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Bonnet F, Balkau B, Lambert O, Diawara Y, Combe C, Frimat L, Laville M, Liabeuf S, Massy ZA, Metzger M, Stengel B, Alencar de Pinho N, Fouque D. The number of nephroprotection targets attained is associated with cardiorenal outcomes and mortality in patients with diabetic kidney disease. The CKD-REIN cohort study. Diabetes Obes Metab 2024; 26:1908-1918. [PMID: 38418407 DOI: 10.1111/dom.15507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
AIM The risk of cardiorenal events remains high among patients with diabetes and chronic kidney disease (CKD), despite the prescription of recommended treatments. We aimed to determine whether the attainment of a combination of nephroprotection targets at baseline (glycated haemoglobin <7.0%, urinary albumin-creatinine ratio <300 mg/g, blood pressure <130/80 mmHg, renin-angiotensin system inhibition) was associated with better cardiorenal outcomes and lower mortality. MATERIALS AND METHODS From the prospective French CKD-REIN cohort, we studied 1260 patients with diabetes and CKD stages 3-4 (estimated glomerular filtration rate: 15-60 ml/min/1.73 m2); 69% were men, and at inclusion, mean ± SD age: 70 ± 10 years; estimated glomerular filtration rate: 33 ± 11 ml/min/1.73 m2. The median follow-up was 4.9 years. RESULTS In adjusted Cox regression models, the attainment of two nephroprotection targets was consistently associated with a lower risk of cardiorenal events [hazard ratio 0.70 (95% confidence interval 0.57-0.85)], incident kidney failure with replacement therapy [0.58 (0.43-0.77)], four major adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure) [0.75 (0.57-0.99)] and all-cause mortality [0.59 (0.42-0.82)] when compared with the attainment of zero or one target. For patients with a urinary albumin-creatinine ratio ≥300 mg/g, those who attained at least two targets had lower hazard ratios for cardiorenal events [0.61 (0.39-0.96)], four major adverse cardiovascular events [0.53 (0.28-0.98)] and all-cause mortality [0.35 (0.17-0.70)] compared with those who failed to attain any targets. CONCLUSIONS These findings suggest that the attainment of a combination of nephroprotection targets is associated with better cardiorenal outcomes and a lower mortality rate in people with diabetic kidney disease.
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Affiliation(s)
- Fabrice Bonnet
- Department of Diabetology, CHU de Rennes, Université de Rennes 1, Rennes, France
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Beverley Balkau
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Yakhara Diawara
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Christian Combe
- Department of Nephrology, transplantation, dialysis, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
- Inserm U1026, Biotis, Bordeaux University, France
| | - Luc Frimat
- Department of Nephrology, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
- Inserm CIC 1433, Clinical Epidemiology Unit, Vandoeuvre-lès-Nancy, France
| | | | - Sophie Liabeuf
- Department of Pharmacology, CHU Amiens-Picardie, MP3CV Unit, Université Picardie Jules Verne, Amiens, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
- Department of Nephrology, AP-HP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Natalia Alencar de Pinho
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Denis Fouque
- Université de Lyon, Lyon, France
- Inserm U1060, CARMEN, Lyon, France
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Laville SM, Gras-Champel V, Hamroun A, Moragny J, Lambert O, Metzger M, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Robinson BM, Bieber B, Stengel B, Alencar De Pinho N, Massy ZA, Liabeuf S. Kidney Function Decline and Serious Adverse Drug Reactions in Patients With CKD. Am J Kidney Dis 2024; 83:601-614.e1. [PMID: 37951340 DOI: 10.1053/j.ajkd.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/16/2023] [Accepted: 09/11/2023] [Indexed: 11/13/2023]
Abstract
RATIONALE & OBJECTIVE Adverse drug reactions (ADRs) are common in patients with chronic kidney disease (CKD). The impact of kidney function decline on serious ADR risk has been poorly investigated. We comprehensively describe ADRs and assess the relationship between estimated glomerular filtration rate (eGFR) and serious ADR risk. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,033 participants in French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study, a nationwide sample of nephrology outpatients with moderate to advanced CKD. PREDICTORS Demographic and biological data (including eGFR), medication prescriptions. OUTCOME ADRs (preventable or not) were prospectively identified from hospital discharge reports, medical records, and patient interviews. Expert pharmacologists used validated tools to adjudicate ADRs. ANALYTICAL APPROACH Restricted cubic splines in fully adjusted cause-specific Cox proportional hazard models were used to evaluate the relationship between eGFR and the risk of serious ADRs (overall and by subtype). RESULTS During a median follow-up period of 4.7 years, 360 patients experienced 488 serious ADRs. Kidney and urinary disorders (n=170) and hemorrhage (n=170) accounted for 70% of serious ADRs. The most common medications classes were antithrombotics and renin-angiotensin system inhibitors. The majority of those serious ADRs were associated with hospitalization (n=467), with 32 directly or indirectly associated with death and 22 associated with a life-threatening event. More than 27% of the 488 serious ADRs were preventable or potentially preventable. The eGFR is a major risk factor for serious ADRs. The risk of acute kidney injury was 2.2% higher and risk of bleeding ADRs was 8% higher for each 1mL/min/1.73m2 lower baseline eGFR. LIMITATIONS The results cannot be extrapolated to patients who are not being treated by a nephrologist. CONCLUSIONS ADRs constitute a major cause of hospitalization in CKD patients for whom lower eGFR level is a major risk factor. PLAIN-LANGUAGE SUMMARY Patients with chronic kidney disease (CKD) have complex clinical presentations, take multiple medications, and often receive inappropriate prescriptions. Using data from a large, prospective CKD cohort, we found a high incidence of serious adverse drug reactions (ADRs). The 2 most common serious ADRs were drug-induced acute kidney injury and bleeding. A large proportion of serious ADRs required hospital admission, and 11% led to death or were life threatening. Lower kidney function was a major risk factor for serious ADRs. Many of these serious ADRs were determined to be partly preventable through greater adherence to prescription guidelines. This report enhances our understanding of the potential toxicity of drugs taken by patients with moderate to advanced CKD. It emphasizes the importance of monitoring kidney function when prescribing drugs, particularly for high-risk medications such as antithrombotic agents.
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Affiliation(s)
- Solène M Laville
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens; MP3CV Laboratory, Jules Verne University of Picardie, Amiens
| | - Valérie Gras-Champel
- Pharmacovigilance Center, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens
| | - Aghilès Hamroun
- Nephrology Department, Lille Regional University Medical Center, Lille; Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Julien Moragny
- Pharmacovigilance Center, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif; Biomedecine Agency, Saint Denis La Plaine
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux; INSERM, U1026, Université Bordeaux Segalen, Bordeaux
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite; Université de Lyon, Carmen INSERM 1060, Lyon
| | | | - Luc Frimat
- Nephrology Department, CHRU de Nancy, Vandoeuvre-lès-Nancy; Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | | | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Natalia Alencar De Pinho
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif; Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt/Paris
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens; MP3CV Laboratory, Jules Verne University of Picardie, Amiens.
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Le Gall L, Harambat J, Combe C, Philipps V, Proust-Lima C, Dussartre M, Drüeke T, Choukroun G, Fouque D, Frimat L, Jacquelinet C, Laville M, Liabeuf S, Pecoits-Filho R, Massy ZA, Stengel B, Alencar de Pinho N, Leffondré K, Prezelin-Reydit M. Haemoglobin trajectories in chronic kidney disease and risk of major adverse cardiovascular events. Nephrol Dial Transplant 2024; 39:669-682. [PMID: 37935529 DOI: 10.1093/ndt/gfad235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The trajectories of haemoglobin in patients with chronic kidney disease (CKD) have been poorly described. In such patients, we aimed to identify typical haemoglobin trajectory profiles and estimate their risks of major adverse cardiovascular events (MACE). METHODS We used 5-year longitudinal data from the CKD-REIN cohort patients with moderate to severe CKD enrolled from 40 nationally representative nephrology clinics in France. A joint latent class model was used to estimate, in different classes of haemoglobin trajectory, the competing risks of (i) MACE + defined as the first event among cardiovascular death, non-fatal myocardial infarction, stroke or hospitalization for acute heart failure, (ii) initiation of kidney replacement therapy (KRT) and (iii) non-cardiovascular death. RESULTS During the follow-up, we gathered 33 874 haemoglobin measurements from 3011 subjects (median, 10 per patient). We identified five distinct haemoglobin trajectory profiles. The predominant profile (n = 1885, 62.6%) showed an overall stable trajectory and low risks of events. The four other profiles had nonlinear declining trajectories: early strong decline (n = 257, 8.5%), late strong decline (n = 75, 2.5%), early moderate decline (n = 356, 11.8%) and late moderate decline (n = 438, 14.6%). The four profiles had different risks of MACE, while the risks of KRT and non-cardiovascular death consistently increased from the haemoglobin decline. CONCLUSION In this study, we observed that two-thirds of patients had a stable haemoglobin trajectory and low risks of adverse events. The other third had a nonlinear trajectory declining at different rates, with increased risks of events. Better attention should be paid to dynamic changes of haemoglobin in CKD.
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Affiliation(s)
- Lisa Le Gall
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Jérôme Harambat
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Bordeaux University Hospital, Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Sorare, Pellegrin-Enfants Hospital, Bordeaux, France
| | - Christian Combe
- Bordeaux University Hospital, Department of Nephrology, transplantation, dialysis, Bordeaux, France
- University Bordeaux, INSERM U1026, Bordeaux, France
| | - Viviane Philipps
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Cécile Proust-Lima
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Maris Dussartre
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Tilman Drüeke
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Gabriel Choukroun
- Amiens Picardie University Hospital, Department of Nephrology Dialysis Transplantation, Amiens, France
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
| | - Denis Fouque
- Hopital Lyon Sud, Département de néphrologie, Lyon, France
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Luc Frimat
- CHRU de Nancy, Department of Nephrology, Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, Nancy, France
| | - Christian Jacquelinet
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Agence de la biomedecine, La Plaine-Saint-Denis, France
| | - Maurice Laville
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Sophie Liabeuf
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
- Amiens-Picardie University Medical Center, Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens, France
| | - Roberto Pecoits-Filho
- DOPPS Program Area, Arbor Research Collaborative for Health, Ann Arbor, MI, USA
- School of Medicine, Pontificia Universidade Catolica do Parana, Cutitiba, PR, Brazil
| | - Ziad A Massy
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Ambroise Paré University Hospital, APHP, Department of Nephrology, Boulogne-Billancourt/Paris, France
| | - Bénédicte Stengel
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Natalia Alencar de Pinho
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Karen Leffondré
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Mathilde Prezelin-Reydit
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Maison du REIN AURAD Aquitaine, Néphrologie, Gradignan, Nouvelle-Aquitaine, FR
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Michon-Colin A, Metzger M, Bankir L, Gauci C, Brunel M, Baron S, Prot-Bertoye C, Stengel B, Thervet E, Haymann JP, Boffa JJ, Vrtovsnik F, Flamant M, Houillier P, Prie D, Courbebaisse M. Fibroblast growth factor 23 but not copeptin is independently associated with kidney failure and mortality in patients with chronic kidney disease. Clin Kidney J 2023; 16:2472-2481. [PMID: 38046034 PMCID: PMC10689138 DOI: 10.1093/ckj/sfad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 12/05/2023] Open
Abstract
Background Copeptin and intact fibroblast growth factor 23 (iFGF23) increase early during chronic kidney disease (CKD) and may be predictive of unfavourable outcomes. The aim of this study was to evaluate their respective associations with renal and vital outcomes in CKD patients. Methods We included CKD patients from the NephroTest cohort with concomitant measurements of plasma copeptin and iFGF23 concentrations and isotopic glomerular filtration rate measurement (mGFR). The primary endpoint was a composite outcome including kidney failure (KF) (dialysis initiation, pre-emptive transplantation or a 57% decrease of mGFR, corresponding to doubling of serum creatinine) or death before KF. Hazard ratios (HRs) of the primary endpoint associated with log-transformed copeptin and iFGF23 concentrations were estimated by Cox models. The slope of mGFR over time was analysed using a linear mixed model. Results A total of 329 CKD patients (243 men, mean age 60.3 ± 14.6 years) were included. Among them, 301 with an mGFR >15 ml/min/1.73 m2 were included in survival and mGFR slope analyses. During a median follow-up of 4.61 years (quartile 1-quartile 3: 3.72-6.07), 61 KFs and 32 deaths occurred. Baseline iFGF23 concentrations were associated with the composite outcome after multiple adjustments {HR 2.72 [95% confidence interval (CI) 1.85-3.99]}, whereas copeptin concentrations were not [HR 1.01 (95% CI 0.74-1.39)]. Neither copeptin nor iFGF23 were associated with mGFR slope over time. Conclusion Our study shows for the first time in population of CKD patients an independent association between iFGF23 and unfavourable renal and vital outcomes and shows no such association regarding copeptin, encouraging the integration of iFGF23 measurement into the follow-up of CKD.
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Affiliation(s)
- Arthur Michon-Colin
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Marie Metzger
- INSERM UMRS 1018, Equipe d'Epidémiologie Clinique, CESP, Université Paris-Saclay, Villejuif, France
| | - Lise Bankir
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- CNRS, ERL 8228, Laboratory of Kidney Physiology and Tubulopathies, Paris, France
| | - Cédric Gauci
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- INSERM UMRS 1018, Equipe d'Epidémiologie Clinique, CESP, Université Paris-Saclay, Villejuif, France
| | - Mélanie Brunel
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Stéphanie Baron
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Caroline Prot-Bertoye
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- CNRS, ERL 8228, Laboratory of Kidney Physiology and Tubulopathies, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Bénédicte Stengel
- INSERM UMRS 1018, Equipe d'Epidémiologie Clinique, CESP, Université Paris-Saclay, Villejuif, France
| | - Eric Thervet
- Université Paris Cité, Paris, France
- Néphrologie et Hémodialyse, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Haymann
- Explorations Fonctionnelles Multidisciplinaires, Sorbonne Université Paris, France
- Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Jean-Jacques Boffa
- Explorations Fonctionnelles Multidisciplinaires, Sorbonne Université Paris, France
- Néphrologie et Dialyse, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - François Vrtovsnik
- Université Paris Cité, Paris, France
- Néphrologie, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Martin Flamant
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Multidisciplinaires, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Pascal Houillier
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Dominique Prie
- Université Paris Cité, Paris, France
- INSERM U1151, Institut Necker Enfants Malades, Paris, France
- Département de Physiologie, Hôpital Necker, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Marie Courbebaisse
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- INSERM U1151, Institut Necker Enfants Malades, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
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5
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Levassort H, Boucquemont J, de Pinho NA, Lambert O, Helmer C, Metzger M, Teillet L, Frimat L, Combe C, Fouque D, Laville M, Jacquelinet C, Liabeuf S, Stengel B, Massy ZA, Pépin M. A New Approach for Cognitive Impairment Pattern in Chronic Kidney Disease. Nephrol Dial Transplant 2023:gfad244. [PMID: 37950574 DOI: 10.1093/ndt/gfad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS Chronic kidney disease (CKD) is associated with an elevated risk of neurocognitive disorders (NCDs). It remains unclear whether CKD-related NCDs have specific cognitive pattern or are earlier-onset phenotypes of the main NCDs (vascular NCDs and Alzheimer's disease). METHODS We used the Mini Mental State Examination score (MMSE) to assess cognitive pattern in 3003 CKD patients (stage 3 to 4) followed up over 5 years in the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort. After normalizing MMSE scores to a 0-to-100 scale, the associations between the baseline estimated glomerular filtration rate (eGFR, using the CKD-EPI-creatinine formula) and changes in each MMSE domain score were assessed in linear mixed models. RESULTS Patients (age: 67±13 years old; males: 65%, mean eGFR: 33±12 ml/min/1.73 m²) had a good baseline cognitive functions: the mean MMSE score was 26.9/30 ±2.9. After adjustment for age, sex, educational level, depression (past or present), cardiovascular risk factors, cerebrovascular disease, a lower baseline eGFR (per 10 ml/min/1.73 m²) was associated with a 0.53-point decrement (p<0.001; 95%CI [-0.98,-0.08]) for orientation, a 1.04-point decrement (p=0.03; 95%CI [-1.96,-0.13]) for attention and calculation, a 0.78-point decrement (p=0.003; 95%CI [-1.30,-0.27]) for language, and a 0.94-point decrement (p=0.02; 95%CI [-1.75,-0.13]) for praxis. Baseline eGFR was not, however, associated with significant changes over time in MMSE domain scores. CONCLUSION A lower eGFR in CKD patients was associated with early impairments in certain cognitive domains: praxis, language and attention domains before an obvious cognitive decline. Early detection of NCD in CKD patients must be perform before clinically cognitive decline using preferably tests assessing executive, attentional functions and language than memory test. This could lead to a better management of cognitive impairment and their consequences on CKD management.
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Affiliation(s)
- Hélène Levassort
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
- Department of Nephrology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Julie Boucquemont
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Natalia Alencar de Pinho
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Oriane Lambert
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Catherine Helmer
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR U1219, Bordeaux, France
| | - Marie Metzger
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Laurent Teillet
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Luc Frimat
- Department of Nephrology, CHRU-Nancy, Lorraine University, Vandoeuvre, France
- EA 4360, INSERM CIC-EC CIE6, Medicine Faculty, Lorraine University, Apemac, France
| | - Christian Combe
- Department of Nephrology, Bordeaux University Hospital, INSERM U1026 Biotis, Univ. Bordeaux, Bordeaux, France
| | - Denis Fouque
- Department of Nephrology, LyonSud hospital - Hospices Civils de Lyon, Claude Bernard Lyon1 University, Pierre Benite, France
| | - Maurice Laville
- Carmen INSERM U1060, Claude Bernard Lyon 1 University, Pierre-Bénite, France
| | - Christian Jacquelinet
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Medical and Scientific Department, Agence de la biomédecine, Saint-Denis la Plaine, France
| | - Sophie Liabeuf
- Pharmacology Department, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
| | - Bénédicte Stengel
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Ziad A Massy
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Nephrology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Marion Pépin
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
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6
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Eckardt KU, Delgado C, Heerspink HJL, Pecoits-Filho R, Ricardo AC, Stengel B, Tonelli M, Cheung M, Jadoul M, Winkelmayer WC, Kramer H. Trends and perspectives for improving quality of chronic kidney disease care: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2023; 104:888-903. [PMID: 37245565 DOI: 10.1016/j.kint.2023.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
Chronic kidney disease (CKD) affects over 850 million people globally, and the need to prevent its development and progression is urgent. During the past decade, new perspectives have arisen related to the quality and precision of care for CKD, owing to the development of new tools and interventions for CKD diagnosis and management. New biomarkers, imaging methods, artificial intelligence techniques, and approaches to organizing and delivering healthcare may help clinicians recognize CKD, determine its etiology, assess the dominant mechanisms at given time points, and identify patients at high risk for progression or related events. As opportunities to apply the concepts of precision medicine for CKD identification and management continue to be developed, an ongoing discussion of the potential implications for care delivery is required. The 2022 KDIGO Controversies Conference on Improving CKD Quality of Care: Trends and Perspectives examined and discussed best practices for improving the precision of CKD diagnosis and prognosis, managing the complications of CKD, enhancing the safety of care, and maximizing patient quality of life. Existing tools and interventions currently available for the diagnosis and treatment of CKD were identified, with discussion of current barriers to their implementation and strategies for improving the quality of care delivered for CKD. Key knowledge gaps and areas for research were also identified.
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Affiliation(s)
- Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Cynthia Delgado
- Division of Nephrology, University of California, San Francisco, San Francisco, California, USA; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; The George Institute for Global Health, Sydney, Australia
| | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
| | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Bénédicte Stengel
- CESP, Centre de Recherche en Epidémiologie et Santé des Populations, Clinical Epidemiology Team, INSERM UMRS 1018, University Paris-Saclay, Villejuif, France
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes (KDIGO), Brussels, Belgium
| | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Holly Kramer
- Departments of Public Health Sciences and Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois, USA.
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7
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Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, Sawhney S, Scholes-Robertson N, Stengel B, Tannor EK, Tesar V, van der Tol A, Luyckx VA. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19:694-708. [PMID: 37580571 DOI: 10.1038/s41581-023-00745-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
- Association Renaloo, Paris, France
| | - Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK
| | - Priya Pais
- Department of Paediatric Nephrology, St John's Medical College, Bengaluru, India
| | - Tanjala S Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Arjan van der Tol
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valérie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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8
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Montalescot L, Dorard G, Speyer E, Legrand K, Ayav C, Combe C, Stengel B, Untas A. The experience of relatives and friends of patients with moderate to advanced chronic kidney disease: Insights from the CKD-REIN cohort study. Br J Health Psychol 2023; 28:930-951. [PMID: 37080946 DOI: 10.1111/bjhp.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES The transition from chronic kidney disease (CKD) to kidney failure requiring kidney replacement therapy (KRT; i.e., dialysis or transplantation) to sustain life is a stressful event for patients. Families play a role in patients' treatment decision-making, but little is known about how they are involved. This study aimed to explore the experience of CKD among relatives and friends, their views and involvement in KRT choice. DESIGN/METHODS We conducted a qualitative study among 56 relatives or friends of patients with moderate to advanced CKD who were enrolled in the CKD-REIN cohort study. A psychologist conducted semi-structured interviews about their experience with CKD, treatment decision-making and their role in this process. Data were analysed using statistical text analysis. RESULTS The mean age of participants was 56.4 ± 14 years; 75% were women, 61% were patients' partners and 48% had a relative or friend with stage G4 CKD. The analysis yielded four lexical classes: listeners with an opinion, coping with CKD on a daily basis, narrating patients' nephrological monitoring and emotions behind facts. Participants reported a listening role in the decision-making period and information needs. Some reported that CKD had no impact on their own daily lives, but others talked about its current and future physical, psychological and social consequences on them, the patients and their relationships. CONCLUSIONS Most relatives/friends reported having little influence on KRT decision-making but expressed opinions on these treatments. Including relatives/friends in education on KRT and providing them with decision aids, especially when family members are supportive, may allow for more suitable decisions.
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Affiliation(s)
| | - Géraldine Dorard
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, F-92100, Boulogne-Billancourt, France
| | - Elodie Speyer
- Université Paris-Saclay, UVSQ, Inserm, Équipe Epidémiologie Clinique, CESP, 94807, Villejuif, France
| | - Karine Legrand
- Clinical Epidemiology, Inserm CIC-EC, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Carole Ayav
- Clinical Epidemiology, Inserm CIC-EC, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèses, Centre Hospitalier Universitaire de Bordeaux, and Unité INSERM U1026, Bordeaux, France
| | - Bénédicte Stengel
- Université Paris-Saclay, UVSQ, Inserm, Équipe Epidémiologie Clinique, CESP, 94807, Villejuif, France
| | - Aurélie Untas
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, F-92100, Boulogne-Billancourt, France
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9
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Canney M, Induruwage D, Tang M, Alencar de Pinho N, Er L, Zhao Y, Djurdjev O, Ahn YH, Behnisch R, Calice-Silva V, Chesnaye NC, de Borst MH, Dember LM, Dionne J, Ebert N, Eder S, Fenton A, Fukagawa M, Furth SL, Hoy WE, Imaizumi T, Jager KJ, Jha V, Kang HG, Kitiyakara C, Mayer G, Oh KH, Onu U, Pecoits-Filho R, Reichel H, Richards A, Schaefer F, Schaeffner E, Scheppach JB, Sola L, Ulasi I, Wang J, Yadav AK, Zhang J, Feldman HI, Taal MW, Stengel B, Levin A. Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts. Kidney Int Rep 2023; 8:2056-2067. [PMID: 37850014 PMCID: PMC10577366 DOI: 10.1016/j.ekir.2023.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Despite recognized geographic and sex-based differences in hemoglobin in the general population, these factors are typically ignored in patients with chronic kidney disease (CKD) in whom a single therapeutic range for hemoglobin is recommended. We sought to compare the distribution of hemoglobin across international nondialysis CKD populations and evaluate predictors of hemoglobin. Methods In this cross-sectional study, hemoglobin distribution was evaluated in each cohort overall and stratified by sex and estimated glomerular filtration rate (eGFR). Relationships between candidate predictors and hemoglobin were assessed from linear regression models in each cohort. Estimates were subsequently pooled in a random effects model. Results A total of 58,613 participants from 21 adult cohorts (median eGFR range of 17-49 ml/min) and 3 pediatric cohorts (median eGFR range of 26-45 ml/min) were included with broad geographic representation. Hemoglobin values varied substantially among the cohorts, overall and within eGFR categories, with particularly low mean hemoglobin observed in women from Asian and African cohorts. Across the eGFR range, women had a lower hemoglobin compared to men, even at an eGFR of 15 ml/min (mean difference 5.3 g/l, 95% confidence interval [CI] 3.7-6.9). Lower eGFR, female sex, older age, lower body mass index, and diabetic kidney disease were all independent predictors of a lower hemoglobin value; however, this only explained a minority of variance (R2 7%-44% across cohorts). Conclusion There are substantial regional differences in hemoglobin distribution among individuals with CKD, and the majority of variance is unexplained by demographics, eGFR, or comorbidities. These findings call for a renewed interest in improving our understanding of hemoglobin determinants in specific CKD populations.
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Affiliation(s)
- Mark Canney
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ontario, Canada
| | | | - Mila Tang
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Canada
| | | | - Lee Er
- Methodology and Analytics, BC Renal, Vancouver, British Columbia, Canada
| | - Yinshan Zhao
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ognjenka Djurdjev
- Methodology and Analytics, BC Renal, Vancouver, British Columbia, Canada
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Rouven Behnisch
- Institute of Medical Biometry, University Hospital Heidelberg, Germany
| | - Viviane Calice-Silva
- Research Department, Pro-rim Foundation, Joinville-SC, Brazil
- School of Medicine, UNIVILLE, Joinville-SC, Brazil
| | - Nicholas C. Chesnaye
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- ERA Registry, Amsterdam UMC Location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
| | - Martin H. de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Laura M. Dember
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Janis Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Canada
| | - Natalie Ebert
- Institute of Public Health, Charité Universitätsmedizin Berlin, Germany
| | - Susanne Eder
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University of Innsbruck, Innsbruck, Austria
| | - Anthony Fenton
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Susan L. Furth
- Division of Nephrology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy E. Hoy
- University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Anatomy and Cell Biology, Monash University, Clayton, Victoria, Australia
- Centre for Chronic Disease, University of Queensland, Brisbane, Queensland, Australia
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kitty J. Jager
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- ERA Registry, Amsterdam UMC Location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Chagriya Kitiyakara
- Departments of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University of Innsbruck, Innsbruck, Austria
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Ugochi Onu
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Roberto Pecoits-Filho
- DOPPS Program Area, Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- School of Medicine, Pontifica Universidade Catolica do Parana, Curitiba, Brazil
| | | | - Anna Richards
- Value Evidence and Outcomes, GSK, Brentford, Middlesex, UK
| | - Franz Schaefer
- Pediatric Nephrology Division, University Children's Hospital, Heidelberg, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Germany
| | | | - Laura Sola
- Hemodialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Ifeoma Ulasi
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Peking University Institute of Nephrology, Peking University Health Science Center, Beijing, China
| | - Ashok K. Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jianzhen Zhang
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Harold I. Feldman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Maarten W. Taal
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, University of Nottingham School of Medicine, Nottingham, UK
| | - Bénédicte Stengel
- CESP, University Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, Villejuif, France
| | - Adeera Levin
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Canada
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10
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Faucon AL, Fu EL, Stengel B, Mazhar F, Evans M, Carrero JJ. A nationwide cohort study comparing the effectiveness of diuretics and calcium channel blockers on top of renin-angiotensin system inhibitors on chronic kidney disease progression and mortality. Kidney Int 2023; 104:542-551. [PMID: 37330214 DOI: 10.1016/j.kint.2023.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/07/2023] [Accepted: 05/18/2023] [Indexed: 06/19/2023]
Abstract
It is unknown whether initiating diuretics on top of renin-angiotensin system inhibitors (RASi) is superior to alternative antihypertensive agents such as calcium channel blockers (CCBs) in patients with chronic kidney disease (CKD). For this purpose, we emulated a target trial in the Swedish Renal Registry 2007-2022 that included nephrologist-referred patients with moderate-advanced CKD and treated with RASi, who initiated diuretics or CCB. Using propensity score-weighted cause-specific Cox regression, we compared risks of major adverse kidney events (MAKE; composite of kidney replacement therapy [KRT], experiencing over a 40% eGFR decline from baseline, or an eGFR under 15 ml/min per 1.73m2), major cardiovascular events (MACE; composite of cardiovascular death, myocardial infarction or stroke), and all-cause mortality. We identified 5875 patients (median age 71 years, 64% men, median eGFR 26 ml/min per 1.73m2), of whom 3165 started a diuretic and 2710 a CCB. After a median follow-up of 6.3 years, 2558 MAKE, 1178 MACE and 2299 deaths occurred. Compared to CCB, diuretic use was associated with a lower risk of MAKE (weighted hazard ratio 0.87 [95% confidence interval: 0.77-0.97]), consistent across single components (KRT: 0.77 [0.66-0.88], over 40% eGFR decline: 0.80 [0.71-0.91] and eGFR under 15ml/min/1.73m2: 0.84 [0.74-0.96]). The risks of MACE (1.14 [0.96-1.36]) and all-cause mortality (1.07 [0.94-1.23]) did not differ between therapies. Results were consistent when modeling the total time drug exposure, across sub-groups and a broad range of sensitivity analyses. Thus, our observational study suggests that in patients with advanced CKD, using a diuretic rather than a CCB on top of RASi may improve kidney outcomes without compromising cardioprotection.
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Affiliation(s)
- Anne-Laure Faucon
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; INSERM UMR 1018, Department of Clinical Epidemiology, Centre for Epidemiology and Population Health, Paris-Saclay University, Villejuif, France.
| | - Edouard L Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bénédicte Stengel
- INSERM UMR 1018, Department of Clinical Epidemiology, Centre for Epidemiology and Population Health, Paris-Saclay University, Villejuif, France
| | - Faizan Mazhar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marie Evans
- Division of Nephrology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Juan-Jesús Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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11
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Alencar de Pinho N, Metzger M, Hamroun A, Laville S, Prezelin-Reydit M, Combe C, Fouque D, Laville M, Massy Z, Herpe YÉ, Untas A, Jacquelinet C, Liabeuf S, Frimat L, Stengel B. Chronic kidney disease and nephrological practices in France: lessons from the CKD-REIN cohort, 2013-2023. Nephrol Ther 2023; 19:1-18. [PMID: 37533268 DOI: 10.1684/ndt.2023.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Launched in 2013 supported by the Program “Cohorts – Investments for the Future”, the CKD-REIN (Chronic Kidney Disease – Renal Epidemiology and Information Network) study is a prospective cohort that included and followed for 5 years more than 3000 patients with moderate or advanced chronic kidney disease (CKD), from 40 nationally representative nephrology clinics. A large amount of data was collected on CKD and its treatments, patient social characteristics and reported outcomes, and nephrology practices and services. A total of 170,000 blood and urine samples were collected and stored in a central biobank. Coordinated with the CKD outcomes and practice pattern study (CKDopps) and collaborating with the international Network of CKD cohorts (iNETCKD), CKD-REIN contributes to the understanding of CKD and the positioning of France with respect to CKD epidemiology and care in the world. This review highlights major findings from the cohort, and their potential implications for clinical practices and the health system, grouped into the following themes: (1) the complexity of patients with CKD; (2) adherence to clinical guidelines; (3) treatment practices and drug risk; (4) acute on chronic kidney disease; (5) CKD metabolic complications; (6) prediction of kidney failure; (7) sex differences in CKD; (8) patient perspective on CKD; (9) transition to kidney failure and replacement therapy; (10) conservative care.
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Affiliation(s)
- Natalia Alencar de Pinho
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
| | - Marie Metzger
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
| | - Aghilès Hamroun
- Santé publique, épidémiologie, néphrologie, Inserm UMR1167 RIDAGE, Institut Pasteur de Lille, Université de Lille, CHU Lille, France
| | - Solène Laville
- CHU Amiens-Picardie, unité de pharmaco-épidémiologie, département de pharmacologie clinique, Amiens, France
| | | | - Christian Combe
- CHU de Bordeaux, service de néphrologie, transplantation, dialyse, aphérèse, Bordeaux, France
- Inserm U1026, Université de Bordeaux Segalen, Bordeaux, France
| | - Denis Fouque
- CHU Lyon Sud, service de néphrologie, Pierre-Bénite, France
- Université de Lyon, CarMeN Inserm 1060, Lyon, France
| | | | - Ziad Massy
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
- CHU Ambroise Paré, AP-HP, service de néphrologie, Boulogne-Billancourt, France
| | | | - Aurélie Untas
- Université Paris Cité, Laboratoire de psychopathologie et processus de santé, Boulogne-Billancourt, France
| | - Christian Jacquelinet
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
- Agence de la biomédecine, Saint-Denis-La-Plaine, France
| | - Sophie Liabeuf
- CHU Amiens-Picardie, unité de pharmaco-épidémiologie, département de pharmacologie clinique, Amiens, France
| | - Luc Frimat
- CHRU de Nancy, service de néphrologie, Vandœuvre-lès-Nancy, France
| | - Bénédicte Stengel
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
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12
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Bienaimé F, Muorah M, Metzger M, Broeuilh M, Houiller P, Flamant M, Haymann JP, Vonderscher J, Mizrahi J, Friedlander G, Stengel B, Terzi F. Combining robust urine biomarkers to assess chronic kidney disease progression. EBioMedicine 2023; 93:104635. [PMID: 37285616 DOI: 10.1016/j.ebiom.2023.104635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 04/21/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Urinary biomarkers may improve the prediction of chronic kidney disease (CKD) progression. Yet, data reporting the applicability of most commercial biomarker assays to the detection of their target analyte in urine together with an evaluation of their predictive performance are scarce. METHODS 30 commercial assays (ELISA) were tested for their ability to quantify the target analyte in urine using strict (FDA-approved) validation criteria. In an exploratory analysis, LASSO (Least Absolute Shrinkage and Selection Operator) logistic regression analysis was used to identify potentially complementary biomarkers predicting fast CKD progression, determined as the 51CrEDTA clearance-based measured glomerular filtration rate (mGFR) decline (>10% per year) in a subsample of 229 CKD patients (mean age, 61 years; 66% men; baseline mGFR, 38 mL/min) from the NephroTest prospective cohort. FINDINGS Among the 30 assays, directed against 24 candidate biomarkers, encompassing different pathophysiological mechanisms of CKD progression, 16 assays fulfilled the FDA-approved criteria. LASSO logistic regressions identified a combination of five biomarkers including CCL2, EGF, KIM1, NGAL, and TGF-α that improved the prediction of fast mGFR decline compared to the kidney failure risk equation variables alone: age, gender, mGFR, and albuminuria. Mean area under the curves (AUC) estimated from 100 re-samples was higher in the model with than without these biomarkers, 0.722 (95% confidence interval 0.652-0.795) vs. 0.682 (0.614-0.748), respectively. Fully-adjusted odds-ratios (95% confidence interval) for fast progression were 1.87 (1.22, 2.98), 1.86 (1.23, 2.89), 0.43 (0.25, 0.70), 1.10 (0.71, 1.83), 0.55 (0.33, 0.89), and 2.99 (1.89, 5.01) for albumin, CCL2, EGF, KIM1, NGAL, and TGF-α, respectively. INTERPRETATION This study provides a rigorous validation of multiple assays for relevant urinary biomarkers of CKD progression which combination may improve the prediction of CKD progression. FUNDING This work was supported by Institut National de la Santé et de la Recherche Médicale, Université de Paris, Assistance Publique Hôpitaux de Paris, Agence Nationale de la Recherche, MSDAVENIR, Pharma Research and Early Development Roche Laboratories (Basel, Switzerland), and Institut Roche de Recherche et Médecine Translationnelle (Paris, France).
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Affiliation(s)
- Frank Bienaimé
- Département « Croissance et Signalisation », Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, Université de Paris Cité, Paris, France; Service d'Explorations Fonctionnelles, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Mordi Muorah
- Département « Croissance et Signalisation », Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, Université de Paris Cité, Paris, France
| | - Marie Metzger
- CESP, Centre de Recherche en Epidémiologie et Santé des Populations, INSERM U1018, Université Paris-Saclay, Villejuif, France
| | - Melanie Broeuilh
- Département « Croissance et Signalisation », Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, Université de Paris Cité, Paris, France
| | - Pascal Houiller
- Service d'Explorations Fonctionnelles, Hôpital Européen George Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martin Flamant
- Service d'Explorations Fonctionnelles, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Haymann
- Service d'Explorations Fonctionnelles, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jacky Vonderscher
- Pharma Research and Early Development, Hoffmann-La-Roche Ltd, Basel, France
| | - Jacques Mizrahi
- Pharma Research and Early Development, Hoffmann-La-Roche Ltd, Basel, France
| | - Gérard Friedlander
- Département « Croissance et Signalisation », Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, Université de Paris Cité, Paris, France
| | - Bénédicte Stengel
- CESP, Centre de Recherche en Epidémiologie et Santé des Populations, INSERM U1018, Université Paris-Saclay, Villejuif, France
| | - Fabiola Terzi
- Département « Croissance et Signalisation », Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, Université de Paris Cité, Paris, France.
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13
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El Chamieh C, Larabi IA, Laville SM, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Pecoits-Filho R, Lange C, Stengel B, Alencar De Pinho N, Alvarez JC, Massy ZA, Liabeuf S. Proton-Pump Inhibitors and Serum Concentrations of Uremic Toxins in Patients with Chronic Kidney Disease. Toxins (Basel) 2023; 15:toxins15040276. [PMID: 37104214 PMCID: PMC10143607 DOI: 10.3390/toxins15040276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
Use of proton-pump inhibitors (PPIs) is common in patients with chronic kidney disease (CKD). PPIs and many uremic toxins (UTs) are eliminated by the kidney's tubular organic anion transporter system. In a cross-sectional study, we sought to evaluate the association between PPI prescription and serum concentrations of various UTs. We studied a randomly selected sub-group of participants in the CKD-REIN cohort (adult patients with a confirmed diagnosis of CKD and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2) with available frozen samples collected at baseline. PPI prescription was recorded at baseline. Serum concentrations of 10 UTs were measured using a validated liquid chromatography tandem mass spectrometry technique. Multiple linear regression was performed, with the log UT concentration as the dependent variable. Of the 680 included patients (median age: 68 years; median eGFR: 32 mL/min/1.73 m2), 31% had PPI prescriptions at baseline. Patients using PPIs had higher levels of certain UTs in comparison to other patients, including total and free indoxyl sulfate (IS), total and free p-cresylsulfate, total and free p-cresylglucuronide (PCG), phenylacetylglutamine (PAG), free kynurenine, and free hippuric acid. After adjustment for baseline co-morbidities, number of co-prescribed drugs, and laboratory data, including eGFR, associations between PPI prescription and elevated serum concentrations of free and total IS, free and total PCG, and PAG remained significant. Our results indicate that PPI prescription is independently associated with serum UT retention. These findings are interesting to better understand the factors that may modulate serum UT concentration in CKD patients, however, they will need to be confirmed by longitudinal studies.
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Affiliation(s)
- Carolla El Chamieh
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
| | - Islam Amine Larabi
- Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France
- UVSQ, Université Paris-Saclay, Inserm U1018, CESP, Équipe MOODS, MasSpecLab, 78180 Montigny-le-Bretonneux, France
| | - Solène M Laville
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, 80054 Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, F-80054 Amiens, France
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
- Biomedecine Agency, 93210 Saint Denis La Plaine, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
- INSERM, U1026, Univ. Bordeaux, 33076 Bordeaux, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, 69495 Pierre-Bénite, France
- Université de Lyon, CarMeN INSERM 1060, 69008 Lyon, France
| | | | - Luc Frimat
- Nephrology Department, CHRU de Nancy, 54000 Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, 54000 Vandoeuvre-lès-Nancy, France
| | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, MI 48108, USA
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba 80215-901, Brazil
| | - Céline Lange
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
| | - Natalia Alencar De Pinho
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
| | - Jean-Claude Alvarez
- Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France
- UVSQ, Université Paris-Saclay, Inserm U1018, CESP, Équipe MOODS, MasSpecLab, 78180 Montigny-le-Bretonneux, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
- Department of Nephrology, Ambroise Paré University Hospital, APHP, 92104 Boulogne-Billancourt, France
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, 80054 Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, F-80054 Amiens, France
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14
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Massy ZA, Lambert O, Metzger M, Sedki M, Chaubet A, Breuil B, Jaafar A, Tack I, Nguyen-Khoa T, Alves M, Siwy J, Mischak H, Verbeke F, Glorieux G, Herpe YE, Schanstra JP, Stengel B, Klein J. Machine Learning-Based Urine Peptidome Analysis to Predict and Understand Mechanisms of Progression to Kidney Failure. Kidney Int Rep 2023; 8:544-555. [PMID: 36938091 PMCID: PMC10014385 DOI: 10.1016/j.ekir.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The identification of patients with chronic kidney disease (CKD) at risk of progressing to kidney failure (KF) is important for clinical decision-making. In this study we assesed whether urinary peptidome (UP) analysis may help classify patients with CKD and improve KF risk prediction. Methods The UP was analyzed using capillary electrophoresis coupled to mass spectrometry in a case-cohort sample of 1000 patients with CKD stage G3 to G5 from the French CKD-Renal Epidemiology and Information Network (REIN) cohort. We used unsupervised and supervised machine learning to classify patients into homogenous UP clusters and to predict 3-year KF risk with UP, respectively. The predictive performance of UP was compared with the KF risk equation (KFRE), and evaluated in an external cohort of 326 patients. Results More than 1000 peptides classified patients into 3 clusters with different CKD severities and etiologies at baseline. Peptides with the highest discriminative power for clustering were fragments of proteins involved in inflammation and fibrosis, highlighting those derived from α-1-antitrypsin, a major acute phase protein with anti-inflammatory and antiapoptotic properties, as the most significant. We then identified a set of 90 urinary peptides that predicted KF with a c-index of 0.83 (95% confidence interval [CI]: 0.81-0.85) in the case-cohort and 0.89 (0.83-0.94) in the external cohort, which were close to that estimated with the KFRE (0.85 [0.83-0.87]). Combination of UP with KFRE variables did not further improve prediction. Conclusion This study shows the potential of UP analysis to uncover new pathophysiological CKD progression pathways and to predict KF risk with a performance equal to that of the KFRE.
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Affiliation(s)
- Ziad A. Massy
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
- Department of Nephrology, CHU Ambroise Paré, APHP, Boulogne Billancourt Cedex, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
| | - Mohammed Sedki
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Methodology Pole, Villejuif, France
| | - Adeline Chaubet
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Acil Jaafar
- Department of Clinical Physiology, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Ivan Tack
- Department of Clinical Physiology, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Thao Nguyen-Khoa
- Laboratory of Biochemistry, HU Necker-Enfants Malades, AP-HP Centre Université de Paris, Paris, France
- INSERM U1151, Institut Necker-Enfants Malades, Université de Paris Cité, Paris, France
| | - Melinda Alves
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Justyna Siwy
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany
| | | | - Francis Verbeke
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Yves-Edouard Herpe
- Biobanque de Picardie, Biological Resource Center of the Amiens University Hospital, 1 rondpoint du Pr Christian Cabrol, Amiens Cedex, France
| | - Joost P. Schanstra
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
- Department of Nephrology, CHU Ambroise Paré, APHP, Boulogne Billancourt Cedex, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
- Correspondence: Julie Klein, Institute of Metabolic and Cardiovascular disease, 1 avenue Jean-Poulhès, 31432 Toulouse Cedex 4, France.
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15
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Pépin M, Levassort H, Boucquemont J, Lambert O, Alencar de Pinho N, Turinici M, Helmer C, Metzger M, Cheddani L, Frimat L, Combe C, Fouque D, Laville M, Ayav C, Liabeuf S, Jacquelinet C, Teillet L, Stengel B, Massy ZA. Cognitive performance is associated with glomerular filtration rate in patients with chronic kidney disease: results from the CKD-REIN cohort. J Neurol Neurosurg Psychiatry 2023; 94:457-466. [PMID: 36693722 DOI: 10.1136/jnnp-2022-330347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with cognitive impairment in general population. We assessed the association between kidney and cognitive functions in patients with CKD and the influence of cardiovascular (CV) risk factors, and depression on this association. METHODS The CKD-Renal Epidemiology and Information Network cohort included 3033 patients with CKD stages 3-4, followed for 5 years. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) and estimated glomerular filtration rate (eGFR) with the CKD-Epidemiology Collaboration equation-creatinin formula. Evolution of the MMSE score over time and its association with baseline eGFR were investigated with linear mixed models. We assessed the risk of incident cognitive outcome (hospitalisation or death with relevant International Classification of Disease-10 codes), with a Cox proportional hazard model. RESULTS The mean age was 66.8, the mean eGFR was 33 mL/min/1.73 m2 and 387 patients (13.0%) had an MMSE score below 24 at baseline. A 10 mL/min/1.73 m2 decrement of baseline eGFR was associated with a mean MMSE decrease of 0.12 (95% CI 0.04 to 0.19) after adjustment for demographic characteristics, depression, CV risk factors and disease; but baseline eGFR was not associated with MMSE temporal evolution. HR for cognitive outcome during follow-up (median 2.01 years) associated with a 10 mL/min/1.73 m2 decrement of baseline eGFR was 1.35 (1.07, 1.70) (p=0.01) after adjustment. CONCLUSIONS In patients with CKD, lower eGFR was associated with worse cognitive performance and incident cognitive events, independently of demographics, CV risk factors and depression. TRIAL REGISTRATION NUMBER NCT03381950.
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Affiliation(s)
- Marion Pépin
- Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France .,Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Hélène Levassort
- Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.,Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Julie Boucquemont
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Oriane Lambert
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | | | - Monica Turinici
- Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.,LIRAES ED 262, Universite de Paris, Paris, France
| | - Catherine Helmer
- Bordeaux Population Health Center, INSERM U1219, Bordeaux, France
| | - Marie Metzger
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Lynda Cheddani
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Luc Frimat
- Nephrology, Lorraine University, CHRU de Nancy, Vandoeuvre, France.,EA 4360, Lorraine University, INSERM CIC-EC, Apemac, France
| | - Christian Combe
- Nephrology, Bordeaux University Hospital, Bordeaux, France.,Biotis, INSERM U1026, Bordeaux, France
| | - Denis Fouque
- Nephrology, Claude Bernard Lyon 1 University, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Maurice Laville
- Carmen, INSERM U1060, University Claude Bernard Lyon 1, Pierre Benite, France
| | - Carole Ayav
- Clinical Epidemiology, INSERM, Lorraine University, CHRU de Nancy, Nancy, France
| | - Sophie Liabeuf
- Pharmacology, Amiens University, Amiens, France.,MP3CV Laboratory EA7517, Université de Picardie Jules Verne, Amiens, France
| | - Christian Jacquelinet
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Medical and Scientific Departement, Agence de la Biomedecine, La Plaine Saint-Denis, France
| | - Laurent Teillet
- Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.,Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Bénédicte Stengel
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Ziad A Massy
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
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16
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Carrero JJ, Fu EL, Vestergaard SV, Jensen SK, Gasparini A, Mahalingasivam V, Bell S, Birn H, Heide-Jørgensen U, Clase CM, Cleary F, Coresh J, Dekker FW, Gansevoort RT, Hemmelgarn BR, Jager KJ, Jafar TH, Kovesdy CP, Sood MM, Stengel B, Christiansen CF, Iwagami M, Nitsch D. Defining measures of kidney function in observational studies using routine health care data: methodological and reporting considerations. Kidney Int 2023; 103:53-69. [PMID: 36280224 DOI: 10.1016/j.kint.2022.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
The availability of electronic health records and access to a large number of routine measurements of serum creatinine and urinary albumin enhance the possibilities for epidemiologic research in kidney disease. However, the frequency of health care use and laboratory testing is determined by health status and indication, imposing certain challenges when identifying patients with kidney injury or disease, when using markers of kidney function as covariates, or when evaluating kidney outcomes. Depending on the specific research question, this may influence the interpretation, generalizability, and/or validity of study results. This review illustrates the heterogeneity of working definitions of kidney disease in the scientific literature and discusses advantages and limitations of the most commonly used approaches using 3 examples. We summarize ways to identify and overcome possible biases and conclude by proposing a framework for reporting definitions of exposures and outcomes in studies of kidney disease using routinely collected health care data.
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Affiliation(s)
- Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
| | - Edouard L Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Søren V Vestergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Kok Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alessandro Gasparini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Viyaasan Mahalingasivam
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Henrik Birn
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Catherine M Clase
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research and Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Faye Cleary
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Meibergdreef, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Manish M Sood
- Department of Medicine, the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Bénédicte Stengel
- CESP (Center for Research in Epidemiology and Population Health), Clinical Epidemiology Team, University Paris-Saclay, University Versailles-Saint Quentin, Inserm U1018, Villejuif, France
| | - Christian F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Masao Iwagami
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; UK Renal Registry, UK Kidney Association, Bristol, UK.
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Hamroun A, Speyer E, Ayav C, Combe C, Fouque D, Jacquelinet C, Laville M, Liabeuf S, Massy ZA, Pecoits-Filho R, Robinson BM, Glowacki F, Stengel B, Frimat L. Barriers to conservative care from patients' and nephrologists' perspectives: the CKD-REIN study. Nephrol Dial Transplant 2022; 37:2438-2448. [PMID: 35026014 DOI: 10.1093/ndt/gfac009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Conservative care is increasingly considered an alternative to kidney replacement therapy for kidney failure management, mostly among the elderly. We investigated its status and the barriers to its implementation from patients' and providers' perspectives. METHODS We analysed data from 1204 patients with advanced chronic kidney disease (CKD) [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2] enrolled at 40 nationally representative nephrology clinics (2013-16) who completed a self-administered questionnaire about the information they received and their preferred treatment option, including conservative care, if their kidneys failed. Nephrologists (n = 137) also reported data about their clinics' resources and practices regarding conservative care. RESULTS All participating facilities reported they were routinely able to offer conservative care, but only 37% had written protocols and only 5% had a person or team primarily responsible for it. Overall, 6% of patients were estimated to use conservative care. Among nephrologists, 82% reported they were fairly or extremely comfortable discussing conservative care, but only 28% usually or always offered this option for older (>75 years) patients approaching kidney failure. They used various terminology for this care, with conservative management and non-dialysis care mentioned most often. Among patients, 5% of those >75 years reported receiving information about this option and 2% preferring it. CONCLUSIONS Although reported by nephrologists to be widely available and easily discussed, conservative care is only occasionally offered to older patients, most of whom report they were not informed of this option. The lack of a person or team responsible for conservative care and unclear information appear to be key barriers to its implementation.
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Affiliation(s)
- Aghilès Hamroun
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France.,Lille University, University Hospital of Lille, Nephrology Department, Lille, France
| | - Elodie Speyer
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France
| | - Carole Ayav
- CHRU-Nancy, INSERM, CIC 1433, Epidémiologie Clinique, Nancy, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Inserm U1026, Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Service de Néphrologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | | | - Maurice Laville
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Sophie Liabeuf
- Service de Pharmacologie Clinique, Département de recherche clinique CHU Amiens-Picardie, Amiens, France.,Laboratoire MP3CV, EA7517, Université de Picardie Jules Verne, Amiens, France
| | - Ziad A Massy
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France.,Service de néphrologie, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | | | | | - François Glowacki
- Lille University, University Hospital of Lille, Nephrology Department, Lille, France
| | - Bénédicte Stengel
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France
| | - Luc Frimat
- Service de Néphrologie, CHRU de Nancy, Vandoeuvre-lès-Nancy, France.,Université de Lorraine, APEMAC, Nancy, France
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Faye M, Legrand K, Le Gall L, Leffondre K, Omorou AY, Alencar de Pinho N, Combe C, Fouque D, Jacquelinet C, Laville M, Liabeuf S, Massy ZA, Speyer E, Pecoits Filho R, Stengel B, Frimat L, Ayav C. Five-Year Symptom Trajectories in Nondialysis-Dependent CKD Patients. Clin J Am Soc Nephrol 2022; 17:1588-1597. [PMID: 36307136 PMCID: PMC9718050 DOI: 10.2215/cjn.06140522] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Late stages of CKD are characterized by significant symptom burden. This study aimed to identify subgroups within the 5-year trajectories of symptom evolution in patients with CKD and to describe associated patient characteristics and outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 2787 participants (66% men) with eGFR <60 ml/min per 1.73 m2 enrolled in the CKD-Renal Epidemiology and Information Network (CKD-REIN) cohort study from July 2013 to May 2016, we assessed symptoms annually using the Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire until December 2020. A total of 9121 measures were reported over follow-up; all participants had symptoms scored for at least one time point. We used a joint latent class-mixed model to distinguish profiles of symptom trajectories. RESULTS Patient mean age (±SD) at baseline was 67±13 years, and mean eGFR was 33±13 ml/min per 1.73 m2. The prevalence of each symptom ranged from 24% (chest pain) to 83% (fatigue), and 98% of participants reported at least one symptom. After a median (interquartile range) follow-up of 5.3 (3.4-6.0) years, 690 participants initiated KRT, and 490 died before KRT. We identified two profiles of symptom trajectories: a "worse symptom score and worsening trajectory" in 31% of participants, characterized by a low initial symptom score that worsened more than ten points over time, and a "better symptom score and stable trajectory" in 69% of participants, characterized by a high initial score that remained stable. Participants in the worse symptom score and worsening trajectory group had more risk factors for CKD progression at baseline, worse quality of life, and a higher risk of KRT and death before KRT than other participants. CONCLUSIONS This study highlights a significant worsening of symptoms in about one third of the participants, whereas the majority reported low symptom severity throughout the study.
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Affiliation(s)
| | - Karine Legrand
- CHRU-Nancy, Nancy, France
- Université de Lorraine, Nancy, France
| | - Lisa Le Gall
- University of Bordeaux, Bordeaux, France
- INSERM, Bordeaux, France
| | - Karen Leffondre
- University of Bordeaux, Bordeaux, France
- INSERM, Bordeaux, France
| | - Abdou Y Omorou
- CHRU-Nancy, Nancy, France
- Université de Lorraine, Nancy, France
| | - Natalia Alencar de Pinho
- Paris-Saclay University, Villejuif, France
- Nephrology Department, Amboise Paré Hospital, Boulogne-Billancourt, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Bordeaux, France
- University of Bordeaux Segalen, Bordeaux, France
| | - Denis Fouque
- Service de Néphrologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | | | | | - Ziad A Massy
- Paris-Saclay University, Villejuif, France
- Nephrology Department, Amboise Paré Hospital, Boulogne-Billancourt, France
| | - Elodie Speyer
- Paris-Saclay University, Villejuif, France
- Nephrology Department, Amboise Paré Hospital, Boulogne-Billancourt, France
| | | | | | - Luc Frimat
- Université de Lorraine, Nancy, France
- Service de Néphrologie, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
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Alencar de Pinho N, Henn L, Raina R, Reichel H, Lopes AA, Combe C, Speyer E, Bieber B, Robinson BM, Stengel B, Pecoits-Filho R. Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy. Kidney Int Rep 2022; 7:2364-2375. [DOI: 10.1016/j.ekir.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022] Open
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Le Gall L, Prezelin-Reydit M, Stengel B, Lange C, Combe C, Harambat J, Leffondré K. Trajectoires d’hémoglobine et risques associés de présenter un évènement cardio-vasculaire majeur chez des sujets présentant une maladie rénale chronique non suppléée. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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21
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Laville S, Gras-Champel V, Jacquelinet C, Laville M, Fouque D, Frimat L, Alencar De Pinho N, Stengel B, Massy Z, Liabeuf S. Effets indésirables médicamenteux chez les patients atteints de maladie rénale chronique : bilan de 5 ans de suivi dans la cohorte CKD-REIN. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Maillet S, Choukroun G, Cazaubon E, Baghdadi Y, Rabiéga P, Champs F, Stengel B. Association entre carence martiale et évolution de la maladie rénale en France. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Wagner S, Merkling T, Metzger M, Koppe L, Laville M, Boutron-Ruault MC, Frimat L, Combe C, Massy ZA, Stengel B, Fouque D. Probiotic Intake and Inflammation in Patients With Chronic Kidney Disease: An Analysis of the CKD-REIN Cohort. Front Nutr 2022; 9:772596. [PMID: 35433774 PMCID: PMC9005823 DOI: 10.3389/fnut.2022.772596] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/07/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Aims Little is known about the effects of probiotics on inflammation in the context of chronic kidney disease (CKD). We investigated the association between probiotic intake and inflammation in patients with moderate-to-advanced CKD. Methods We performed a cross-sectional study of 888 patients with stage 3–5 CKD and data on serum C-reactive protein (CRP) levels and a concomitant food frequency questionnaire. We estimated the odds ratios (ORs) [95% confidence interval (CI)] for various CRP thresholds (>3, >4, >5, >6, and >7 mg/L) associated with three intake categories (no yoghurt, ordinary yoghurt, and probiotics from yoghurts or dietary supplements) and two frequency categories (daily or less than daily). Results The 888 study participants (median age: 70; men: 65%) had a median estimated glomerular filtration rate of 28.6 mL/min/1.73 m2 and a median [interquartile range] CRP level of 3.0 [1.6, 7.0] mg/L. Fifty-seven percent consumed ordinary yoghurt and 30% consumed probiotic yoghurt. The median intake frequency for yoghurt and probiotics was 7 per week. Relative to participants not consuming yoghurt, the ORs [95% CI] for CRP > 6 or >7 mg/L were significantly lower for participants consuming ordinary yoghurt (0.58 [0.37, 0.93] and 0.57 [0.35, 0.91], respectively) and for participants consuming probiotics (0.54 [0.33, 0.9] and 0.48 [0.28, 0.81], respectively), independently of age, sex, body mass index, CKD stage, cardiovascular disease, and fibre, protein and total energy intakes. The ORs were not significantly lower for CRP thresholds >3, >4, and >5 mg/L and were not significantly greater in daily consumers than in occasional consumers. Conclusion We observed independent associations between the consumption of yoghurt or probiotics and lower levels of inflammation in patients with CKD. There was no evidence of a dose-effect relationship. Clinical Trial Registration [https://www.clinicaltrials.gov/ct2/show/NCT03381950], identifier [NCT03381950].
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Affiliation(s)
- Sandra Wagner
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, Nancy, France
- FCRIN INI-CRCT, Nancy, France
- *Correspondence: Sandra Wagner,
| | - Thomas Merkling
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, Nancy, France
| | - Marie Metzger
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Univ Paris-Saclay, UVSQ, INSERM, Equipe Epidémiologie Clinique, Villejuif, France
| | - Laetitia Koppe
- Département de Néphrologie, Hopital Lyon Sud – HCL, Pierre-Bénite, France
- Université de Lyon, CarMeN Laboratory, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Maurice Laville
- Université de Lyon, CarMeN Laboratory, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Marie-Christine Boutron-Ruault
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Saclay, UVSQ, INSERM, Gustave Roussy, Equipe Exposome-Hérédité, Villejuif, France
| | - Luc Frimat
- EA4360 APEMAC, Université de Lorraine, Université Paris Descartes, Nancy, France
- Département de Néphrologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Christian Combe
- Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, Université Bordeaux Segalen, Bordeaux, France
| | - Ziad A. Massy
- FCRIN INI-CRCT, Nancy, France
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Univ Paris-Saclay, UVSQ, INSERM, Equipe Epidémiologie Clinique, Villejuif, France
- Service de Néphrologie, Hôpital Ambroise Paré, APHP, Paris, France
| | - Bénédicte Stengel
- FCRIN INI-CRCT, Nancy, France
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Univ Paris-Saclay, UVSQ, INSERM, Equipe Epidémiologie Clinique, Villejuif, France
| | - Denis Fouque
- Département de Néphrologie, Hopital Lyon Sud – HCL, Pierre-Bénite, France
- Université de Lyon, CarMeN Laboratory, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
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Laville SM, Couturier A, Lambert O, Metzger M, Mansencal N, Jacquelinet C, Laville M, Frimat L, Fouque D, Combe C, Robinson BM, Stengel B, Liabeuf S, Massy ZA. Urea levels and cardiovascular disease in patients with chronic kidney disease. Nephrol Dial Transplant 2022; 38:gfac045. [PMID: 35544273 PMCID: PMC9869852 DOI: 10.1093/ndt/gfac045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Elevated serum urea levels are common in moderate-to-advanced CKD. Several studies have shown that urea is a direct and indirect uremic toxin, especially with regard to cardiovascular disease. We sought to determine whether serum urea levels are associated with adverse cardiovascular events and death before renal replacement therapy (RRT) in patients with CKD. METHODS CKD-REIN is a prospective cohort of CKD nephrology outpatients not receiving maintenance dialysis. The 2507 patients included in the analysis were divided into three groups according to the baseline serum urea level (T1 < 10.5, T2:10.5 to 15.1, and T3 ≥ 15.1 mmol/L). Cox proportional hazard models were used to estimate hazard ratios (HRs) for first atheromatous or nonatheromatous cardiovascular (CV) events, and all-cause mortality before RRT. The models were adjusted for baseline comorbidities, laboratory data, and medications. FINDINGS Of the 2507 included patients (median [interquartile range (IQR)] age: 69[61-77]; mean (standard deviation) eGFR 33.5(11.6) mL/min/1.73 m²), 54% had a history of cardiovascular disease. After multiple adjustments for cardiovascular risk factors (including eGFR), patients in T3 had a higher risk of atheromatous and nonatheromatous cardiovascular events than patient in T1 (n events = 451, HR[95%CI]: 1.93[1.39-2.69]). The adjusted HRs for death before RRT (n events = 407) were 1.31[0.97; 1.76] and 1.73[1.22; 2.45] for patients T2 and those in T3, respectively. INTERPRETATION Our data suggested that urea is a predictor of cardiovascular outcomes beyond CV risk factors including eGFR.
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Affiliation(s)
- Solène M Laville
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
| | - Aymeric Couturier
- Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
| | - Nicolas Mansencal
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
- Department of Cardiology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France
| | | | | | - Luc Frimat
- Nephrology Department, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | - Denis Fouque
- Université de Lyon, CarMeN INSERM, Lyon, France
- Nephrology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, Univ Bordeaux Segalen, Bordeaux, France
| | | | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
| | - Ziad A Massy
- Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
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Faucon AL, Flamant M, Delanaye P, Lambert O, Essig M, Peraldi MN, Tabibzadeh N, Haymann JP, Stengel B, Geri G, Vidal-Petiot E. Estimating extracellular fluid volume in healthy individuals: evaluation of existing formulae and development of a new equation. Kidney Int Rep 2022; 7:810-822. [PMID: 35497800 PMCID: PMC9039904 DOI: 10.1016/j.ekir.2022.01.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Several clinical settings require an accurate estimation of the physiologically expected extracellular fluid volume (ECFV). We aimed to analyze the performances of existing ECFV-estimating equations and to develop a new equation. Methods The performances of 11 ECFV-estimating equations were analyzed in 228 healthy kidney donor candidates (Bichat Hospital, Paris, France) who underwent ECFV measurement using the distribution volume of 51Cr-labeled EDTA (51Cr-EDTA). An equation was developed using a penalized linear modeling approach (elastic net regression) and externally (Tenon Hospital, Paris, France, N = 142) validated. Results Participants from Bichat (mean age 45.2 ± 12.0 years, 43.0% men) and Tenon (47.8 ± 10.3 years, 29.6% men) hospitals had a mean measured ECFV of 15.4 ± 2.8 l and 15.1 ± 2.1 l, respectively. Available ECFV-estimating formulae have highly variable precision and accuracy. The new equation incorporating body weight, height, sex, and age had better precision and accuracy than all other equations in the external validation cohort, with a median bias of −0.20 (95% CI: −0.35 to −0.05) l versus −2.63 (−2.87 to −2.42) l to −0.57 (− 0.83 to −0.40) l and 0.21 (0.12 to 0.43) l to 2.89 (2.65 to 3.11) l, for underestimating and overestimating equations, respectively, an interquartile range for the bias of 0.88 (0.70 to 1.08) l versus 0.91 (0.71 to 1.20) l to 1.93 (1.67 to 2.25) l, and an accuracy within 10% of 90.9% (83.8 to 94.4) versus 88.0% (81.0 to 92.3) to 8.5% (4.2 to 13.4). These results were consistent across subgroups defined by sex, body mass index (BMI), body surface area (BSA), age, and ethnicity. Conclusion We developed and validated a new equation to estimate the individual reference value of ECFV, which is easily usable in clinical practice. Further validation in cohorts including individuals of extreme age and corpulence remains needed.
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Zee J, Muenz D, McCullough KP, Bieber B, Metzger M, Alencar de Pinho N, Lopes AA, Fliser D, Robinson BM, Young E, Pisoni RL, Stengel B, Pecoits-Filho R, Combe C, Duttlinger J, Fliser D, Jacquelinet C, Lonnemann G, Lopes A, Massy Z, Pecoits-Filho R, Reichel H, Stengel B, Wada T, Yamagata K. Potential Surrogate Outcomes for Kidney Failure in Advanced CKD: Evaluation of Power and Predictive Ability in CKDopps. Kidney Med 2021; 4:100395. [PMID: 35243307 PMCID: PMC8861958 DOI: 10.1016/j.xkme.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Rationale & Objective Potential surrogate end points for kidney failure have been proposed in chronic kidney disease (CKD); however, they must be evaluated to ensure accurate, powerful, and harmonized research, particularly among patients with advanced CKD. The aim of the current study was to investigate the power and predictive ability of surrogate kidney failure end points in a population with moderate-to-advanced CKD. Study Design Analysis of longitudinal data of a large multinational CKD observational study (Chronic Kidney Disease Outcomes and Practice Patterns Study). Setting & Participants CKD stage 3-5 patients from Brazil, France, Germany, and the United States. Outcomes Reaching an estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m2 or eGFR decline of ≥40%, and composite end points of these individual end points. Analytical Approach Each end point was used as a time-varying indicator in the Cox model to predict the time to kidney replacement therapy (KRT; dialysis or transplant) and was compared by the number of events and prediction accuracy. Results 8,211 patients had a median baseline eGFR of 27 mL/min/1.73 m2 (interquartile range, 21-36 mL/min/1.73 m2) and 1,448 KRT events over a median follow-up of 2.7 years (interquartile range, 1.2-3.0 years). Among CKD stage 4 patients, the eGFR < 15 mL/min/1.73 m2 end point had higher prognostic ability than 40% eGFR decline, but the end points were similar for CKD stage 3 patients. The combination of eGFR < 15 mL/min/1.73 m2 and 40% eGFR decline had the highest prognostic ability for predicting KRT, regardless of the CKD stage. Including KRT in the composite can increase the number of events and, therefore, the power. Limitations Variable visit frequency resulted in variable eGFR measurement frequency. Conclusions The composite end point can be useful for CKD progression studies among patients with advanced CKD. Harmonized use of this approach has the potential to accelerate the translation of new discoveries to clinical practice by identifying risk factors and treatments for kidney failure.
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Hecking M, Tu C, Zee J, Bieber B, Hödlmoser S, Reichel H, Sesso R, Port FK, Robinson BM, Carrero JJ, Tong A, Combe C, Stengel B, Pecoits-Filho R. Sex-Specific Differences in Mortality and Incident Dialysis in the Chronic Kidney Disease Outcomes and Practice Patterns Study. Kidney Int Rep 2021; 7:410-423. [PMID: 35257054 PMCID: PMC8897674 DOI: 10.1016/j.ekir.2021.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction More men than women start kidney replacement therapy (KRT) although the prevalence of chronic kidney disease (CKD) is higher in women than men. We therefore aimed at analyzing sex-specific differences in clinical outcomes among 8237 individuals with CKD in stages 3 to 5 from Brazil, France, Germany, and the United States participating in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). Methods Fine and Gray models, evaluating the effect of sex on time to events, were adjusted for age, Black race (model A); plus diabetes, cardiovascular disease, albuminuria (model B); plus estimated glomerular filtration rate (eGFR) slope during the first 12 months after enrollment and first eGFR after enrollment (model C). Results There were more men than women at baseline (58% vs. 42%), men were younger than women, and men had higher eGFR (28.9 ± 11.5 vs. 27.0 ± 10.8 ml/min per 1.73 m2). Over a median follow-up of 2.7 and 2.5 years for men and women, respectively, the crude dialysis initiation and pre-emptive transplantation rates were higher in men whereas that of pre-KRT death was more similar. The adjusted subdistribution hazard ratios (SHRs) between men versus women for dialysis were 1.51 (1.27–1.80) (model A), 1.32 (1.10–1.59) (model B), and 1.50 (1.25–1.80) (model C); for pre-KRT death, were 1.25 (1.02–1.54) (model A), 1.14 (0.92–1.40) (model B), and 1.15 (0.93–1.42) (model C); for transplantation, were 1.31 (0.73–2.36) (model A), 1.44 (0.76–2.74) (model B), and 1.53 (0.79–2.94) (model C). Conclusion Men had a higher probability of commencing dialysis before death, unexplained by CKD progression alone. Although the causal mechanisms are uncertain, this finding helps interpret the preponderance of men in the dialysis population.
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Villain C, Metzger M, Liabeuf S, Hamroun A, Laville S, Mansencal N, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Ayav C, Briançon S, Pecoits-Filho R, Hannedouche T, Stengel B, Massy ZA. Effectiveness and Tolerance of Renin-Angiotensin System Inhibitors With Aging in Chronic Kidney Disease. J Am Med Dir Assoc 2021; 23:998-1004.e7. [PMID: 34856172 DOI: 10.1016/j.jamda.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Renin-angiotensin system inhibitors (RASi) are recommended for slowing chronic kidney disease (CKD) progression to kidney failure. Their effectiveness and tolerance as patients age remain uncertain because older patients have often been excluded from clinical trials. DESIGN CKD-REIN cohort study. SETTING AND PARTICIPANTS We studied 2762 patients with CKD stages 3 and 4 and a clinical indication for RASi enrolled between 2013 and 2016 in 40 nephrology clinics nationally representative in France. METHODS The primary outcome was the occurrence of kidney failure or death. The secondary outcomes were the occurrence of cardiovascular events and hospitalizations with acute kidney injury (AKI) or hyperkalemia. A propensity score analysis was performed. We used Cox models to estimate hazard ratios (HRs) for each outcome associated with RASi prescription and tested interactions with age. RESULTS Patients' mean age was 67 years, including 841 (30%) aged 75 years and older; 2178 (79%) were prescribed RASi's. During a median follow-up of 4.6 years, 33% of patients reached kidney failure or died. RASi prescription was associated with a lower risk of kidney failure or death (HR 0.79, 95% CI 0.66, 0.95), an association not modified by age (P for interaction = .72). It was not significantly associated with cardiovascular events. During the first 3 years of follow-up, 14% of patients were hospitalized with AKI or hyperkalemia, but risk was not higher among those prescribed RASi's (HR 0.75, 95% CI 0.55-1.02) and age did not modify its effect (P for interaction = .28). CONCLUSIONS AND IMPLICATIONS This study shows that aging does not appear to modify either RASi's beneficial effects on major CKD outcomes or their potential adverse effects.
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Affiliation(s)
- Cédric Villain
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Service de Gériatrie, CHU de Caen, Normandie Université UNICAEN, Caen, France.
| | - Marie Metzger
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France
| | - Sophie Liabeuf
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Service de Pharmacologie Clinique, Département de Recherche Clinique, CHU d'Amiens, Université de Picardie Jules Verne, INSERM U-1088, Amiens, France
| | - Aghilès Hamroun
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France
| | - Solene Laville
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France
| | - Nicolas Mansencal
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Service de Cardiologie, CHU Ambroise Paré, APHP, Boulogne-Billancourt, Université de Versailles-Saint Quentin (UVSQ), France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèses, CHU de Bordeaux, Bordeaux, France; INSERM Unité 1026, Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Université de Lyon, Service de Néphrologie, CarMeN INSERM 1060, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Luc Frimat
- Service de Néphrologie, Université de Lorraine, APEMAC, CHRU de Nancy-Hôpitaux de Brabois, Nancy, France
| | - Christian Jacquelinet
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Agence de Biomédecine, La Plaine Saint-Denis, France
| | - Maurice Laville
- Université de Lyon, Service de Néphrologie, CarMeN INSERM 1060, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Carole Ayav
- CIC 1433 Epidémiologie Clinique, INSERM, CHRU, Université de Lorraine, CHRU de Nancy-Hôpitaux de Brabois, Nancy, France
| | - Serge Briançon
- CIC 1433 Epidémiologie Clinique, INSERM, CHRU, Université de Lorraine, CHRU de Nancy-Hôpitaux de Brabois, Nancy, France
| | | | - Thierry Hannedouche
- Service de Néphrologie-Hémodialyse, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine de Strasbourg, Strasbourg, France
| | - Bénédicte Stengel
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France
| | - Ziad A Massy
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Service de Néphrologie-Dialyse, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
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Hamroun A, Frimat L, Laville M, Metzger M, Combe C, Fouque D, Jacquelinet C, Ayav C, Liabeuf S, Lange C, Herpe YE, Zee J, Glowacki F, Massy ZA, Robinson B, Stengel B. New Insights into Acute-on-Chronic Kidney Disease in Nephrology Patients: The CKD-REIN Study. Nephrol Dial Transplant 2021; 37:1700-1709. [PMID: 34473306 DOI: 10.1093/ndt/gfab249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Acute-on-chronic kidney disease (ACKD) is poorly understood and often overlooked. We studied its incidence, circumstances, determinants, and outcomes in patients with CKD. METHODS We used the Kidney Disease Improving Global Outcomes criteria to identify all-stage acute kidney injury (AKI) events in 3033 nephrology outpatients with CKD stage 3-5 participating in the CKD-REIN cohort study (2013-2020), and cause-specific Cox models to estimate hazard ratios (HR, 95% confidence intervals [CI]) of AKI-associated risk factors. RESULTS At baseline, 22% of the patients (mean age 67 years, 65% men, mean eGFR 32 ml/min/1.73m2) had a history of AKI. Over a 3-year follow-up, 443 had at least one AKI event: 27% were stage 2 or 3, and 11% required dialysis; 74% involved hospitalization including 47% acquired as hospital inpatients; a third were not reported in hospital discharge reports. Incidence rates were 10.1 and 4.8 per 100 person-years in patients with and without an AKI history, respectively. In 2375 patients without this history, male sex, diabetes, cardiovascular disease, cirrhosis, several drugs, low eGFR, and serum albumin levels were significantly associated with a higher risk of AKI, as were low birth weight (<2500 g) (adjusted HR, 1.98; 95%CI, 1.35 to 2.91) and hemoglobin level (HR 1.21; 1.12 to 1.32 per 1 g/dl decrease). Within one year, only 63% of the patients had recovered their previous kidney function, 13.7% had started kidney replacement therapy, and 12.7% had died. CONCLUSIONS The study highlights the high rate of hospital-acquired AKI events in patients with CKD, and their underreporting at hospital discharge. It also reveals low birth weight and anemia as possible new risk factors in CKD patients.
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Affiliation(s)
- Aghilès Hamroun
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France.,Department of Nephrology, Dialysis, and Transplantion, Regional University Hospital Centre of Lille, F-59037 Lille, France
| | - Luc Frimat
- Department of Nephrology, Nancy University Hospital, F-54000 Vandoeuvre-lès-Nancy, France.,Lorraine University, APEMAC, F-54000 Nancy, France
| | - Maurice Laville
- Department of Nephrology, Lyon Sud Hospital, F-69495 Pierre Bénite, France.,Lyon University, INSERM U1060, CarMeN, F-69495 Pierre Bénite, France
| | - Marie Metzger
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France
| | - Christian Combe
- Nephrology Transplantation, Dialysis, Bordeaux University Hospital, F-33076 Bordeaux, France.,Inserm U1026, Bordeaux Segalen University, F-33076 Bordeaux, France
| | - Denis Fouque
- Department of Nephrology, Lyon Sud Hospital, F-69495 Pierre Bénite, France.,Lyon University, INSERM U1060, CarMeN, F-69495 Pierre Bénite, France
| | | | - Carole Ayav
- Department of Clinical Epidemiology, INSERM CIC-EC 1433, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Sophie Liabeuf
- Amiens University Hospital, Clinical Research Centre, Avenue R.Laennec, AMIENS, Picardie, FR 80000
| | - Céline Lange
- Agence de la Biomédecine, La Plaine Saint-Denis, France
| | | | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
| | - François Glowacki
- Department of Nephrology, Dialysis, and Transplantion, Regional University Hospital Centre of Lille, F-59037 Lille, France
| | - Ziad A Massy
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France.,Department of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, Paris, France
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
| | - Bénédicte Stengel
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France
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Faucon AL, Metzger M, Gauci C, Houillier P, Banchard A, Haymann J, Flamant M, Stengel B, Froissart M. Valeurs de références du débit de filtration glomérulaire par sexe chez le sujet sain de 18 à 90 ans. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zacharias HU, Altenbuchinger M, Schultheiss UT, Raffler J, Kotsis F, Ghasemi S, Ali I, Kollerits B, Metzger M, Steinbrenner I, Sekula P, Massy ZA, Combe C, Kalra PA, Kronenberg F, Stengel B, Eckardt KU, Köttgen A, Schmid M, Gronwald W, Oefner PJ. A Predictive Model for Progression of CKD to Kidney Failure Based on Routine Laboratory Tests. Am J Kidney Dis 2021; 79:217-230.e1. [PMID: 34298143 DOI: 10.1053/j.ajkd.2021.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 05/01/2021] [Indexed: 12/23/2022]
Abstract
RATIONALE & OBJECTIVE Stratification of chronic kidney disease (CKD) patients at risk for progressing to end-stage kidney disease (ESKD) requiring kidney replacement therapy (KRT) is important for clinical decision-making and trial enrollment. STUDY DESIGN Four independent prospective observational cohort studies. SETTING & PARTICIPANTS The development cohort was comprised of 4,915 CKD patients and three independent validation cohorts were comprised of a total of 3,063. Patients were followed-up for approximately five years. NEW PREDICTORS & ESTABLISHED PREDICTORS 22 demographic, anthropometric and laboratory variables commonly assessed in CKD patients. OUTCOMES Progression to ESKD requiring KRT. ANALYTICAL APPROACH A Least Absolute Shrinkage and Selection Operator (LASSO) Cox proportional hazards model was fit to select laboratory variables that best identified patients at high risk for ESKD. Model discrimination and calibration were assessed and compared against the 4-variable Tangri (T4) risk equation. Both used a resampling approach within the development cohort and in the validation cohorts using cause-specific concordance (C) statistics, net reclassification improvement, and calibration graphs. RESULTS The newly derived 6-variable (Z6) risk score included serum creatinine, albumin, cystatin C and urea, as well as hemoglobin and the urine albumin-to-creatinine ratio. Based on the resampling approach, Z6 achieved a median C value of 0.909 (95% CI, 0.868-0.937) at two years after the baseline visit, whereas the T4 achieved a median C value of 0.855 (95% CI, 0.799-0.915). In the three independent validation cohorts, Z6 C values were 0.894, 0.921, and 0.891, whereas the T4 C values were 0.882, 0.913, and 0.862. LIMITATIONS The Z6 was both derived and tested only in White European cohorts. CONCLUSIONS A new risk equation, based on six routinely available laboratory tests facilitates identification of patients with CKD who are at high risk of progressing to ESKD.
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Affiliation(s)
- Helena U Zacharias
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany; Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany; Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Michael Altenbuchinger
- Chair of Statistical Bioinformatics, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany; Computational Biology Group, University of Hohenheim, Stuttgart, Germany
| | - Ulla T Schultheiss
- Institute of Genetic Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Renal Division, Department of Medicine IV, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Johannes Raffler
- Institute of Computational Biology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Fruzsina Kotsis
- Institute of Genetic Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Renal Division, Department of Medicine IV, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Sahar Ghasemi
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Ibrahim Ali
- Salford Royal Hospital and University of Manchester, Salford M6 8HD, UK
| | - Barbara Kollerits
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marie Metzger
- Université Paris-Saclay, Université Versailles Saint Quentin, National Institute of Health and Medical Research (Inserm), Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Inga Steinbrenner
- Institute of Genetic Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Peggy Sekula
- Institute of Genetic Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Ziad A Massy
- Université Paris-Saclay, Université Versailles Saint Quentin, National Institute of Health and Medical Research (Inserm), Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France; Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt/Paris, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Inserm, U1026, Univ Bordeaux Segalen, Bordeaux, France
| | - Philip A Kalra
- Salford Royal Hospital and University of Manchester, Salford M6 8HD, UK
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bénédicte Stengel
- Université Paris-Saclay, Université Versailles Saint Quentin, National Institute of Health and Medical Research (Inserm), Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Germany; Department of Nephrology and Hypertension, Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Wolfram Gronwald
- Chair and Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Peter J Oefner
- Chair and Institute of Functional Genomics, University of Regensburg, Regensburg, Germany.
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Laville SM, Lambert O, Hamroun A, Metzger M, Jacquelinet C, Laville M, Frimat L, Fouque D, Combe C, Ayav C, Pecoits-Filho R, Stengel B, Massy ZA, Liabeuf S. Consequences of oral antithrombotic use in patients with chronic kidney disease. Clin Transl Sci 2021; 14:2242-2253. [PMID: 34080321 PMCID: PMC8604253 DOI: 10.1111/cts.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/07/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Abstract
We assessed the risks of bleeding, acute kidney injury (AKI), and kidney failure associated with the prescription of antithrombotic agents (oral anticoagulants and/or antiplatelet agents) in patients with moderate‐to‐advanced chronic kidney disease (CKD). CKD‐REIN is a prospective cohort of 3022 nephrology outpatients with CKD stages 2–5 at baseline. We used cause‐specific Cox proportional hazard models to estimate hazard ratios (HRs) for bleeding (identified through hospitalizations), AKI, and kidney failure. Prescriptions of oral antithrombotics were treated as time‐dependent variables. At baseline, 339 (11%) patients (65% men; 69 [60–76] years) were prescribed oral anticoagulants only, 1095 (36%) antiplatelets only, and 101 (3%) both type of oral antithrombotics. Over a median (interquartile range [IQR]) follow‐up period of 3.0 (IQR, 2.8–3.1) years, 152 patients experienced a bleeding event, 414 patients experienced an episode of AKI, and 270 experienced kidney failure. The adjusted HRs (95% confidence interval [95% CI]) for bleeding associated with prescriptions of antiplatelets only, oral anticoagulants only, and antiplatelet + oral anticoagulant were, respectively, 0.74 (95% CI, 0.46–1.19), 2.38 (95% CI, 1.45–3.89), and 3.96 (95% CI, 2.20–7.12). An increased risk of AKI risk was associated with the prescription of oral anticoagulants (adjusted HR, 1.90, 95% CI, 1.47–2.45) but not the prescription of antiplatelets (HR, 1.24, 95% CI, 0.98–1.56). Kidney failure was not associated with the prescription of oral antithrombotics of any type. This study confirms the high risk of AKI associated with oral anticoagulants prescription in patients with CKD and also highlights the potential aggravating effect of combining vitamin K antagonist (VKA) and antiplatelets on the risk of bleeding.
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Affiliation(s)
- Solène M Laville
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France
| | - Aghiles Hamroun
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France.,Nephrology Department, CHRU Lille, University of Lille, Lille, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France
| | | | - Maurice Laville
- CarMeN INSERM 1060, et AURAL, Université de Lyon, Lyon, France
| | - Luc Frimat
- Nephrology Department, CHRU de Nancy, Vandoeuvre-lès-Nancy, France.,APEMAC, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,INSERM, U1026, Univ Bordeaux Segalen, Bordeaux, France
| | - Carole Ayav
- APEMAC, Lorraine University, Vandoeuvre-lès-Nancy, France
| | | | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France.,Department of Nephrology, APHP, Ambroise Paré University Hospital, Boulogne-Billancourt/Paris, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
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Fages V, de Pinho NA, Hamroun A, Lange C, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Ayav C, Liabeuf S, Pecoits-Filho R, Massy ZA, Boucquemont J, Stengel B. Urgent-start dialysis in patients referred early to a nephrologist-the CKD-REIN prospective cohort study. Nephrol Dial Transplant 2021; 36:1500-1510. [PMID: 33944928 DOI: 10.1093/ndt/gfab170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The lack of a well-designed prospective study of the determinants of urgent dialysis start led us to investigate its individual- and provider-related factors in patients seeing nephrologists. METHODS The Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort study that included 3033 patients with CKD [mean age 67 years, 65% men, mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] from 40 nationally representative nephrology clinics from 2013 to 2016 who were followed annually through 2020. Urgent-start dialysis was defined as that 'initiated imminently or <48 hours after presentation to correct life-threatening manifestations' according to the Kidney Disease: Improving Global Outcomes 2018 definition. RESULTS Over a 4-year (interquartile range 3.0-4.8) median follow-up, 541 patients initiated dialysis with a known start status and 86 (16%) were identified with urgent starts. The 5-year risks for the competing events of urgent and non-urgent dialysis start, pre-emptive transplantation and death were 4, 17, 3 and 15%, respectively. Fluid overload, electrolytic disorders, acute kidney injury and post-surgery kidney function worsening were the reasons most frequently reported for urgent-start dialysis. Adjusted odds ratios for urgent start were significantly higher in patients living alone {2.14 [95% confidence interval (CI) 1.08-4.25] or with low health literacy [2.22 (95% CI 1.28-3.84)], heart failure [2.60 (95% CI 1.47-4.57)] or hyperpolypharmacy [taking >10 drugs; 2.14 (95% CI 1.17-3.90)], but not with age or lower eGFR at initiation. They were lower in patients with planned dialysis modality [0.46 (95% CI 0.19-1.10)] and more nephrologist visits in the 12 months before dialysis [0.81 (95% CI 0.70-0.94)] for each visit. CONCLUSIONS This study highlights several patient- and provider-level factors that are important to address to reduce the burden of urgent-start dialysis.
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Affiliation(s)
- Victor Fages
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Service de Néphrologie, Dialyse, Transplantation Rénale et Aphérèse, CHU de Lille, Lille, France
| | - Natalia Alencar de Pinho
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France
| | - Aghilès Hamroun
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Service de Néphrologie, Dialyse, Transplantation Rénale et Aphérèse, CHU de Lille, Lille, France
| | - Céline Lange
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Agence de Biomédecine, La Plaine Saint-Denis, France
| | - Christian Combe
- Service de Néphrologie, Transplantation, Dialyse, Aphérèses, CHU de Bordeaux, Bordeaux, France.,INSERM Unité 1026, Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Université Claude Bernard Lyon1, CarMeN INSERM 1060, Lyon, France.,Service de Néphrologie, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Luc Frimat
- Service de Néphrologie, Université de Lorraine, APEMAC, CHRU de Nancy - Hôpitaux de Brabois, Nancy, France
| | - Christian Jacquelinet
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Agence de Biomédecine, La Plaine Saint-Denis, France
| | - Maurice Laville
- Université Claude Bernard Lyon1, CarMeN INSERM 1060, Lyon, France.,Association Utilisation Rein Artificiel Région Lyonnaise, Lyon, France
| | - Carole Ayav
- CHRU de Nancy, Université de Lorraine, INSERM, CIC Epidémiologie Clinique, Hôpitaux de Brabois, Nancy, France
| | - Sophie Liabeuf
- Département de Recherche Clinique, Service de Pharmacologie Clinique, CHU d'Amiens, Université de Picardie Jules Verne, INSERM U-1088, Amiens, France
| | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA.,Pontificia Universidade Catolica do Prana, Curitiba, Brazil
| | - Ziad A Massy
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Service de Néphrologie-Dialyse, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Julie Boucquemont
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France
| | - Bénédicte Stengel
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France
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Mercadal L, Lambert O, Couchoud C, Metzger M, Edet S, Merle S, Jacquelinet C, Stengel B. Prescription patterns of dialysate potassium and potassium binders and survival on haemodialysis-the French Renal Epidemiology and Information Network registry. Nephrol Dial Transplant 2021; 36:151-159. [PMID: 32582941 DOI: 10.1093/ndt/gfaa077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Management of potassium disorders in patients on haemodialysis (HD) is complex. We studied prescription patterns of dialysate potassium and potassium binders, and their associations with patient survival. METHODS This national registry-based study included 25 629 incident adult patients alive after 3 months of HD from 2010 through 2013 and followed-up through 31 December 2014. We used Cox proportional hazard models to estimate multiadjusted mortality hazard ratios (HRs) associated with time-dependent exposure to facility-level dialysate potassium concentrations and patient-level potassium binder exposure. RESULTS Almost all dialysis units used, and generally most often, dialysate potassium concentrations of 2 mmol/L. During this period, use of concentrations <2 mmol/L tended to decrease and those ≥3 mmol/L to increase. In 2014, 9% of units used a single dialysate formula, 41% used two and 50% three or more. The most frequent combinations were 2 and 3 mmol/L (40%), and <2, 2 and 3 mmol/L (37%). Compared with patients on HD in units using only one dialysate formula, those in units using two or three had adjusted mortality HRs of 0.91 [95% confidence interval (CI) 0.82-1.01] and 0.84 (0.75-0.93), respectively. Potassium binders were prescribed for 37% of all patients at baseline. Adjusted mortality HRs associated with doses <4, 4-8 and ≥8 g/day versus none were 1.22 (95% CI 1.04-1.51), 0.6 (0.54-0.66) and 0.25 (0.24-0.33), respectively. CONCLUSIONS Diversity in facility-level use of dialysate potassium concentrations and potassium binder use at an appropriate dose appear to be associated with better survival in HD patients.
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Affiliation(s)
- Lucile Mercadal
- Nephrology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,CESP, Centre for Research in Epidemiology and Population Health, Inserm UMRS 1018, Université Paris-Saclay, Villejuif, France
| | - Oriane Lambert
- CESP, Centre for Research in Epidemiology and Population Health, Inserm UMRS 1018, Université Paris-Saclay, Villejuif, France
| | | | - Marie Metzger
- CESP, Centre for Research in Epidemiology and Population Health, Inserm UMRS 1018, Université Paris-Saclay, Villejuif, France
| | - Stéphane Edet
- Nephrology Department, Rouen University Hospital, Rouen, France
| | - Sylvie Merle
- Regional Observatory on Health, University Hospital of Martinique, Le Lamentin, France
| | - Christian Jacquelinet
- CESP, Centre for Research in Epidemiology and Population Health, Inserm UMRS 1018, Université Paris-Saclay, Villejuif, France
| | - Bénédicte Stengel
- CESP, Centre for Research in Epidemiology and Population Health, Inserm UMRS 1018, Université Paris-Saclay, Villejuif, France
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Guedes M, Muenz D, Zee J, Lopes MB, Waechter S, Stengel B, Massy ZA, Speyer E, Ayav C, Finkelstein F, Sesso R, Pisoni RL, Robinson BM, Pecoits-Filho R. Serum biomarkers of iron stores are associated with worse physical health-related quality of life (HRQoL) in non-dialysis dependent chronic kidney disease (NDD-CKD) patients with or without anemia. Nephrol Dial Transplant 2021; 36:1694-1703. [PMID: 33624825 PMCID: PMC8396397 DOI: 10.1093/ndt/gfab050] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Indexed: 12/28/2022] Open
Abstract
Background Iron deficiency (ID) is a common condition in nondialysis-dependent chronic kidney disease (NDD-CKD) patients that is associated with poorer clinical outcomes. However, the effect of ID on health-related quality of life (HRQoL) in this population is unknown. We analyzed data from a multinational cohort of NDD-CKD Stages 3–5 patients to test the association between transferrin saturation (TSAT) index and ferritin with HRQoL. Methods Patients from Brazil (n = 205), France (n = 2015) and the USA (n = 293) in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps, 2013–2019) were included. We evaluated the association of TSAT and ferritin (and functional and absolute ID, defined as TSAT ≤20% and ferritin ≥300 or <50 ng/mL) on pre-specified HRQoL measures, including the 36-item Kidney Disease Quality of Life physical component summary (PCS) and mental component summary (MCS) as the primary outcomes. Models were adjusted for confounders including hemoglobin (Hb). Results TSAT ≤15% and ferritin <50 ng/mL and ≥300 ng/mL were associated with worse PCS scores, but not with MCS. Patients with composite TSAT ≤20% and ferritin <50 or ≥300 ng/mL had lower functional status and worse PCS scores than those with a TSAT of 20–30% and ferritin 50–299 ng/mL. Patients with a lower TSAT were less likely to perform intense physical activity. Adjustment for Hb only slightly attenuated the observed effects. Conclusions Low TSAT levels, as well as both low TSAT with low ferritin and low TSAT with high ferritin, are associated with worse physical HRQoL in NDD-CKD patients, even after accounting for Hb level. Interventional studies of iron therapy on HRQoL among NDD-CKD individuals are needed to confirm these findings.
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Affiliation(s)
- Murilo Guedes
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA.,Pontificia Universidade Catolica do Parana, Curitiba, Brazil
| | - Daniel Muenz
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | - Bénédicte Stengel
- Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, 94807, Villejuif, France
| | - Ziad A Massy
- Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, 94807, Villejuif, France.,France, Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt/Paris, France
| | - Elodie Speyer
- Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, 94807, Villejuif, France
| | - Carole Ayav
- Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, 94807, Villejuif, France
| | | | | | | | | | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA.,Pontificia Universidade Catolica do Parana, Curitiba, Brazil
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Wagner S, Merkling T, Metzger M, Bankir L, Laville M, Frimat L, Combe C, Jacquelinet C, Fouque D, Massy ZA, Stengel B. Water intake and progression of chronic kidney disease: the CKD-REIN cohort study. Nephrol Dial Transplant 2021; 37:730-739. [DOI: 10.1093/ndt/gfab036] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Optimal daily water intake to prevent chronic kidney disease (CKD) progression is unknown. Taking the kidney’s urine-concentrating ability into account, we studied the relation of kidney outcomes in patients with CKD to total and plain water intake and urine volume.
Methods
Including 1265 CKD patients [median age 69 years; mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] from the Chronic Kidney Disease–Renal Epidemiology and Information Network cohort (2013–19), we assessed fluid intake at baseline interviews, collected 24-h urine volumes and estimated urine osmolarity (eUosm). Using Cox and then linear mixed models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for kidney failure and eGFR decline associated with hydration markers, adjusting for CKD progression risk factors and eUosm.
Results
Patients’ median daily intake was 2.0 L [interquartile range (IQR) 1.6–2.6] for total water and 1.5 L (1–1.7) for plain water, median urine volume was 1.9 L/24 h (IQR 1.6–2.4) and mean eUosm was 374 ± 104 mosm/L. Neither total water intake nor urine volume was associated with either kidney outcome. Kidney failure risk increased significantly with decreasing eUosm ˂292 mosm/L. Adjusted HRs (95% CIs) for kidney failure associated with plain water intake were 1.88 (1.02–3.47), 1.59 (1.06–2.38), 1.76 (0.95–3.24) and 1.55 (1.03–2.32) in patients drinking <0.5, 0.5–1.0, 1.5–2.0 and >2.0 L/day compared with those drinking 1.0–1.5 L/day. High plain water intake was also significantly associated with faster eGFR decline.
Conclusions
In patients with CKD, the relation between plain water intake and progression to kidney failure appears to be U-shaped. Both low and high intake may not be beneficial in CKD.
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Affiliation(s)
- Sandra Wagner
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Thomas Merkling
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Marie Metzger
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Lise Bankir
- Sorbonne Université, INSERM, Centre de Recherche des Cordeliers, Paris, France
| | - Maurice Laville
- Département de Néphrologie, Centre Hospitalier Lyon-Sud, Université de Lyon, UCBL, Carmen, Pierre-Bénite, France
| | - Luc Frimat
- EA4360 Apemac, Université de Lorraine, Université Paris-Descartes, Nancy, France
- Département de Néphrologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Christian Combe
- Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, Université Bordeaux Segalen, Bordeaux, France
| | - Christian Jacquelinet
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Agence de Biomédecine, Saint Denis la Plaine, France
| | - Denis Fouque
- Département de Néphrologie, Centre Hospitalier Lyon-Sud, Université de Lyon, UCBL, Carmen, Pierre-Bénite, France
| | - Ziad A Massy
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Service de Néphrologie, Hôpital Ambroise Paré, AP-HP, Paris, France
| | - Bénédicte Stengel
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
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37
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Faucon AL, Leffondré K, Flamant M, Metzger M, Boffa JJ, Haymann JP, Houillier P, Thervet E, Vrtovsnik F, Proust-Lima C, Stengel B, Vidal-Petiot E, Geri G. Trajectory of extracellular fluid volume over time and subsequent risks of end-stage kidney disease and mortality in chronic kidney disease: a prospective cohort study. J Intern Med 2021; 289:193-205. [PMID: 32654192 DOI: 10.1111/joim.13151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extracellular fluid volume (ECF) is independently associated with chronic kidney disease (CKD) progression and mortality in patients with CKD, but the prognostic value of the trajectory of ECF over time beyond that of baseline value is unknown. OBJECTIVES To characterize ECF trajectory and evaluate its association with the risks of end-stage kidney disease (ESKD) and mortality. METHODS From the prospective tricentric NephroTest cohort, we included 1588 patients with baseline measured glomerular filtration rate (mGFR) ≥15 mL min-1 /1.73 m2 and ECF measurement. ECF and GFR were measured repeatedly using the distribution volume and clearance of 51 Cr-EDTA, respectively. ESKD and mortality were traced through record linkage with the national registries. Adjusted shared random-effect joint models were used to analyse the association between the trajectory of ECF over time and the two competing outcomes. RESULTS Patients were mean age 58.7 years, 66.7% men, mean mGFR of 43.6 ± 18.6 mL min-1 /1.73 m2 and mean ECF of 16.1 ± 3.6 L. Over a median follow-up of 5.3 [IQR: 3.0;7.4] years, ECF increased by 136 [95%CI 106;167] mL per year on average, whilst diuretic prescription and 24-hour urinary sodium excretion remained stable. ESKD occurred in 324 (20.4%) patients, and 185 (11.6%) patients died before ESKD. A higher current value of ECF was associated with increased hazards of ESKD (adjusted hazard ratio [aHR]: 1.12 [95%CI 1.06;1.18]; P < 0.001 per 1 L increase in ECF), and death before ESKD (aHR: 1.10 [95%CI 1.04;1.17]; P = 0.002). CONCLUSIONS The current value of ECF was associated with the risks of ESKD and mortality, independent of multiple potential confounders, including kidney function decline. This highlights the need for a close monitoring and adjustment of treatment to avoid fluid overload in CKD patients.
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Affiliation(s)
- A-L Faucon
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France
| | - K Leffondré
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, ISPED, Bordeaux, France
| | - M Flamant
- Department of Physiology, AP-HP, Hôpital Bichat and INSERM U1149, Paris, France.,Université de Paris, Paris, France
| | - M Metzger
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France
| | - J-J Boffa
- Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - J-P Haymann
- Université Pierre et Marie Curie, Paris, France.,Department of Physiology, AP-HP, Hôpital Tenon, Paris, France
| | - P Houillier
- Université de Paris, Paris, France.,Department of Physiology, AP-HP, INSERM U1138, Centre de Recherche des Cordeliers, Hôpital Européen Georges Pompidou and Centre de Recherche des Cordeliers, Paris, France
| | - E Thervet
- Université de Paris, Paris, France.,Department of Nephrology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - F Vrtovsnik
- Université de Paris, Paris, France.,Department of Nephrology, AP-HP, Hôpital Bichat, Paris, France
| | - C Proust-Lima
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, ISPED, Bordeaux, France
| | - B Stengel
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France
| | - E Vidal-Petiot
- Department of Physiology, AP-HP, Hôpital Bichat and INSERM U1149, Paris, France.,Université de Paris, Paris, France
| | - G Geri
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France.,Medical Intensive Care Unit, AP-HP, Hôpital Ambroise Paré, Boulogne-Billancourt, France.,Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France
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Liabeuf S, Lambert O, Metzger M, Hamroun A, Laville M, Laville SM, Frimat L, Pecoits-Filho R, Fouque D, Massy ZA, Jacquelinet C, Stengel B. Adverse outcomes of proton pump inhibitors in patients with chronic kidney disease: The CKD-REIN cohort study. Br J Clin Pharmacol 2021; 87:2967-2976. [PMID: 33368448 DOI: 10.1111/bcp.14713] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Long-term use of proton pump inhibitors (PPIs) has been associated with adverse kidney events in the general population, but their impact among chronic kidney disease (CKD) patients is unclear. We studied the prevalence and incidence (new users) of PPI prescriptions and their relation to kidney outcomes and mortality in CKD patients. METHODS We collected drug prescriptions prospectively in a cohort of 3023 nephrology outpatients with CKD stages 2-5 at inclusion. Hazard ratios (HR, 95% confidence intervals [95% CI]) for acute kidney injury (AKI), end-stage kidney disease (ESKD), and mortality associated with new PPI prescriptions as a time-dependent variable were estimated with cause-specific Cox models in 1940 non-users with eGFR ≥ 15 mL/min/1.73 m2 at baseline, adjusted for comorbidities, laboratory data and drugs. RESULTS There were 981/3023 (32%) prevalent users (67 ± 13 years, 65% men) at baseline, and 366/3023 (12%) were prescribed PPI (new users) over a median follow-up of 3.9 years (interquartile range, 3-4.2). Among these new users, their median cumulative duration of prescription was 1 year (interquartile range: 0.4-2.3). During follow-up, 354 patients developed ESKD and 216 died before ESKD. The adjusted HRs associated with PPI prescription were 1.74 (95% CI, 1.26-2.40) for ESKD and 2.42 (95% CI, 1.73-3.39) for all-cause mortality. Over the first 3 years of follow-up, 211 AKI events had occurred. The adjusted HR for AKI associated with PPI prescription was 2.89 (95% CI, 1.91-4.38). CONCLUSIONS Long-term PPI prescription was common in CKD patients. Our results call attention to its potential risks of both acute and chronic kidney failure.
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Affiliation(s)
- Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,Laboratory, EA7517, University of Picardie Jules Verne, Amiens, Amiens, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Aghiles Hamroun
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Maurice Laville
- Nephrology Department, Lyon Sud Hospital, Pierre Benite, France.,Lyon University, INSERM U1060, CarMeN, Pierre Benite, France
| | - Solène M Laville
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Luc Frimat
- Nephrology Department, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.,Laboratory, EA4360, Lorraine University, Nancy, France
| | | | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France.,Biomedecine Agency, Saint Denis La Plaine, France
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
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Alencar de Pinho N, Drueke T, Massy ZA, Stengel B. The Authors Reply. Kidney Int Rep 2020; 5:2403-2404. [PMID: 33305142 PMCID: PMC7710823 DOI: 10.1016/j.ekir.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Natalia Alencar de Pinho
- University Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Clinical Epidemiology team, CESP, Villejuif, France
| | - Tilman Drueke
- University Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Clinical Epidemiology team, CESP, Villejuif, France
| | - Ziad A. Massy
- University Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Clinical Epidemiology team, CESP, Villejuif, France
- Ambroise Paré University Hospital, APHP, Department of Nephrology, Boulogne-Billancourt/Paris, France
| | - Bénédicte Stengel
- University Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Clinical Epidemiology team, CESP, Villejuif, France
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40
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Sylvestre R, Alencar de Pinho N, Massy ZA, Jacquelinet C, Prezelin-Reydit M, Galland R, Stengel B, Coscas R. Practice patterns of dialysis access and outcomes in patients wait-listed early for kidney transplantation. BMC Nephrol 2020; 21:422. [PMID: 33008322 PMCID: PMC7532567 DOI: 10.1186/s12882-020-02080-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early kidney transplantation (KT) is the best option for patients with end-stage kidney disease, but little is known about dialysis access strategy in this context. We studied practice patterns of dialysis access and how they relate with outcomes in adults wait-listed early for KT according to the intended donor source. METHODS This study from the REIN registry (2002-2014) included 9331 incident dialysis patients (age 18-69) wait-listed for KT before or by 6 months after starting dialysis: 8342 candidates for deceased-donor KT and 989 for living-donor KT. Subdistribution hazard ratios (SHR) of KT and death associated with hemodialysis by catheter or peritoneal dialysis compared with arteriovenous (AV) access were estimated with Fine and Gray models. RESULTS Living-donor candidates used pretransplant peritoneal dialysis at rates similar to deceased-donor KT candidates, but had significantly more frequent catheter than AV access for hemodialysis (adjusted OR 1.25; 95%CI 1.09-1.43). Over a median follow-up of 43 (IQR: 23-67) months, 6063 patients received transplants and 305 died before KT. Median duration of pretransplant dialysis was 15 (7-27) months for deceased-donor recipients and 9 (5-15) for living-donor recipients. Catheter use in deceased-donor candidates was associated with a lower SHR for KT (0.88, 95%CI 0.82-0.94) and a higher SHR for death (1.53, 95%CI 1.14-2.04). Only five deaths occurred in living-donor candidates, three of them with catheter use. CONCLUSIONS Pretransplant dialysis duration may be quite long even when planned with a living donor. Advantages from protecting these patients from AV fistula creation must be carefully evaluated against catheter-related risks.
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Affiliation(s)
- Raphaëlle Sylvestre
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.,Division of Vascular Surgery, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Natalia Alencar de Pinho
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.
| | - Ziad A Massy
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.,Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Christian Jacquelinet
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.,Agence de la Biomédecine, Direction Médicale et Scientifique, Boulogne-Billancourt, France
| | - Mathilde Prezelin-Reydit
- Aurad-Aquitaine, Service Hémodialyse, Saint Denis La Plaine, France.,Bordeaux Population Health Research Center, Clinical Investigation Center-Clinical Epidemiology-CIC-1401, University of Bordeaux, INSERM, UMR1219, Bordeaux, France
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France
| | - Raphael Coscas
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.,Division of Vascular Surgery, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
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Fages V, Alencar de Pinho N, Hamroun A, Jacquelinet C, Frimat L, Foucque D, Combe C, Massy Z, Boucquemont J, Stengel B. Déterminants sociaux et organisationnels du démarrage de la dialyse en urgence chez des patients suivis en néphrologie – Une étude de cohorte prospective. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Montalescot L, Speyer E, Legrand K, Ayav C, Combe C, Stengel B, Untas A. Reliability and validity of the French adaptation of the Family Relationship Index-short form in patients' with chronic kidney disease. J Health Psychol 2020; 27:166-175. [PMID: 32772863 DOI: 10.1177/1359105320949921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Family Relationship Index (FRI) measures family cohesion, expressiveness and conflict. This study aimed to investigate its reliability and validity in patients with chronic kidney disease (CKD). Confirmatory factor analysis was performed on 1657 patients and on subgroups according to socio-demographics and medical variables. Two items with poor saturation were excluded. The indexes indicated an acceptable fit. Reliability was especially weak for expressiveness. Our results provide partial support for the use of the French-version of the FRI in patients with advanced CKD. The family relationship index should be used with caution, especially in certain subgroups and for the expressiveness subscale.
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Affiliation(s)
| | - Elodie Speyer
- Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France
| | - Karine Legrand
- Epidémiologie Clinique, Inserm CIC-EC, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Carole Ayav
- Epidémiologie Clinique, Inserm CIC-EC, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèses, Centre Hospitalier Universitaire de Bordeaux, and Unité INSERM U1026, Bordeaux, France
| | - Bénédicte Stengel
- Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France
| | - Aurélie Untas
- Université de Paris, LPPS, Boulogne-Billancourt, France
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43
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Laville SM, Gras-Champel V, Moragny J, Metzger M, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Robinson BM, Stengel B, Massy ZA, Liabeuf S. Adverse Drug Reactions in Patients with CKD. Clin J Am Soc Nephrol 2020; 15:1090-1102. [PMID: 32611662 PMCID: PMC7409761 DOI: 10.2215/cjn.01030120] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the burden of adverse drug reactions in CKD. We estimated the incidence of overall and serious adverse drug reactions and assessed the probability of causation, preventability, and factors associated with adverse drug reactions in patients seen by nephrologists. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Chronic Kidney Disease-Renal Epidemiology and Information Network cohort included 3033 outpatients (65% men) with CKD and eGFR<60 ml/min per 1.73 m2, with follow-up for 2 years. Adverse drug reactions were identified from hospitalization reports, medical records, and participant interviews and finally assessed for causality, preventability, and immediate therapeutic management by experts in pharmacology. RESULTS Median (interquartile range) age was 69 (60-76) years old; 55% had eGFR≥30 ml/min per 1.73 m2, and 45% had eGFR<30 ml/min per 1.73 m2. Participants were prescribed a median (range) of eight (five to ten) drugs. Over 2 years, 536 patients had 751 adverse drug reactions, 150 (in 125 participants) classified as serious, for rates of 14.4 (95% confidence interval, 12.6 to 16.5) and 2.7 (95% confidence interval, 1.7 to 4.3) per 100 person-years, respectively. Among the serious adverse drug reactions, 32% were considered preventable or potentially preventable; 16 caused death, directly or indirectly. Renin-angiotensin system inhibitors (15%), antithrombotic agents (14%), and diuretics (10%) were the drugs to which the most adverse drug reactions were imputed, but antithrombotic agents caused 34% of serious adverse drug reactions. The drug was discontinued in 71% of cases, at least temporarily. Adjusted hazard ratios for serious adverse drug reaction were significantly higher in patients with eGFR<30 versus ≥30 ml/min per 1.73 m2 (1.8; 95% confidence interval, 1.3 to 2.6), in those prescribed more than ten versus less than five medications (2.4; 95% confidence interval, 1.1 to 5.2), or in those with poor versus good adherence (1.6; 95% confidence interval, 1.4 to 2.4). CONCLUSIONS Adverse drug reactions are common and sometimes serious in patients with CKD. Many serious adverse drug reactions may be preventable. Some specific pharmacologic classes, particularly antithrombotic agents, are at risk of serious adverse drug reactions. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN), NCT03381950.
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Affiliation(s)
- Solène M Laville
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | | | - Julien Moragny
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Marie Metzger
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Christian Jacquelinet
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France.,Renal Epidemiology and Information Network Registry, Biomedicine Agency, Saint Denis, France
| | - Christian Combe
- Department of Nephrology Transplantation Dialysis, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Inserm Unit 1026, University of Bordeaux Segalen, Bordeaux, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Maurice Laville
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Luc Frimat
- Nephrology Department, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France.,Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | | | - Bénédicte Stengel
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Ziad A Massy
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France.,Division of Nephrology, Ambroise Paré University Hospital, Assistance publique - Hôpitaux de Paris, Boulogne-Billancourt/Paris, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
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44
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Legrand K, Speyer E, Stengel B, Frimat L, Ngueyon Sime W, Massy ZA, Fouque D, Laville M, Combe C, Jacquelinet C, Durand AC, Edet S, Gentile S, Briançon S, Ayav C. Perceived Health and Quality of Life in Patients With CKD, Including Those With Kidney Failure: Findings From National Surveys in France. Am J Kidney Dis 2020; 75:868-878. [DOI: 10.1053/j.ajkd.2019.08.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023]
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Reichel H, Zee J, Tu C, Young E, Pisoni RL, Stengel B, Duttlinger J, Lonnemann G, Robinson BM, Pecoits-Filho R, Fliser D. Chronic kidney disease progression and mortality risk profiles in Germany: results from the Chronic Kidney Disease Outcomes and Practice Patterns Study. Nephrol Dial Transplant 2020; 35:803-810. [PMID: 31953939 PMCID: PMC7203560 DOI: 10.1093/ndt/gfz260] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) progression among German patients in a representative setting has not been described previously. The Verband Deutsche Nierenzentren and Chronic Kidney Disease Outcomes and Practice Patterns Study established a longitudinal observational cohort among German CKD patients to research variations in patient care and outcomes in real-world nephrology practices. METHODS A cohort of CKD Stages 3 (25%) and 4 (75%) patients was established from German nephrologist-run CKD clinics in 2013-16. Linear models were used to determine the estimated glomerular filtration rate (eGFR) slope during follow-up and Cox models were used to assess outcomes of end-stage kidney disease (ESKD) and death. RESULTS A total of 1834 patients (median age 75 years, 58% male, 42% diabetics, median baseline eGFR 25 mL/min/1.73 m2) were followed for a median of 29 months. More than 50% had slow or no decline and 17% declined ≥5 mL/min/1.73 m2/year. After 4.5 years, the incidence of ESKD was 8% and of deaths without ESKD 16% among patients with eGFR ≥30 mL/min/1.73 m2 and 37% and 19% for eGFR <30 mL/min/1.73 m2. Adjusted models showed higher risks of ESKD or death for patients with worse kidney function at baseline, male sex, diabetes and higher blood pressure; a higher risk of ESKD with higher albuminuria; and a higher risk of death with older age or cardiovascular comorbidity. CONCLUSIONS Routine nephrology care of patients in Germany comprises mostly elderly patients, many with slow CKD progression. Identification of risk factors for CKD progression and mortality may help guide resources by closer follow-up of high-risk patients.
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Affiliation(s)
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Charlotte Tu
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Eric Young
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Bénédicte Stengel
- French National Institute of Health and Medical Research, Villejuif, France
| | | | | | | | | | - Danilo Fliser
- Internal Medicine - Nephrology and Hypertension, University Hospital of the Saarland, Homburg, Germany
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46
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Mansouri I, Alencar de Pinho N, Snanoudj R, Jacquelinet C, Lassalle M, Béchade C, Vigneau C, de Vathaire F, Haddy N, Stengel B. Trends and Outcomes with Kidney Failure from Antineoplastic Treatments and Urinary Tract Cancer in France. Clin J Am Soc Nephrol 2020; 15:484-492. [PMID: 32144099 PMCID: PMC7133127 DOI: 10.2215/cjn.10230819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/10/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Cancer survival is improving along with an increase in the potential for adverse kidney effects from antineoplastic treatments or nephrectomy. We sought to describe recent trends in the incidence of kidney failure related to antineoplastic treatments and urinary tract cancers and evaluate patient survival and kidney transplantation access. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used the French Renal Epidemiology and Information Network registry to identify patients with kidney failure related to antineoplastic treatments or urinary tract cancer from 2003 to 2015. We identified 287 and 1157 cases with nephrotoxin- and urinary tract cancer-related kidney failure, respectively. The main study outcomes were death and kidney transplantation. After matching cases to two to ten controls (n=11,678) with other kidney failure causes for age, sex, year of dialysis initiation, and diabetes status, we estimated subdistribution hazard ratios (SHR) of each outcome separately for patients with and without active malignancy. RESULTS The mean age- and sex-adjusted incidence of nephrotoxin-related kidney failure was 0.43 (95% CI, 0.38 to 0.49) per million inhabitants and 1.80 (95% CI, 1.68 to 1.90) for urinary tract cancer-related kidney failure; they increased significantly by 5% and 2% annually, respectively, during 2006-2015. Compared with matched controls, age-, sex-, and comorbidity-adjusted SHRs for mortality in patients with nephrotoxin-related kidney failure were 4.2 (95% CI, 3.2 to 5.5) and 1.4 (95% CI, 1.0 to 2.0) for those with and without active malignancy, respectively; for those with urinary tract cancer, SHRs were 2.0 (95% CI, 1.7 to 2.2) and 1.1 (95% CI, 0.9 to 1.2). The corresponding SHRs for transplant wait-listing were 0.19 (95% CI, 0.11 to 0.32) and 0.62 (95% CI, 0.43 to 0.88) for nephrotoxin-related kidney failure cases and 0.28 (95% CI, 0.21 to 0.37) and 0.47 (95% CI, 0.36 to 0.60) for urinary tract cancer cases. Once on the waiting list, access to transplantation did not differ significantly between cases and controls. CONCLUSIONS Cancer-related kidney failure is slowly but steadily increasing. Mortality does not appear to be increased among patients without active malignancy at dialysis start, but their access to kidney transplant remains limited.
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Affiliation(s)
- Imène Mansouri
- University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Sud, Inserm, Radiation Epidemiology Team, CESP, Villejuif, France
| | - Natalia Alencar de Pinho
- University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Sud, Inserm, Clinical Epidemiology team, CESP, Villejuif, France
| | - Renaud Snanoudj
- Nephrology and Transplantation Department, Foch Hospital, Suresnes, France
| | - Christian Jacquelinet
- University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Sud, Inserm, Clinical Epidemiology team, CESP, Villejuif, France.,Renal Epidemiology and Information Network Registry, Biomedicine Agency, Saint Denis, France
| | - Mathilde Lassalle
- Renal Epidemiology and Information Network Registry, Biomedicine Agency, Saint Denis, France
| | - Clémence Béchade
- Department of Nephrology, CHU Caen, Caen, France.,Nephrology Department, Pontchaillou University Hospital, Rennes, France
| | - Cécile Vigneau
- Research Institute for Environmental and Occupational Health (IRSET), the French School of Public Health EHESP, INSERM Unit 1085, Rennes University, Rennes, France; and.,U1086 INSERM "Anticipe", Center François Baclesse, Caen, France
| | - Florent de Vathaire
- University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Sud, Inserm, Radiation Epidemiology Team, CESP, Villejuif, France
| | - Nadia Haddy
- University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Sud, Inserm, Radiation Epidemiology Team, CESP, Villejuif, France;
| | - Bénédicte Stengel
- University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Sud, Inserm, Clinical Epidemiology team, CESP, Villejuif, France
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47
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Lannou S, Mansencal N, Couchoud C, Lassalle M, Dubourg O, Stengel B, Jacquelinet C, Charron P. The Public Health Burden of Cardiomyopathies: Insights from a Nationwide Inpatient Study. J Clin Med 2020; 9:jcm9040920. [PMID: 32230881 PMCID: PMC7230913 DOI: 10.3390/jcm9040920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/16/2022] Open
Abstract
Cardiomyopathies are responsible for heart failure and sudden cardiac death, but epidemiological data are scarce and the public health burden may be underestimated. We studied aggregating data from all public or private hospitals in France. Patients were categorized from relevant ICD-10 codes into dilated, hypertrophic, restrictive, or other cardiomyopathies (DCM, HCM, RCM, or OCM, respectively). Between 2008 and 2015, a total of 326,461 distinct patients had cardiomyopathy-related hospitalizations. The hospital-based prevalence of cardiomyopathy was 809 per million inhabitants (PMI) per year, including 428 PMI for DCM, 101 PMI for HCM, 26 PMI for RCM, and 253 PMI for OCM. Patients with cardiomyopathies accounted for 51% of all heart transplants, 33% of defibrillator implantations, 38% of mechanical circulatory supports, and 11.3% of hospitalizations for heart failure. In patients less than 40 years of age, these figures were 71%, 51%, 63%, and 23%, respectively. Over 2008–2015 and considering all cardiomyopathies, there was a significant increase for heart transplant (average annual percentage change, AAPC: +3.86%, p = 0.0015) and for defibrillator implantation (AAPC: +6.98%, p < 0.0001), and a significant decrease of in-hospital mortality (AAPC: −4.7%, p = 0.0002). This nationwide study shows that cardiomyopathies constitute an important cause of hospitalization, with increasing invasive therapeutic procedures and decreasing mortality.
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Affiliation(s)
- Simon Lannou
- APHP, Service de Cardiologie, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; (S.L.); (N.M.); (O.D.)
| | - Nicolas Mansencal
- APHP, Service de Cardiologie, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; (S.L.); (N.M.); (O.D.)
- Univ Paris-Saclay, Univ Versailles-Saint Quentin, Univ Paris-Sud, Inserm, Clinical Epidemiology Team, CESP Centre for Research in Epidemiology and Population Health, 94807 Villejuif, France; (B.S.); (C.J.)
| | - Cécile Couchoud
- Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France; (C.C.); (M.L.)
| | - Mathilde Lassalle
- Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France; (C.C.); (M.L.)
| | - Olivier Dubourg
- APHP, Service de Cardiologie, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; (S.L.); (N.M.); (O.D.)
- Univ Paris-Saclay, Univ Versailles-Saint Quentin, Univ Paris-Sud, Inserm, Clinical Epidemiology Team, CESP Centre for Research in Epidemiology and Population Health, 94807 Villejuif, France; (B.S.); (C.J.)
| | - Bénédicte Stengel
- Univ Paris-Saclay, Univ Versailles-Saint Quentin, Univ Paris-Sud, Inserm, Clinical Epidemiology Team, CESP Centre for Research in Epidemiology and Population Health, 94807 Villejuif, France; (B.S.); (C.J.)
| | - Christian Jacquelinet
- Univ Paris-Saclay, Univ Versailles-Saint Quentin, Univ Paris-Sud, Inserm, Clinical Epidemiology Team, CESP Centre for Research in Epidemiology and Population Health, 94807 Villejuif, France; (B.S.); (C.J.)
- Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France; (C.C.); (M.L.)
| | - Philippe Charron
- APHP, Service de Cardiologie, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; (S.L.); (N.M.); (O.D.)
- APHP, Département de Génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Sorbonne Université, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
- Correspondence: ; Tel.: +33-1-42-16-13-47
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48
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Stengel B, Metzger M, Combe C, Jacquelinet C, Briançon S, Ayav C, Fouque D, Laville M, Frimat L, Pascal C, Herpe YE, Morel P, Deleuze JF, Schanstra JP, Lange C, Legrand K, Speyer E, Liabeuf S, Robinson BM, Massy ZA. Risk profile, quality of life and care of patients with moderate and advanced CKD: The French CKD-REIN Cohort Study. Nephrol Dial Transplant 2020; 34:277-286. [PMID: 29635335 DOI: 10.1093/ndt/gfy058] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/01/2018] [Indexed: 12/20/2022] Open
Abstract
Background The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study was designed to investigate the determinants of prognosis and care of patients referred to nephrologists with moderate and advanced chronic kidney disease (CKD). We examined their baseline risk profile and experience. Methods We collected bioclinical and patient-reported information from 3033 outpatients with CKD and estimated glomerular filtration rates (eGFRs) of 15-60 mL/min/1.73 m2 treated at 40 nationally representative public and private facilities. Results The patients' median age was 69 (60-76) years, 65% were men, their mean eGFR was 33 mL/min/1.73 m2, 43% had diabetes, 24% had a history of acute kidney injury (AKI) and 57% had uncontrolled blood pressure (BP; >140/90 mmHg). Men had worse risk profiles than women and were more likely to be past or current smokers (73% versus 34%) and have cardiovascular disease (59% versus 42%), albuminuria >30 mg/mmol (or proteinuria > 50) (40% versus 30%) (all P < 0.001) and a higher median risk of end-stage renal disease within 5 years, predicted by the kidney failure risk equation {12% [interquartile range (IQR) 3-37%] versus 9% [3-31%], P = 0.008}. During the previous year, 60% of patients reported one-to-two nephrologist visits and four or more general practitioner visits; only 25% saw a dietician and 75% were prescribed five or more medications daily. Physical and mental quality of life (QoL) were poor, with scores <50/100. Conclusions The CKD-REIN study highlights high-risk profiles of cohort members and identifies several priorities, including improving BP control and dietary counselling and increasing doctors' awareness of AKI, polypharmacy and QoL. Trial registration ClinicalTrials.gov identifier: NCT03381950.
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Affiliation(s)
- Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Christian Combe
- Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,INSERM, U1026, Université Bordeaux Segalen, Bordeaux, France
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,Agence de la Biomédecine, Saint-Denis, France
| | - Serge Briançon
- Department of Clinical Epidemiology, University Hospital of Nancy, INSERM CIC-EC 1433, Nancy, France.,EA4360 Apemac, Université de Lorraine, Université Paris-Descartes, Nancy, France
| | - Carole Ayav
- Department of Clinical Epidemiology, University Hospital of Nancy, INSERM CIC-EC 1433, Nancy, France
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon-Sud, Université de Lyon, UCBL, Carmen, Pierre-Bénite, France
| | - Maurice Laville
- Department of Nephrology, Centre Hospitalier Lyon-Sud, Université de Lyon, UCBL, Carmen, Pierre-Bénite, France
| | - Luc Frimat
- EA4360 Apemac, Université de Lorraine, Université Paris-Descartes, Nancy, France.,Department of Nephrology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Christophe Pascal
- Institute for Education and Research in Health Care and Social Service, Jean Moulin Lyon 3 university, Lyon, France
| | - Yves-Edouard Herpe
- Biobanque de Picardie, Amiens, France.,Department of Clinical Pharmacology, Centre Hospitalier Universitaire, Amiens, France
| | - Pascal Morel
- Etablissement Français du Sang, Bourgogne Franche Comté, Besançon, France
| | - Jean-François Deleuze
- Centre National de Recherche en Génomique Humaine (CNRGH), Institut de Biologie François-Jacob, CEA, Evry, France
| | - Joost P Schanstra
- INSERM U1048, Institute of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Céline Lange
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,Agence de la Biomédecine, Saint-Denis, France
| | - Karine Legrand
- Department of Clinical Epidemiology, University Hospital of Nancy, INSERM CIC-EC 1433, Nancy, France.,EA4360 Apemac, Université de Lorraine, Université Paris-Descartes, Nancy, France
| | - Elodie Speyer
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Sophie Liabeuf
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,Department of Clinical Pharmacology, Centre Hospitalier Universitaire, Amiens, France
| | | | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,Department of Nephrology, CHU Ambroise Paré, Boulogne, France
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Liabeuf S, McCullough K, Young EW, Pisoni R, Zee J, Reichel H, Pecoits-Filho R, Port FK, Stengel B, Csomor PA, Metzger M, Robinson B, Massy ZA. International variation in the management of mineral bone disorder in patients with chronic kidney disease: Results from CKDopps. Bone 2019; 129:115058. [PMID: 31493530 DOI: 10.1016/j.bone.2019.115058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) is commonly associated with mineral and bone metabolism disorders, but these are less frequently studied in non-dialysis CKD patients than in dialysis patients. We examined and described international variation in mineral and bone disease (MBD) markers and their treatment and target levels in Stage 3-5 CKD patients. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Prospective cohort study of 7658 adult patients with eGFR <60mL/min/1.73m2, excluding dialysis or transplant patients, participating in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) in Brazil, France, Germany, and the US. CKD-MBD laboratory markers included serum levels of phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH), and 25-hydroxyvitamin D (25-D). MBD treatment data included phosphate binders and vitamin D (nutritional and active). Nephrologist survey data were collected on target MBD marker levels. RESULTS Over two-thirds of the patients had MBD markers measured at time intervals in line with practice guidelines. P and iPTH increased and Ca decreased gradually from eGFR 60-20mL/min/1.73m2 and more sharply for eGFR<20. 25-D showed no relation to eGFR. Nephrologist survey data indicated marked variation in upper target P and iPTH levels. Among patients with P>5.5mg/dL, phosphate binder use was 14% to 43% across the four countries. Among patients with PTH >300pg/mL, use of active (calcitriol and related analogs) vitamin D was 12%-51%, and use of any (active or nutritional) vitamin D was 60%-87%. CONCLUSIONS Although monitoring of CKD-MBD laboratory markers by nephrologists in CKDopps countries is consistent with guidelines, target levels vary notably and prescription of medications to treat abnormalities in these laboratory markers is generally low in these cross-sectional analyses. While there are opportunities to increase treatment of hyperphosphatemia, hyperparathyroidism, and vitamin D deficiency in advanced CKD, the effect on longer-term complications of these conditions requires study.
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Affiliation(s)
- Sophie Liabeuf
- Pharmacology Department and Laboratory EA 7517, Amiens University Hospital, 80000 Amiens, France
| | | | - Eric W Young
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA; Pontifícia Universidade Católica Do Paraná, Nephrology, Do Paraná, Brazil
| | | | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, UVSQ, University Paris-Saclay, Villejuif, France
| | | | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, UVSQ, University Paris-Saclay, Villejuif, France
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, UVSQ, University Paris-Saclay, Villejuif, France; Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne Billancourt/Paris, France.
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50
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Vidal-Petiot E, Metzger M, Faucon AL, Boffa JJ, Haymann JP, Thervet E, Houillier P, Geri G, Stengel B, Vrtovsnik F, Flamant M. Extracellular Fluid Volume Is an Independent Determinant of Uncontrolled and Resistant Hypertension in Chronic Kidney Disease: A NephroTest Cohort Study. J Am Heart Assoc 2019; 7:e010278. [PMID: 30371309 PMCID: PMC6404875 DOI: 10.1161/jaha.118.010278] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Hypertension is highly prevalent during chronic kidney disease (CKD) and, in turn, worsens CKD prognosis. We aimed to describe the determinants of uncontrolled and resistant hypertension during CKD. Methods and Results We analyzed baseline data from patients with CKD stage 1 to 5 (NephroTest cohort) who underwent thorough renal explorations, including measurements of glomerular filtration rate (clearance of 51Cr‐EDTA) and of extracellular water (volume of distribution of the tracer). Hypertension was defined as blood pressure (BP; average of 3 office measurements) ≥140/90 mm Hg or the use of antihypertensive drugs. In 2015 patients (mean age, 58.7±15.3 years; 67% men; mean glomerular filtration rate, 42±15 mL/min per 1.73 m2), prevalence of hypertension was 88%. Among hypertensive patients, 44% and 32% had uncontrolled (≥140/90 mm Hg) and resistant (uncontrolled BP despite 3 drugs, including a diuretic, or ≥4 drugs, including a diuretic, regardless of BP level) hypertension, respectively. In multivariable analysis, extracellular water, older age, higher albuminuria, diabetic nephropathy, and the absence of aldosterone blockers were independently associated with uncontrolled BP. Extracellular water, older age, lower glomerular filtration rate, higher albuminuria and body mass index, male sex, African origin, diabetes mellitus, and diabetic and glomerular nephropathies were associated with resistant hypertension. Conclusions In this large population of patients with CKD, a lower glomerular filtration rate, a higher body mass index, diabetic status, and African origin were associated with hypertension severity but not with BP control. Higher extracellular water, older age, and higher albuminuria were independent determinants of both resistant and uncontrolled hypertension during CKD. Our results advocate for the large use of diuretics in this population.
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Affiliation(s)
- Emmanuelle Vidal-Petiot
- 1 Physiology Department Assistance Publique-Hôpitaux de Paris Hôpital Bichat and Inserm U1149 Paris France.,2 Paris Diderot University Sorbonne Paris Cité Paris France
| | - Marie Metzger
- 3 Inserm Centre de recherche en Epidéemiologie et Santée des Populations U1018 Hôpital Paul Brousse Villejuif France
| | - Anne-Laure Faucon
- 3 Inserm Centre de recherche en Epidéemiologie et Santée des Populations U1018 Hôpital Paul Brousse Villejuif France
| | - Jean-Jacques Boffa
- 4 Nephrology Department APHP, Hôpital Tenon Paris France.,5 Pierre et Marie Curie University Paris France
| | - Jean-Philippe Haymann
- 5 Pierre et Marie Curie University Paris France.,6 Physiology Department APHP, Hôpital Tenon Paris France
| | - Eric Thervet
- 7 Nephrology Department APHP HEGP Paris France.,8 Paris Descartes University Sorbonne Paris Cité Paris France
| | - Pascal Houillier
- 1 Physiology Department Assistance Publique-Hôpitaux de Paris Hôpital Bichat and Inserm U1149 Paris France.,8 Paris Descartes University Sorbonne Paris Cité Paris France.,9 Physiology Department APHP Hôpital Tenon, Georges Pompidou Paris France.,10 INSERM UMR_S1138 Paris France
| | - Guillaume Geri
- 3 Inserm Centre de recherche en Epidéemiologie et Santée des Populations U1018 Hôpital Paul Brousse Villejuif France.,11 Intensive Care Unit APHP, Hopital Ambroise Paré Boulogne France.,12 Versailles Saint Quentin University Versailles France
| | - Bénédicte Stengel
- 3 Inserm Centre de recherche en Epidéemiologie et Santée des Populations U1018 Hôpital Paul Brousse Villejuif France
| | - François Vrtovsnik
- 2 Paris Diderot University Sorbonne Paris Cité Paris France.,13 Nephrology Department APHP, Hôpital Bichat Paris France
| | - Martin Flamant
- 1 Physiology Department Assistance Publique-Hôpitaux de Paris Hôpital Bichat and Inserm U1149 Paris France.,2 Paris Diderot University Sorbonne Paris Cité Paris France
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