Outcome Assessment ,Endocrinology ,chemistry ,Parathyroid Hormone ,Kidney Failure, Chronic ,Calcium ,Female ,Hyperparathyroidism, Secondary ,Secondary hyperparathyroidism ,Hemodialysis ,Drug Monitoring ,business ,medicine.drug - Abstract
The optimal vitamin D3 therapy for the treatment of secondary hyperparathyroidism (SHPT) in chronic hemodialysis patients is still controversial. Recent studies suggest that uremia in end-stage renal disease is associated with enzymatic hepatic dysfunction altering 25-hydroxylation of vitamin D3. The goal of our study was to compare the efficacy of calcitriol, the fully hydroxylated active form of vitamin D3, to alfacalcidol which needs 25-hydroxylation to be effective, for the treatment of SHPT in chronic hemodialysis patients. We retrospectively reviewed 45 chronic hemodialysis patients who were switched from oral alfacalcidol to oral calcitriol for the treatment of SHPT. Parathyroid hormone (PTH), serum calcium and serum phosphorus levels were compared pre- and post-conversion using paired Student’s t tests. The mean dose of active vitamin D3 decreased from 3.50 mcg/week at baseline to 2.86 mcg (P
- Published
- 2016
21. Association of Neutrophil-to-Lymphocyte Ratio With Inflammation and Erythropoietin Resistance in Chronic Dialysis Patients
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Jean-Philippe Lafrance, Vincent Pichette, Caroline Lamarche, Jérôme Pineault, Martine Leblanc, Sarah Bezzaoucha, Georges Ouellet, Michel Vallée, and Robert Bell
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Nephrology ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Inflammation ,030204 cardiovascular system & hematology ,lcsh:RC870-923 ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Research Letter ,Medicine ,Neutrophil to lymphocyte ratio ,Dialysis ,neutrophil-to-lymphocyte ratio (NLR) ,business.industry ,fungi ,lcsh:Diseases of the genitourinary system. Urology ,Chronic dialysis ,Erythropoietin ,inflammation ,Biomarker (medicine) ,dialysis ,biomarker ,medicine.symptom ,business ,medicine.drug - Abstract
Neutrophil-to-lymphocyte ratio (NLR) was widely studied as a prognostic marker in various medical and surgical specialties, but its significance in nephrology is not yet established.We evaluated its accuracy as an inflammation biomarker in a dialysis population.Single-center retrospective study.The records of all 550 patients who were treated with hemodialysis (HD) or peritoneal dialysis (PD) from September 2008 to March 2011 were included.NLR was calculated from the monthly complete blood count.Association between NLR and markers of inflammation (C-reactive protein [CRP], serum albumin, and erythropoietin resistance index [ERI]) was measured using Spearman coefficient.In total, 120 patients were eligible for the correlation analyses. We found a positive correlation between NLR and CRP (all patients:CRP and albumin are not measured routinely and were ordered for a specific clinical reason leading to an indication bias. Also, no relationship with clinical outcome was established.NLR seems to be a good inflammatory biomarker in dialysis in addition to being easily available. However, controlled studies should be conducted to properly assess and validate NLR levels that would be clinically significant and relevant, as well as its prognostic significance and utility in a clinical setting.La qualité de marqueur pronostique du ratio neutrophiles/lymphocytes a fait l’objet d’études approfondies dans plusieurs disciplines médicales et spécialités chirurgicales. En revanche, son importance n’est toujours pas établie dans le domaine de la néphrologie.Nous avons voulu évaluer l’efficacité du ratio neutrophiles/lymphocytes comme biomarqueur de l’inflammation chez une population de patients dialysés.Il s’agit d’une étude rétrospective restreinte à un seul établissement.Les dossiers médicaux des 550 patients ayant été traités par hémodialyse (HD) ou par dialyse péritonéale (DP) entre septembre 2008 et mars 2011 ont été retenus pour cette étude.Le ratio neutrophiles/lymphocytes a été calculé à partir de la formule sanguine complète prélevée mensuellement.On a utilisé le coefficient de Spearman pour mesurer la corrélation entre le ratio neutrophiles/lymphocytes et certains marqueurs de l’inflammation : la protéine C-réactive, l’albumine sérique et l’index de résistance à l’érythropoïétine (IRE).De tous les dossiers médicaux retenus, seuls 120 patients étaient admissibles à l’analyse de corrélation. Nous avons pu établir une corrélation positive entre le ratio neutrophiles/lymphocytes et la protéine C-réactive (r=0,45;Règle générale, l’albumine sérique et la protéine C-réactive ne sont mesurées que lorsqu’une raison d’ordre clinique le demande, ce qui pourrait signaler un biais. De plus, aucun lien n’a été établi entre le ratio neutrophiles/lymphocytes et les devenirs cliniques des patients.Le calcul du ratio neutrophiles/lymphocytes semble être un bon indicateur de l’état inflammatoire chez les patients dialysés. Qui plus est, les données nécessaires pour évaluer ce ratio sont faciles à obtenir. Néanmoins, des études contrôlées devraient être menées pour déterminer les valeurs de ratio neutrophiles/lymphocytes qui seraient significatives du point de vue clinique, de même que pour établir l’importance du ratio neutrophiles/lymphocytes sur le plan du pronostic et sa pertinence dans un cadre clinique.
- Published
- 2017
22. The effect of lanthanum carbonate on metabolic acidosis in patients with chronic kidney disease stage IV, V and V-D
- Author
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William Beaubien-Souligny, Jean-Philippe Lafrance, Caroline Lamarche, Robert Bell, Denis Ouimet, Sarah Bezzaoucha, Vincent Pichette, and Michel Vallée
- Subjects
Male ,Nephrology ,Canada ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Nutritional Status ,Kidney Function Tests ,urologic and male genital diseases ,Gastroenterology ,Metabolic bone disease ,Peritoneal dialysis ,Hyperphosphatemia ,Lanthanum ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Renal Insufficiency, Chronic ,Dialysis ,Chelating Agents ,Retrospective Studies ,business.industry ,Patient Acuity ,Metabolic acidosis ,Middle Aged ,medicine.disease ,Bicarbonates ,Lanthanum carbonate ,Treatment Outcome ,Endocrinology ,Disease Progression ,Female ,Drug Monitoring ,Acidosis ,business ,Kidney disease ,medicine.drug - Abstract
Hyperphosphatemia and metabolic acidosis are frequently encountered in advanced chronic kidney disease (CKD) patients. Correction of metabolic acidosis in patients with advanced CKD leads to a decrease in the progression of renal impairment and improves nutritional outcomes. Lanthanum carbonate is used for control of hyperphosphatemia. This study evaluated the effect of lanthanum carbonate on metabolic acidosis in CKD IV-V patients and in patients on dialysis.Retrospective data of patients in whom lanthanum carbonate therapy was initiated were collected from 2009 to 2013 in a single dialysis center. Of the 79 patients in whom lanthanum carbonate was introduced, 51 patients were included in the analysis. Of the 51 patients, 39 patients received chronic hemodialysis, two patients received peritoneal dialysis therapy, and 10 patients had stage IV-V CKD not on dialysis. The primary outcome was the serum bicarbonate change after the introduction of lanthanum carbonate.There was a significant increase in mean serum bicarbonate concentration of 2.79 mmol/L (p ≤ 0.001) compared to baseline. The increase remained in the CKD IV-V patients (2.50 mmol/L, p = 0.005) and in the patients on dialysis (2.81 mmol/L, p0.001). Serum bicarbonate remained higher (p0.05) than baseline up to 6 months after lanthanum carbonate introduction.In this study, lanthanum carbonate introduction increased serum bicarbonate concentration in a small sample of CKD IV-V patients and in patients on dialysis. Further studies are needed to confirm this effect and investigate whether the correction of metabolic acidosis by using lanthanum carbonate in CKD IV-V patients can improve clinical outcomes.
- Published
- 2015
23. Outcomes of Infection-Related Hospitalization according to Dialysis Modality
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Naoual Elftouh, Hind Harrak, Louis-Philippe Laurin, Michel Vallée, Jean-Philippe Lafrance, and Denis Ouimet
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Male ,medicine.medical_specialty ,Time Factors ,Epidemiology ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Patient Readmission ,Peritoneal dialysis ,Renal Dialysis ,Risk Factors ,Sepsis ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,Propensity Score ,Dialysis ,Survival analysis ,Aged ,Retrospective Studies ,Transplantation ,business.industry ,Hazard ratio ,Quebec ,Retrospective cohort study ,Pneumonia ,Original Articles ,Middle Aged ,Confidence interval ,Surgery ,Nephrology ,Propensity score matching ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business ,Peritoneal Dialysis - Abstract
Background and objectives Peritoneal dialysis (PD) is associated with an increased risk of infection-related hospitalization (IRH) compared with hemodialysis. The objective of this study was to compare mortality and overall readmission after an IRH between PD and hemodialysis. Design, setting, participants, & measurements This propensity score–matched retrospective cohort study assessed patients undergoing long-term dialysis patients, derived from the Canadian Organ Replacement Register and Regie de l’assurance maladie du Quebec, who had at least one IRH between January 2001 and December 2007. Patients were followed until death, kidney transplantation, or end of the study period. To estimate the probability of receiving PD versus hemodialysis, propensity scores were obtained using multivariable logistic regression. Mortality and overall readmission risks after the initial IRH were compared using a Cox survival model. Results A total of 354 pairs of patients who had at least one IRH were matched for propensity score. During follow-up (median, 1.25 years), 138 hemodialysis patients (24.7/100 patient-years; 95% confidence interval [95% CI], 20.7 to 29.1) and 130 PD patients (21.2/100 patient-years; 95% CI, 17.7 to 25.1) died; 265 hemodialysis patients (144.6/100 patient-years; 95% CI, 127.7 to 163.1) and 299 PD patients (173.2/100 patient-years; 95% CI, 154.1 to 194.0) were readmitted for any cause; and 121 hemodialysis patients (29.7/100 patient-years; 95% CI, 24.7 to 35.5) and 168 PD patients (44.7/100 patient-years; 95% CI, 38.2 to 52.0) were readmitted for an infection. Compared with hemodialysis, PD was not associated with a different mortality risk after an IRH (hazard ratio [HR], 0.87; 95% CI, 0.69 to 1.11). PD was associated with a higher risk of infection-related overall readmission compared with hemodialysis (HR, 1.44; 95% CI, 1.14 to 1.81), but not with the risk of all-cause overall readmission (HR, 1.15; 95% CI, 0.98 to 1.36). Conclusions PD was not associated with higher mortality or all-cause overall readmission following an IRH compared with hemodialysis, but PD patients were at higher risk of infection-related overall readmission after IRH. IRHs are associated with significant mortality and overall readmissions. Evaluation of strategies to reduce infections in both hemodialysis and PD recipients are needed to improve patient care and outcomes.
- Published
- 2015
24. Single-Pill Combinations in the Treatment of Hypertension in Adults: Beyond Convenience
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Michel Vallée and Benoit Imbeault
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Drug ,Adult ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,media_common.quotation_subject ,Physical exercise ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Weight loss ,Internal Medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Intensive care medicine ,Antihypertensive Agents ,media_common ,business.industry ,Disease Management ,General Medicine ,Drug Combinations ,Blood pressure ,Pill ,Hypertension ,Smoking cessation ,medicine.symptom ,Patient motivation ,business - Abstract
Adequate blood pressure control in patients with hypertension remains the pillar of cardiovascular-event prevention. Smoking cessation, reduced dietary salt intake, physical exercise and weight loss contribute to better blood pressure control and reduced cardiovascular morbidity, but alone, they are often insufficient in doing so, and their success is highly dependent on individual patient motivation. Pharmacologic therapy, thus, remains necessary for most patients, and our conception of the optimal way of approaching this therapy has evolved over the past decade. Traditionally, monotherapy using a first-line drug was initiated and uptitrated, with the addition of other antihypertensive agents as needed. The latest Hypertension Canada guidelines, however, now recommend first-line treatment with single-pill combinations in patients without compelling indications for treatment. In this review, we discuss the evidence behind this recommendation and how single-pill combinations can improve patient care.
- Published
- 2017
25. Retrospective Study Looking at Cinacalcet in the Management of Hyperparathyroidism after Kidney Transplantation
- Author
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Vincent Pichette, Michel Vallée, Sarah Bezzaoucha, Robert Bell, Hugues Bouchard, Anne Boucher, Lynne Senécal, Denis Ouimet, Jean-Philippe Lafrance, Duy Tran, Habib Mawad, and Suzon Collette
- Subjects
Hyperparathyroidism ,Pediatrics ,medicine.medical_specialty ,Cinacalcet ,Article Subject ,business.industry ,030232 urology & nephrology ,lcsh:Surgery ,Retrospective cohort study ,lcsh:RD1-811 ,030230 surgery ,medicine.disease ,Kidney transplant ,Surgery ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Chart review ,Clinical Study ,medicine ,Effective treatment ,business ,Kidney transplantation ,medicine.drug - Abstract
Objectives.The primary objective of this study is to evaluate the use of cinacalcet in the management of hyperparathyroidism in kidney transplant recipients. The secondary objective is to identify baseline factors that predict cinacalcet use after transplantation.Methods.In this single-center retrospective study, we conducted a chart review of all patients having been transplanted from 2003 to 2012 and having received cinacalcet up to kidney transplantation and/or thereafter.Results.Twenty-seven patients were included with a mean follow-up of2.9±2.4years. Twenty-one were already taking cinacalcet at the time of transplantation. Cinacalcet was stopped within the first month in 12 of these patients of which 7 had to restart therapy. The main reason for restarting cinacalcet was hypercalcemia. Length of treatment was23±26months. There were only 3 cases of mild hypocalcemia. There was no statistically significant association between baseline factors and cinacalcet status a year later.Conclusions.Discontinuing cinacalcet within the first month of kidney transplantation often leads to hypercalcemia. Cinacalcet appears to be an effective treatment of hypercalcemic hyperparathyroidism in kidney transplant recipients. Further studies are needed to evaluate safety and long-term benefits.
- Published
- 2017
26. Trends in infection-related hospital admissions and impact of length of time on dialysis among patients on long-term dialysis: a retrospective cohort study
- Author
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Sameena Iqbal, Naoual Elftouh, Michel Vallée, Louis-Philippe Laurin, Jean-Philippe Lafrance, and Elham Rahme
- Subjects
medicine.medical_specialty ,Future studies ,Long term dialysis ,business.industry ,Research ,medicine.medical_treatment ,Retrospective cohort study ,General Medicine ,Peritoneal dialysis ,Cohort ,Emergency medicine ,Epidemiology ,medicine ,Hemodialysis ,business ,Dialysis - Abstract
BACKGROUND After cardiovascular disease, infection is the second leading reason for admission to hospital among patients receiving long-term dialysis. We examined whether duration of dialysis treatment influences the rate of infection-related admission to hospital. METHODS Using provincial administrative databases for Quebec, we built a retrospective cohort of all adults receiving long-term dialysis (hemodialysis or peritoneal dialysis) between 2001 and 2007. We evaluated rates of infection-related admission to hospital according to length of time on dialysis. RESULTS A cohort of 9822 patients (mean age 66.3 [standard deviation ± 14.7] yr; 39.7% female) were followed for a median of 2.1 (range 1.0-3.9) years. Between 2001 and 2007, infection-related hospital admissions remained stable (from 0.20 to 0.19 per person-year; p = 0.7). All-cause hospital admission rates decreased by 22.9% (from 1.53 to 1.18 per person-year; p
- Published
- 2014
27. Retroperitoneal fibrosis: retrospective descriptive study on clinical features and management
- Author
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Robert Bell, Ann-Sophie Laroche, Eva Földes, Caroline Lamarche, Michel Vallée, and Sarah Bezzaoucha
- Subjects
renal failure ,medicine.medical_specialty ,retroperitoneal fibrosis ,Urology ,medicine.medical_treatment ,Retroperitoneal fibrosis ,03 medical and health sciences ,0302 clinical medicine ,hydronephrosis ,Refractory ,Prednisone ,Biopsy ,Back pain ,Medicine ,030212 general & internal medicine ,Hydronephrosis ,Original Research ,030203 arthritis & rheumatology ,medicine.diagnostic_test ,business.industry ,Research and Reports in Urology ,medicine.disease ,Nephrectomy ,Surgery ,Radiology ,Hemodialysis ,medicine.symptom ,business ,medicine.drug - Abstract
Ann-Sophie Laroche,1 Robert Z Bell,1 Sarah Bezzaoucha,1 Eva Földes,2 Caroline Lamarche,1 Michel Vallée11Section of Nephrology, 2Section of Internal Medicine, Department of Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada Introduction: Retroperitoneal fibrosis (RPF) is a rare condition characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encases the ureters or abdominal organs. This study describes the clinical characteristics, diagnostic methods, and treatments and their effects on renal function.Methods: We conducted a retrospective analysis of patients diagnosed with RPF at Maisonneuve-Rosemont Hospital.Results: We identified 17 patients with RPF between 1998 and 2013. Eight patients were females (47%), and the mean age was 62±18years. Eleven patients were idiopathic. Back pain was the most common symptom. All diagnoses were made based on the finding of a retroperitoneal mass on the computed tomography scan. Three patients had histological diagnosis of RPF and seven patients had unspecific changes on their biopsy. Twelve patients needed double-J stents, three patients had a temporary percutaneous nephrostomy, two patients had to have a nephrectomy for refractory ureteral obstruction, and one patient required hemodialysis. Ten patients with idiopathic RPF received medical treatment. In the treated group, only two patients had complete remission of the disease and five patients had improvement of their lesions. There were no deteriorations and only one relapse. Seven patients did not receive any treatment; two of them achieved complete remission, one of them deteriorated, and two of them had no changes.Conclusion: Most of our cases of RPF were idiopathic. Almost all treated patients received prednisone and seemed to respond, at least partially. There was a lot of heterogeneity in patient management, which makes it difficult to compare treatment effects. However, treated patients seemed to have more favorable outcomes than those who were not. Keywords: retroperitoneal fibrosis, hydronephrosis, renal failure
- Published
- 2016
28. The 2013 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension
- Author
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Daniel G. Hackam, Robert R. Quinn, Pietro Ravani, Doreen M. Rabi, Kaberi Dasgupta, Stella S. Daskalopoulou, Nadia A. Khan, Robert J. Herman, Simon L. Bacon, Lyne Cloutier, Martin Dawes, Simon W. Rabkin, Richard E. Gilbert, Marcel Ruzicka, Donald W. McKay, Tavis S. Campbell, Steven Grover, George Honos, Ernesto L. Schiffrin, Peter Bolli, Thomas W. Wilson, Ross D. Feldman, Patrice Lindsay, Michael D. Hill, Mark Gelfer, Kevin D. Burns, Michel Vallée, G.V. Ramesh Prasad, Marcel Lebel, Donna McLean, J. Malcolm O. Arnold, Gordon W. Moe, Jonathan G. Howlett, Jean-Martin Boulanger, Pierre Larochelle, Lawrence A. Leiter, Charlotte Jones, Richard I. Ogilvie, Vincent Woo, Janusz Kaczorowski, Luc Trudeau, Robert J. Petrella, Alain Milot, James A. Stone, Denis Drouin, Kim L. Lavoie, Maxime Lamarre-Cliche, Marshall Godwin, Guy Tremblay, Pavel Hamet, George Fodor, S. George Carruthers, George B. Pylypchuk, Ellen Burgess, Richard Lewanczuk, George K. Dresser, S. Brian Penner, Robert A. Hegele, Philip A. McFarlane, Mukul Sharma, Debra J. Reid, Sheldon W. Tobe, Luc Poirier, and Raj S. Padwal
- Subjects
Adult ,Aging ,Canada ,Cardiovascular Diseases ,Hypertension ,Humans ,Blood Pressure ,Blood Pressure Determination ,Cardiology and Cardiovascular Medicine ,Exercise ,Health Education ,Risk Assessment ,Antihypertensive Agents - Abstract
We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2013. This year's update includes 2 new recommendations. First, among nonhypertensive or stage 1 hypertensive individuals, the use of resistance or weight training exercise does not adversely influence blood pressure (BP) (Grade D). Thus, such patients need not avoid this type of exercise for fear of increasing BP. Second, and separately, for very elderly patients with isolated systolic hypertension (age 80 years or older), the target for systolic BP should be150 mm Hg (Grade C) rather than140 mm Hg as recommended for younger patients. We also discuss 2 additional topics at length (the pharmacological treatment of mild hypertension and the possibility of a diastolic J curve in hypertensive patients with coronary artery disease). In light of several methodological limitations, a recent systematic review of 4 trials in patients with stage 1 uncomplicated hypertension did not lead to changes in management recommendations. In addition, because of a lack of prospective randomized data assessing diastolic BP thresholds in patients with coronary artery disease and hypertension, no recommendation to set a selective diastolic cut point for such patients could be affirmed. However, both of these issues will be examined on an ongoing basis, in particular as new evidence emerges.
- Published
- 2013
29. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension
- Author
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Janis M. Dionne, Shelagh B. Coutts, Donna McLean, Mark Gelfer, Michel Vallée, Sheldon W. Tobe, Kara Nerenberg, Debra Reid, Milan Khara, Raj Padwal, Kaberi Dasgupta, Pierre Larochelle, Robert A. Hegele, Marcel Lebel, Vincent Woo, Peter Bolli, Patrice Lindsay, Gregory Moullec, Luc Trudeau, Gord Gubitz, Michael D. Hill, Robert J. Herman, Alexander G. Logan, Lyne Cloutier, Maxime Lamarre-Cliche, Philip A. McFarlane, Kim L. Lavoie, Charlotte Jones, Richard E. Gilbert, Janusz Kaczorowski, Steven A. Grover, Geneviève Benoit, Alain Milot, Ally P.H. Prebtani, Lawrence A. Leiter, G. V. Ramesh Prasad, George K. Dresser, Andrew L. Pipe, Milan Gupta, Swapnil Hiremath, George Fodor, Tavis S. Campbell, Kevin D. Burns, Simon W. Rabkin, Peter Selby, Stella S. Daskalopoulou, Alexander A. Leung, Norman R.C. Campbell, Simon L. Bacon, Richard I. Ogilvie, Thomas W. Wilson, Marcel Ruzicka, Ellen Burgess, Robert J. Petrella, Gordon W. Moe, Anne Fournier, Kevin C. Harris, George Honos, Kelly B. Zarnke, Paul Oh, Janusz Feber, Kerry McBrien, Laura A. Magee, Jean Grégoire, S. Brian Penner, Luc Poirier, Ernesto L. Schiffrin, Mukul Sharma, Jonathan G. Howlett, Doreen M. Rabi, Ross D. Feldman, Jean-Martin Boulanger, Pavel Hamet, Richard Lewanczuk, Denis Drouin, Guy Tremblay, and Scott A. Lear
- Subjects
medicine.medical_specialty ,Canada ,Hyperkalemia ,medicine.drug_class ,Secondary hypertension ,Calcium channel blocker ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Hyperaldosteronism ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Health Education ,Antihypertensive Agents ,Evidence-Based Medicine ,business.industry ,Blood Pressure Determination ,Guideline ,Evidence-based medicine ,medicine.disease ,Blood pressure ,Hypertension ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business - Abstract
Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force provides annually updated, evidence-based recommendations to guide the diagnosis, assessment, prevention, and treatment of hypertension. This year, we present 4 new recommendations, as well as revisions to 2 previous recommendations. In the diagnosis and assessment of hypertension, automated office blood pressure, taken without patient-health provider interaction, is now recommended as the preferred method of measuring in-office blood pressure. Also, although a serum lipid panel remains part of the routine laboratory testing for patients with hypertension, fasting and nonfasting collections are now considered acceptable. For individuals with secondary hypertension arising from primary hyperaldosteronism, adrenal vein sampling is recommended for those who are candidates for potential adrenalectomy. With respect to the treatment of hypertension, a new recommendation that has been added is for increasing dietary potassium to reduce blood pressure in those who are not at high risk for hyperkalemia. Furthermore, in selected high-risk patients, intensive blood pressure reduction to a target systolic blood pressure ≤ 120 mm Hg should be considered to decrease the risk of cardiovascular events. Finally, in hypertensive individuals with uncomplicated, stable angina pectoris, either a β-blocker or calcium channel blocker may be considered for initial therapy. The specific evidence and rationale underlying each of these recommendations are discussed. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will continue to provide annual updates.
- Published
- 2016
30. The 2012 Canadian Hypertension Education Program Recommendations for the Management of Hypertension: Blood Pressure Measurement, Diagnosis, Assessment of Risk, and Therapy
- Author
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Debra Reid, Robert J. Herman, Donna McLean, Philip A. McFarlane, Gordon W. Moe, Vincent Woo, Nadia A. Khan, Marcel Ruzicka, Ross D. Feldman, Rhian M. Touyz, Marshall Godwin, George Honos, Mark Gelfer, Tavis S. Campbell, Brenda R. Hemmelgarn, Richard Lewanczuk, S. George Carruthers, Robert R. Quinn, Robert A. Hegele, Peter Bolli, Donald W. McKay, M. Patrice Lindsay, George Pylypchuk, Stella S. Daskalopoulou, Simon W. Rabkin, Lyne Cloutier, Raj Padwal, Ellen Burgess, Robert J. Petrella, G. V. Ramesh Prasad, Simon L. Bacon, Luc Poirier, George K. Dresser, Denis Drouin, Daniel G. Hackam, Luc Trudeau, Thomas W. Wilson, Michael D. Hill, Pierre Larochelle, Ernesto L. Schiffrin, Pavel Hamet, George Fodor, Steven A. Grover, J. Malcolm O. Arnold, Michel Vallée, Brian Penner, Sheldon W. Tobe, Jonathan G. Howlett, Doreen M. Rabi, Richard I. Ogilvie, Lawrence A. Leiter, Jean-Martin Boulanger, Mukul Sharma, Janusz Kaczorowski, Kevin D. Burns, Martin Dawes, Marcel Lebel, James A. Stone, Charlotte Jones, Richard E. Gilbert, Norman R.C. Campbell, Maxime Lamarre-Cliche, Alain Milot, and Guy Tremblay
- Subjects
Adult ,Male ,Canada ,medicine.medical_specialty ,Risk Assessment ,Mineralocorticoid receptor ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Health Education ,Antihypertensive Agents ,Aged ,Monitoring, Physiologic ,Evidence-Based Medicine ,business.industry ,Blood Pressure Determination ,Atrial fibrillation ,Evidence-based medicine ,Middle Aged ,Prognosis ,medicine.disease ,Treatment Outcome ,Blood pressure ,Cardiovascular Diseases ,Heart failure ,Hypertension ,Practice Guidelines as Topic ,Physical therapy ,Cardiology ,Education, Medical, Continuing ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Kidney disease - Abstract
We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2012. The new recommendations are: (1) use of home blood pressure monitoring to confirm a diagnosis of white coat syndrome; (2) mineralocorticoid receptor antagonists may be used in selected patients with hypertension and systolic heart failure; (3) a history of atrial fibrillation in patients with hypertension should not be a factor in deciding to prescribe an angiotensin-receptor blocker for the treatment of hypertension; and (4) the blood pressure target for patients with nondiabetic chronic kidney disease has now been changed to < 140/90 mm Hg from < 130/80 mm Hg. We also reviewed the recent evidence on blood pressure targets for patients with hypertension and diabetes and continue to recommend a blood pressure target of less than 130/80 mm Hg.
- Published
- 2012
31. Treatment of Polyomavirus-Associated Nephropathy With the Association of Sirolimus and Leflunomide
- Author
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Caroline, Lamarche, Anne, Boucher, Raymond, Dandavino, Lynne, Senécal, Suzon, Collette, Duy, Tran, and Michel, Vallée
- Subjects
Sirolimus ,Polyomavirus Infections ,Humans ,Kidney Diseases ,Isoxazoles ,Antiviral Agents ,Kidney Transplantation ,Leflunomide ,Retrospective Studies - Published
- 2015
32. A case of an aortic dissection in a young adult: a refresher of the literature of this 'great masquerader'
- Author
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Vincent Pichette, Denis Ouimet, Michel Vallée, and Jérôme Pineault
- Subjects
Aortic dissection ,medicine.medical_specialty ,hypertension ,business.industry ,Mortality rate ,pleuritic chest pain ,Case Report ,General Medicine ,medicine.disease ,Chest pain ,Pericardial effusion ,Surgery ,Young age ,Pericarditis ,cardiovascular system ,Medicine ,Young adult ,Differential diagnosis ,medicine.symptom ,aortic dissection ,business - Abstract
Aortic dissection is often misdiagnosed, especially among young patients, and it is associated with a high mortality rate. We present here a case of fatal acute aortic dissection in a young man who was misdiagnosed with pericarditis. We reviewed the literature of acute aortic dissection in young people and we focused particularly on clinical presentations, outcomes and investigations of aortic dissection. We report a case of a 33-year-old man with a history of uncontrolled hypertension with acute pleuretic chest pain who was transferred to our hospital for suspected pulmonary embolism and died of acute hemorragic pericardial effusion from an ascendant aortic dissection. We should never rule out aortic dissection off our differential diagnosis on the sole basis of a patient's young age.
- Published
- 2011
33. Comparison of the prevalence of calcidiol insufficiency in predialysis and osteoporotic populations
- Author
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Alain Bonnardeaux, Lyne Sénécal, Martine Leblanc, Michel Vallée, Josée Bouchard, Denis Ouimet, Jean-Philippe Lafrance, Vincent Pichette, and Jean-Pierre Mathieu
- Subjects
Male ,Nephrology ,medicine.medical_specialty ,Urology ,Osteoporosis ,Population ,Renal function ,Parathyroid hormone ,Single Center ,Risk Assessment ,Gastroenterology ,Age Distribution ,Renal Dialysis ,Internal medicine ,Prevalence ,medicine ,Humans ,Renal Insufficiency, Chronic ,Sex Distribution ,education ,Aged ,Calcifediol ,Probability ,Aged, 80 and over ,education.field_of_study ,Hyperparathyroidism ,business.industry ,Middle Aged ,Vitamin D Deficiency ,medicine.disease ,Endocrinology ,Parathyroid Hormone ,Case-Control Studies ,Multivariate Analysis ,Linear Models ,Female ,Seasons ,business ,Biomarkers ,Follow-Up Studies ,Kidney disease - Abstract
Calcidiol insufficiency is highly prevalent in chronic kidney disease (CKD) and osteoporotic patients. We assessed and compared calcidiol levels in these two groups from the same geographical area to differentiate environmental factors from characteristics related to CKD.We measured calcidiol levels in 160 predialysis (group 1) and 53 osteoporotic (group 2) patients from a single center. Calcidiol insufficiency was defined as a level between 37.5 and 75 nmol/l and calcidiol deficiency was defined as a level below 37.5 nmol/l.In group 1, mean glomerular filtration rate (GFR), calcidiol, and parathyroid hormone (PTH) levels were 18.3 +/- 4.7 ml/min, 38.7 +/- 15.1 nmol/l, and 21.9 +/- 19.1 pmol/l. Calcidiol insufficiency and deficiency were present in 98.7% of patients. There was an inverse correlation between calcidiol and PTH levels (r = -0.25; P = 0.001). In group 2, mean GFR, calcidiol levels, and PTH levels were 68.6 +/- 17.6 ml/min, 73.8 +/- 27.1 nmol/l, and 4.23 +/- 1.83 pmol/l, respectively. Calcidiol insufficiency and deficiency were present in 50.9% of patients. There was an inverse correlation between calcidiol and PTH levels (r =-0.44; P = 0.02).In our predialysis population, calcidiol insufficiency and deficiency are present in almost every patient, being more common than previously reported. It is also more frequent than in a similar osteoporotic population, suggesting a cause unrelated to environmental factors. Interestingly, there is a significant inverse correlation between calcidiol and parathyroid levels in both populations. Further studies are needed to enable understanding of the mechanisms underlying calcidiol insufficiency.
- Published
- 2008
34. Reporting on sex-based analysis in clinical trials of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker efficacy
- Author
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Louise Pilote, Michel Vallée, S.W. Tobe, Nadia A. Khan, M.A. Hladunewich, and Doreen M. Rabi
- Subjects
medicine.medical_specialty ,Angiotensin receptor ,Angiotensin-Converting Enzyme Inhibitors ,law.invention ,Sex Factors ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Sex Distribution ,Randomized Controlled Trials as Topic ,biology ,business.industry ,Angiotensin-converting enzyme ,Clinical trial ,Treatment Outcome ,Endocrinology ,Blood pressure ,Hypertension ,biology.protein ,Patient Compliance ,Morbidity ,Outcome data ,Cardiology and Cardiovascular Medicine ,business ,Angiotensin II Type 1 Receptor Blockers ,Cardiovascular outcomes ,Hormone - Abstract
Background Clinical practice recommendations for hypertension do not make recommendations specific to men or women. However, the sex hormones appear to modulate differently the renin-angiotensin system (RAS), which plays a central role in the regulation of blood pressure. Today, little is known about the effects of sex on the efficacy of therapies that antagonize the RAS, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). Objective To identify randomized controlled trials evaluating the efficacy of ACEIs and ARBs in preventing major cardiovascular outcomes, determine what proportion of the trial participants were female, and evaluate whether there was any evidence of a sex difference in the efficacy of these agents. Methods A systematic review of the literature was conducted to identify randomized controlled trials that used either ACEIs or ARBs for the treatment of hypertension. Results Thirteen ACEI trials and nine ARB trials were identified. Sex-specific outcome data were available in six of the ACEI trials and three of the ARB trials. These trials enrolled 74,105 patients; 39.1% were women. Seven of the nine trials indicated that ACEIs or ARBs may be slightly more beneficial in men. The magnitude of these differences, in most trials, was small. Conclusions Sex-specific data are reported in 43% of large hypertension clinical trials. Review of the trials reporting sex-specific effect sizes indicates that ACEIs and ARBs may be more effective in men.
- Published
- 2008
35. Randomized Clinical Trial of Sodium Polystyrene Sulfonate for the Treatment of Mild Hyperkalemia in CKD
- Author
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Louis-Philippe Laurin, Laurence Lepage, Jean-Philippe Lafrance, Sylvie Perreault, Anne-Claude Dufour, Robert Bell, Michel Savoie, Vincent Pichette, Michel Vallée, Katia Handfield, Jessica Doiron, and Katherine Desforges
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Hyperkalemia ,Epidemiology ,Potassium ,chemistry.chemical_element ,Down-Regulation ,Critical Care and Intensive Care Medicine ,Placebo ,Gastroenterology ,law.invention ,chemistry.chemical_compound ,Randomized controlled trial ,Double-Blind Method ,law ,Internal medicine ,Statistical significance ,medicine ,Humans ,Renal Insufficiency, Chronic ,Aged ,Aged, 80 and over ,Transplantation ,business.industry ,Quebec ,Patiromer ,Original Articles ,Middle Aged ,Confidence interval ,Treatment Outcome ,chemistry ,Nephrology ,Polystyrenes ,Female ,medicine.symptom ,Sodium Polystyrene Sulfonate ,business ,Biomarkers - Abstract
Background and objectives Hyperkalemia affects up to 10% of patients with CKD. Sodium polystyrene sulfonate has long been prescribed for this condition, although evidence is lacking on its efficacy for the treatment of mild hyperkalemia over several days. This study aimed to evaluate the efficacy of sodium polystyrene sulfonate in the treatment of mild hyperkalemia. Design, setting, participants, & measurements In total, 33 outpatients with CKD and mild hyperkalemia (5.0–5.9 mEq/L) in a single teaching hospital were included in this double–blind randomized clinical trial. We randomly assigned these patients to receive either placebo or sodium polystyrene sulfonate of 30 g orally one time per day for 7 days. The primary outcome was the comparison between study groups of the mean difference of serum potassium levels between the day after the last dose of treatment and baseline. Results The mean duration of treatment was 6.9 days. Sodium polystyrene sulfonate was superior to placebo in the reduction of serum potassium levels (mean difference between groups, −1.04 mEq/L; 95% confidence interval, −1.37 to −0.71). A higher proportion of patients in the sodium polystyrene sulfonate group attained normokalemia at the end of their treatment compared with those in the placebo group, but the difference did not reach statistical significance (73% versus 38%; P=0.07). There was a trend toward higher rates of electrolytic disturbances and an increase in gastrointestinal side effects in the group receiving sodium polystyrene sulfonate. Conclusions Sodium polystyrene sulfonate was superior to placebo in reducing serum potassium over 7 days in patients with mild hyperkalemia and CKD.
- Published
- 2015
36. The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension
- Author
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Stella S. Daskalopoulou, Doreen M. Rabi, Kelly B. Zarnke, Kaberi Dasgupta, Kara Nerenberg, Lyne Cloutier, Mark Gelfer, Maxime Lamarre-Cliche, Alain Milot, Peter Bolli, Donald W. McKay, Guy Tremblay, Donna McLean, Sheldon W. Tobe, Marcel Ruzicka, Kevin D. Burns, Michel Vallée, G.V. Ramesh Prasad, Marcel Lebel, Ross D. Feldman, Peter Selby, Andrew Pipe, Ernesto L. Schiffrin, Philip A. McFarlane, Paul Oh, Robert A. Hegele, Milan Khara, Thomas W. Wilson, S. Brian Penner, Ellen Burgess, Robert J. Herman, Simon L. Bacon, Simon W. Rabkin, Richard E. Gilbert, Tavis S. Campbell, Steven Grover, George Honos, Patrice Lindsay, Michael D. Hill, Shelagh B. Coutts, Gord Gubitz, Norman R.C. Campbell, Gordon W. Moe, Jonathan G. Howlett, Jean-Martin Boulanger, Ally Prebtani, Pierre Larochelle, Lawrence A. Leiter, Charlotte Jones, Richard I. Ogilvie, Vincent Woo, Janusz Kaczorowski, Luc Trudeau, Robert J. Petrella, Swapnil Hiremath, James A. Stone, Denis Drouin, Kim L. Lavoie, Pavel Hamet, George Fodor, Jean C. Grégoire, Anne Fournier, Richard Lewanczuk, George K. Dresser, Mukul Sharma, Debra Reid, Geneviève Benoit, Janusz Feber, Kevin C. Harris, Luc Poirier, and Raj S. Padwal
- Subjects
Male ,medicine.medical_specialty ,Canada ,Ambulatory blood pressure ,medicine.medical_treatment ,White coat hypertension ,Renal artery stenosis ,Risk Assessment ,medicine ,Humans ,Antihypertensive Agents ,medicine.diagnostic_test ,business.industry ,Blood Pressure Determination ,Auscultation ,Blood Pressure Monitoring, Ambulatory ,medicine.disease ,Surgery ,Primary Prevention ,Mean blood pressure ,Blood pressure ,Emergency medicine ,Hypertension ,Practice Guidelines as Topic ,Smoking cessation ,Education, Medical, Continuing ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office blood pressure measurement; (2) if the visit 1 mean blood pressure is increased but < 180/110 mm Hg, out-of-office blood pressure measurements using ambulatory blood pressure monitoring (preferably) or home blood pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory blood pressure monitoring protocol and an update on automated office blood pressure are also presented. Several other recommendations on accurate measurement of blood pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.
- Published
- 2015
37. Pharmacokinetic and Dynamic of Furosemide in Peritoneal Dialysis Patients
- Author
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Vincent Pichette, Caroline Lamarche, John Stewart, Maude Pichette, Georges Ouellet, Michel Vallée, Robert Bell, and Denis Ouimet
- Subjects
Male ,medicine.medical_specialty ,Pathology ,medicine.medical_treatment ,Urology ,Renal function ,Diuresis ,Peritoneal dialysis ,Natriuresis ,03 medical and health sciences ,0302 clinical medicine ,Short Reports ,Pharmacokinetics ,Furosemide ,Humans ,Medicine ,Diuretics ,business.industry ,General Medicine ,Middle Aged ,Blood pressure ,Nephrology ,030220 oncology & carcinogenesis ,Pharmacodynamics ,Female ,business ,Peritoneal Dialysis ,030217 neurology & neurosurgery ,medicine.drug - Abstract
The aim of our study was to evaluate the efficacy and bioavailibility of a commonly used oral furosemide dose (500 mg) compared to a 250 mg intravenous (IV) dose in PD patients with significant residual renal function (urine volume > 100 mL). We also evaluated the immediate blood pressure effect in these patients. The data were obtained from a study we performed for the homologation of a 500-mg dose of furosemide by Health Canada.
- Published
- 2016
38. Ten-year experience with fungal peritonitis in peritoneal dialysis patients: antifungal susceptibility patterns in a North-American center
- Author
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Annie-Claire Nadeau-Fredette, Michel Vallée, Annie-Claude Labbé, Michel Laverdière, Denis Ouimet, and Jasmin Levallois
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Adult ,Male ,Microbiology (medical) ,medicine.medical_specialty ,Microbiological culture ,Antifungal Agents ,Itraconazole ,Bacterial Peritonitis ,medicine.medical_treatment ,Microbial Sensitivity Tests ,Biology ,Peritonitis ,Peritoneal dialysis ,Microbiology ,chemistry.chemical_compound ,Echinocandins ,Lipopeptides ,Caspofungin ,Drug Resistance, Fungal ,Internal medicine ,Amphotericin B ,medicine ,Humans ,Fluconazole ,Aged ,Candida ,Voriconazole ,Micafungin ,General Medicine ,Middle Aged ,Triazoles ,Fungal peritonitis ,Pyrimidines ,Infectious Diseases ,chemistry ,Mycoses ,North America ,Female ,Antifungal susceptibility ,Peritoneal Dialysis ,medicine.drug ,Follow-Up Studies - Abstract
Summary Objective To describe the clinical and microbiological features associated with fungal peritonitis in peritoneal dialysis (PD) patients at Hopital Maisonneuve-Rosemont, from August 1996 to July 2006. Methods Cases were retrieved from the microbiology laboratory culture registry. Antifungal susceptibility was determined by the Clinical and Laboratory Standards Institute M27A3 method. Results Among 288 PD patients (total follow-up of 7258 patient-months), nine were found with fungal peritonitis. Candida spp were identified in all of them, with a majority of non-albicans Candida species. Resistance to fluconazole, itraconazole, or voriconazole was as frequent as potential resistance to amphotericin B. No isolate was resistant to caspofungin and one was resistant to micafungin. Prior bacterial peritonitis was frequent (67%). All patients had their PD catheter removed and all of them survived. Conclusions In our institution, fungal peritonitis in PD patients is rare. All cases were caused by Candida species. Variable susceptibility patterns were observed, which may influence the initial empirical antifungal therapy and underscore the importance of individual speciation and susceptibility testing of invasive Candida isolates.
- Published
- 2012
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39. Efficacy of calcitriol compared to alfacalcidol for the treatment of secondary hyperparathyroidism in peritoneal dialysis patients
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Michel Vallée, Sarah Bezzaoucha, Robert Bell, Caroline Lamarche, Pichette, Denis Ouimet, and Jean-Philippe Lafrance
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Pharmacology ,medicine.medical_specialty ,Hyperparathyroidism ,Calcitriol ,business.industry ,medicine.medical_treatment ,Urology ,Alfacalcidol ,medicine.disease ,Peritoneal dialysis ,chemistry.chemical_compound ,chemistry ,medicine ,Pharmacology (medical) ,Secondary hyperparathyroidism ,business ,medicine.drug - Published
- 2015
40. SP477TIN-CAT STUDY: CONVERSION OF UNFRACTIONNED HEPARIN TO TINZAPARIN IN HEMODIALYSIS AND ITS IMPACT ON ALTEPLASE (CATHFLO) UTILIZATION
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Robert Bell, Gisele Guenette, Pierre Cartier, Michel Korkemaz, Naoual Elftouh, Alexandra Renald, Marie-Christine Simard-Meilleur, and Michel Vallée
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Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,medicine.medical_treatment ,Urology ,Medicine ,Heparin ,Hemodialysis ,Tinzaparin ,business ,medicine.drug - Published
- 2017
41. Conversion from twice-daily to once-daily extended-release tacrolimus in renal transplant recipients: 2-year results and review of the literature
- Author
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Duy, Tran, Michel, Vallée, Suzon, Collette, Lynne, Senécal, Jean-Philippe, Lafrance, Raymond, Dandavino, and Anne, Boucher
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Graft Rejection ,Male ,Time Factors ,Chemistry, Pharmaceutical ,Graft Survival ,Quebec ,Middle Aged ,Kidney Transplantation ,Drug Administration Schedule ,Tacrolimus ,Treatment Outcome ,Creatinine ,Delayed-Action Preparations ,Humans ,Female ,Prospective Studies ,Drug Monitoring ,Biomarkers ,Immunosuppressive Agents - Abstract
Tacrolimus extended-release formulation has been approved for use in Canada since October 2008. In initial studies, efficacy and safety profile were demonstrated as similar for both formulations (twice-daily tacrolimus and extended-release formula tacrolimus). To validate the safety and efficacy of extended-release formula tacrolimus, we conducted a prospective observational study.At our institution, between January 2009 and January 2010, the switch from tacrolimus to extended-release formula tacrolimus was done in 130 stable kidney recipients. Clinical data were accessed at baseline (data before conversion), 1 to 2 weeks, 1 month, 3 months, 6 months, 12 months, and 24 months after conversion.One hundred thirty renal transplant recipients were included in the current study. During the observation period, we saw no acute rejection and no change in graft function (mean serum creatinine levels remained stable). However, compared with baseline, mean tacrolimus trough levels were significantly reduced at 1 to 2 weeks, at 1 month, 6 months, 12 months, and at 24 months after conversion. Regarding the safety profile, no significant changes were noted in blood glucose, potassium, and magnesium. Approximately 35% of recipients preferred the extended-release formula tacrolimus to twice-daily tacrolimus.Conversion from twice-daily tacrolimus to extended-release once-daily tacrolimus appears to be safe and convenient up to 2 years after conversion in some recipients.
- Published
- 2014
42. Difficulty of patient selection in a combined heart-kidney transplant: a case report
- Author
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Rémi, Goupil, Alain, Bonnardeaux, Anne, Boucher, Suzon, Collette, Denis, Ouimet, Lynne, Sénécal, Duy, Tran, and Michel, Vallée
- Subjects
Cardiomyopathy, Dilated ,Heart Failure ,Male ,Patient Selection ,Myocardial Ischemia ,Stroke Volume ,Recovery of Function ,Middle Aged ,Kidney ,Ventricular Function, Left ,Treatment Outcome ,Renal Dialysis ,Heart Transplantation ,Humans ,Renal Insufficiency ,Lung Transplantation - Abstract
Combined heart-kidney transplant has become an alternative for heart transplant candidates with significant chronic kidney disease. However, it is not clear which patients will benefit most from such intervention, and in whom cardiac transplant alone will be sufficient to restore adequate renal function. We report the case of a man with ischemic cardiomyopathy and chronic kidney disease who was wait-listed for heart-kidney transplant after acute decompensated heart failure and renal failure requiring hemodialysis. Because of unexpected circumstances, the kidney transplant was cancelled, and only a heart transplant was performed. Nonetheless, the kidney function rapidly improved beyond the levels before hospitalization and remains stable months after transplant. This case illustrates the difficulties in assessing the reversibility of kidney damage in the context of heart failure requiring transplant. This issue is primordial to improve selection of patients who will benefit most from combined heart-kidney transplant in a context of scarce organ allocation resources.
- Published
- 2014
43. Glucuronidation of the Nonsteroidal Antiestrogen EM-652 (SCH 57068), by Human and Monkey Steroid Conjugating UDP-Glucuronosyltransferase Enzymes
- Author
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Olivier Barbier, Dean W. Hum, Isabelle Martineau, Claude Labrie, Fernand Labrie, Caroline Albert, Kim High, Alain Bélanger, and Michel Vallée
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Male ,medicine.medical_specialty ,Metabolite ,medicine.medical_treatment ,Glucuronidation ,Glucuronates ,Biology ,Steroid ,Rats, Sprague-Dawley ,chemistry.chemical_compound ,Estrogen Receptor Modulators ,Piperidines ,In vivo ,Internal medicine ,medicine ,Animals ,Humans ,Glucuronosyltransferase ,Cells, Cultured ,Pharmacology ,chemistry.chemical_classification ,Haplorhini ,Metabolism ,Antiestrogen ,Rats ,Enzyme ,Endocrinology ,chemistry ,Microsomes, Liver ,Microsome ,Molecular Medicine ,Female ,Steroids - Abstract
EM-652 (SCH 57068) is a new orally active antiestrogen that demonstrates pure antagonistic effects in the mammary gland and endometrium. In vivo studies have shown that EM-652 is primarily glucuronidated at the 7-hydroxy position in rats and that the metabolite is present in the plasma of female monkeys and human subjects after EM-800 (SCH 57050) or EM-652.HCl oral administration. Using hepatic microsomes from rat, monkey, and human, the formation of two EM-652 monoglucuronides at positions 4' and 7 was demonstrated by a liquid chromatographic tandem mass spectrometric method. Although no difference in EM-652 conjugation was observed between male and female monkey livers, an interindividual variation of hepatic EM-652 glucuronidation was shown with female human donors. Using microsome preparations from human embryonic kidney 293 cells stably expressing each of the 12 human and 11 monkey UGT enzymes cloned to date, the two EM-652-monoglucuronides were detected after incubation with microsomes containing human UGT1A1, UGT1A3, UGT1A8, UGT1A9, and monkey monUGT1A01, monUGT1A03, and monUGT1A09. Despite human UGT1A1 and monkey monUGT1A09 favored formation of EM-652-7-glucuronide, other active UGT1A enzymes formed both 4'- and 7-glucuronide derivatives in equal amounts. Kinetic analysis of EM-652 glucuronidation by these enzymes showed Michaelis constant (K(m)) values between 36 and 302 microM for EM-652-4'-glucuronide and 19 and 233 microM for EM-652-7-glucuronide. The present results demonstrate the importance of UGT1A isoforms, mainly UGT1A1, for EM-652 metabolism in humans.
- Published
- 2001
44. Quiz Page April 2010
- Author
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Jasmin Levallois, Annie-Claude Labbé, Michel Vallée, and Denis Ouimet
- Subjects
medicine.medical_specialty ,Nephrology ,business.industry ,medicine ,Organ involvement ,Intensive care medicine ,business ,medicine.disease ,Leptospirosis - Published
- 2010
45. Characterization of UDP-glucuronosyltransferases active on steroid hormones
- Author
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Olivier Barbier, Chantal Guillemette, David Turgeon, Alain Bélanger, Éric Lévesque, Caroline Albert, Michel Vallée, Stéphanie Dubois, Dean W. Hum, Martin Beaulieu, and André Tchernof
- Subjects
Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Clinical Biochemistry ,Glucuronidation ,Biology ,digestive system ,Biochemistry ,Steroid ,Endocrinology ,Western blot ,LNCaP ,Gene expression ,medicine ,Animals ,Humans ,Northern blot ,Glucuronosyltransferase ,Molecular Biology ,medicine.diagnostic_test ,Dihydrotestosterone ,Cell Biology ,Molecular biology ,Steroid hormone ,Molecular Medicine ,Hormone - Abstract
In recent years, the enzymes which are involved in the formation of DHT in steroid target tissues have been well investigated, however, enzymes responsible for the catabolism and elimination of steroids in these tissues, in particular the uridine diphospho-glucuronosyltransferase (UGT) family of enzymes, have received much less attention. We have recently demonstrated that human and monkey are unique in having high plasma levels of C19 steroid glucuronides. These circulating conjugates have been proposed to reflect the peripheral conversion of adrenal and gonadal C19 steroids to potent androgens, especially DHT. In humans, the presence of steroid UGT activities is found in the liver and several extrahepatic tissues including the prostate, mammary gland and ovary. In addition, UGT activities were observed in breast and prostate tumor cell lines such as MCF-7 and LNCaP, respectively. In agreement with the presence of steroid conjugating enzymes in extrahepatic tissues, UGT cDNA clones, which encode steroid conjugating proteins, have been isolated from libraries constructed from human and monkey prostate mRNA. The presence of UGT transcripts and proteins in extrahepatic tissues in both species, as determined by Northern blot, ribonuclease protection, specific RT-PCR, in situ hybridization, Western blot and immunocytochemistry analysis, indicate the relevance of steroid glucuronidation in tissues other than the liver. Knowing that both the human prostate and the human prostate cancer LNCaP cell line express steroid metabolizing proteins, including UGT enzymes, regulation of UGT mRNA and protein levels, as well as promoter activity was studied in these cells. The results demonstrate a differential regulation between the two highly related isoforms UGT2B15 and UGT2B17, where only the expression of UGT2B17 was affected following treatments of LNCaP cells with androgens, growth factors or cytokines. Steroid conjugation by UGT enzymes is potentially involved in hormone inactivation in steroid target tissues, thus modifications in UGT expression levels may influence hormonal responses.
- Published
- 1999
46. Characterisation of the spectral distribution of scattered photons for the French national primary 60Co beam
- Author
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Michel Etcheverry, Michel Vallée, and Jean Morel
- Subjects
Physics ,Nuclear and High Energy Physics ,Photon ,Spectral power distribution ,Scattering ,business.industry ,Dose profile ,Radiation ,Spectral line ,Optics ,Deconvolution ,business ,Instrumentation ,Beam (structure) - Abstract
The beam from a 60Co source is degraded due to photon scattering by the irradiation system and the source itself. The resulting gamma-ray spectrum includes a continuous spectral distribution of scattered photons up to 1 MeV. Since accurate dose measurements require precise knowledge of the flux density, the French national primary beam originating from the Colire teletherapy head has been experimentally characterised. A deconvolution process was carried out using a library of monoenergetic pulse-height spectra. The measurement procedure also generated the scattering shape and intensity relative to the main radiation for different source-to-detector distances. Using these data, the mean-energy values of the radiation beam have been calculated.
- Published
- 1996
47. Regulation of guinea pig adrenal P450c21 messenger RNA, protein and activity by RU486
- Author
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Alain Bélanger, Sylvie Perron, Michel Vallée, and Yves Tremblay
- Subjects
Male ,endocrine system ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Guinea Pigs ,Clinical Biochemistry ,Stimulation ,Cycloheximide ,Biology ,Biochemistry ,chemistry.chemical_compound ,Endocrinology ,Adrenocorticotropic Hormone ,Cytochrome P-450 Enzyme System ,Internal medicine ,Adrenal Glands ,Gene expression ,medicine ,Animals ,RNA, Messenger ,Northern blot ,Molecular Biology ,Incubation ,Cells, Cultured ,Messenger RNA ,Forskolin ,Cell Biology ,Molecular biology ,Enzyme assay ,Enzyme Activation ,Mifepristone ,chemistry ,biology.protein ,Molecular Medicine ,Steroid 21-Hydroxylase ,hormones, hormone substitutes, and hormone antagonists - Abstract
The role of ACTH, forskolin and 8Br-cAMP on the regulation of mRNA abundance, protein levels and enzymatic activity of cytochrome P450 21-hydroxylase (P450c21, CYP21) were investigated in guinea pig adrenal cell cultures. In untreated cells, 21-hydroxylase activity was diminished throughout a 48 h period of incubation. Although incubation with forskolin and 8Br-cAMP restored 21-hydroxylase activity to normal levels, the addition of ACTH did not prevent the decrease of 21-hydroxylase activity. Treatment of cells with RU486 for 24 h inhibited 21-hydroxylase activity by 93%; however, after removal of the drug a slight increase of enzyme activity was observed; this rise was enhanced by the addition of ACTH. Forskolin and 8Br-cAMP increased the levels of 21-hydroxylase activity to the same range as seen in untreated cells. In cells that were not pretreated with RU486, incubation with cycloheximide for 1 h had no effect on 21-hydroxylase activity and could not prevent the modest increase of 21-hydroxylase activity induced by forskolin or 8Br-cAMP after 48 h of incubation. In RU486-treated cells, cycloheximide blocks the stimulation of enzyme activity induced by ACTH, forskolin and 8Br-cAMP. Our findings indicate that 21-hydroxylase activity can be stimulated by ACTH, forskolin or 8Br-cAMP solely in the presence of reduced enzymatic activity. Western immunoblot analysis of P450c21 protein levels in untreated or RU486-treated adrenal cells indicate that P450c21 protein levels were in the same range and further incubation with ACTH caused a similar elevation of P450c21 protein levels in both the untreated and RU486-treated cells. Northern blot analysis on RNA isolated from adrenal cells showed that RU486 did not alter the basal steady state levels of P450c21 mRNA. As well, incubation with ACTH or 8Br-cAMP increased the levels of P450c21 transcript to the same extent in both untreated and RU486-treated cells. These results taken together provide additional evidence for the presence of an adrenal specific protein factor(s) modulating 21-hydroxylase activity.
- Published
- 1995
48. Association of erythropoiesis-stimulating agents and the incidence risk of cancer diagnosis among chronic dialysis patients: a nested case–control study
- Author
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Émilie René, Naoual Elftouh, Jean-Philippe Lafrance, Michel Vallée, Hind Harrak Lazrak, and Louis-Philippe Laurin
- Subjects
Male ,medicine.medical_specialty ,Anemia ,medicine.medical_treatment ,030232 urology & nephrology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Risk Factors ,Neoplasms ,hemic and lymphatic diseases ,Internal medicine ,Epidemiology ,Odds Ratio ,medicine ,Humans ,Dialysis ,Aged ,Retrospective Studies ,Transplantation ,Dose-Response Relationship, Drug ,business.industry ,Incidence ,Incidence (epidemiology) ,Cancer ,Odds ratio ,Middle Aged ,medicine.disease ,Logistic Models ,Nephrology ,Case-Control Studies ,030220 oncology & carcinogenesis ,Nested case-control study ,Cohort ,Hematinics ,Kidney Failure, Chronic ,Female ,business - Abstract
Erythropoiesis-stimulating agents (ESAs) are the cornerstone of the treatment for anemia in end-stage renal disease (ESRD) patients. Although a correlation has been established between ESAs and increased tumor growth among patients with cancer-related anemia, an association with a higher incidence of cancer among chronic dialysis patients remains relatively unclear.We completed a nested case-control study in a cohort of 4574 patients who began chronic dialysis treatment between 1 January 2001 and 31 December 2007 in Quebec, Canada, utilizing dialysis registry and administrative databases exclusively to extract our data. We excluded patients with a prior diagnosis of cancer. Eligible cases were identified by the time of initial cancer diagnosis obtained from either the hospital's discharge or physician billing form. We then randomly selected up to 10 controls for each case. ESA exposure was evaluated between 6 and 9 months prior to the initial cancer diagnosis. The mean weekly exposure was used to categorize ESA usage as either a low dose (30 µg/week), moderate dose (30-70 µg/week) or high dose (70 µg/week). We estimated the association between ESAs and the risk of developing cancer using a multivariable conditional logistic regression.We identified 419 cases of cancer and 3895 matched controls during the study period. The use of ESAs was associated with a higher risk of cancer {odds ratio [OR] 1.04 [95% confidence interval (CI) 1.02-1.07]}. Specifically, patients in the high exposure group (70 µg/week) had an increased risk of developing cancer [OR 1.77 (95% CI 1.18-2.66)] compared with patients in the unexposed group.High-dose ESA was associated with an increased incidence risk of new cancer diagnosis among chronic dialysis patients.
- Published
- 2016
49. Regulation of 21-Hydroxylase activity by steroids
- Author
-
Patricia H. Provencher, Alain Bélanger, Sylvie Perron, Michel Vallée, and Yves Tremblay
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Steroid ,Guinea pig ,Endocrinology ,Adrenocorticotropic Hormone ,Cricetinae ,Internal medicine ,Adrenal Glands ,Gene expression ,medicine ,Animals ,Androstenedione ,Cells, Cultured ,biology ,Chemistry ,Adrenal cortex ,21-Hydroxylase ,General Medicine ,Stimulation, Chemical ,In vitro ,Mifepristone ,medicine.anatomical_structure ,biology.protein ,Cattle ,Steroids ,Basal Metabolism ,Steroid 21-Hydroxylase ,Glucocorticoid ,medicine.drug - Abstract
In this study, we investigated the effect of steroids on guinea pig and bovine adrenal steroidogenesis, especially 21-hydroxylase activity. Analysis of guinea pig adrenal steroids indicated the presence of high concentrations of androstenedione in the guinea pig adrenal; furthermore, in vitro studies using guinea pig adrenal cortex cells in primary culture confirmed that androstenedione is one of the major C19 steroids produced and secreted. The direct action of steroids on steroid production by adrenal cells was investigated. Our data indicate that steroids themselves increase C19 steroid synthesis and inhibit glucocorticoid production by guinea pig adrenal cells without affecting gene expression for steroidogenic enzymes. Incubation of a series of C19 steroids, namely, androstenedione, with guinea pig adrenal cell cultures demonstrated that the decrease in 21-hydroxylase activity is largely independent of the androgenic activity of C19 steroids. RU38486, a synthetic C18 steroid possessing a 4-ene-3-ketosteroid with an aryl group at position 11 and a very low affinity for the androgen receptor, also irreversibly altered 21-hydroxylase activity. An effect of RU38486 on 21-hydroxylase activity was also demonstrated in bovine adrenal cells. Further studies with bovine adrenal cells showed that the decrease in 21-hydroxylase activity induced by RU38486 was accompanied by a small but significant inhibition of P450c21 protein levels at both basal and ACTH-stimulated levels. In summary, our data indicate that alteration of 21-hydroxylase activity by steroids is likely due to a direct action on P540c21 protein, and the levels of androstenedione in the adrenal are high enough to inhibit 21-hydroxylase activity.
- Published
- 1995
50. Changes in Urinary and Serum Levels of Novel Biomarkers after Administration of Gadolinium-based Contrast Agents
- Author
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Michel Vallée, François A. Leblond, Jean-François Naud, Louis-Philippe Laurin, Habib Mawad, Martine Leblanc, Nathalie Henley, and Vincent Pichette
- Subjects
medicine.medical_specialty ,Pathology ,Gadolinium ,Urinary system ,Short Report ,030232 urology & nephrology ,Contrast-induced nephropathy ,Urology ,chemistry.chemical_element ,030204 cardiovascular system & hematology ,Lipocalin ,Nephrotoxicity ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,In patient ,Pharmacology ,lcsh:R5-920 ,Creatinine ,business.industry ,nephrotoxicity ,Biochemistry (medical) ,biomarkers ,medicine.disease ,chemistry ,contrast-induced nephropathy ,Molecular Medicine ,Cystatin ,gadolinium ,lcsh:Medicine (General) ,business - Abstract
Objective The aim of our study is to describe the changes in urinary and serum levels of novel biomarkers after gadolinium contrast administration in patients with normal renal function. Methods We measured four biomarkers in 28 volunteers: interleukin-18 (IL-18), N-acetyl-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin, and cystatin C. Urinary and serum samples were collected at 0, 3, and 24 hours following gadolinium administration. Results Baseline serum creatinine was 57.8 ± 34.5 μmol/L and remained stable. Urinary IL-18 levels increased significantly at three hours (10.7 vs. 7.3 ng/mg creatinine; P < 0.05). Similarly, urinary NAG levels increased significantly at three hours (3.9 vs. 2.2 IU/mg creatinine; P < 0.001). For both these markers, the difference was no longer significant at 24 hours. No statistically significant differences were observed for urinary and serum neutrophil gelatinase-associated lipocalin levels and for serum cystatin C levels. Conclusions Urinary IL-18 and NAG levels increased transiently after administration of gadolinium-based contrast agents in patients with normal renal function.
- Published
- 2016
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