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Gaumond L, Lamarche C, Beauchemin S, Henley N, Elftouh N, Gerarduzzi C, Laurin LP. Identification of inflammatory biomarkers in IgA nephropathy using the NanoString technology: a validation study in Caucasians. Inflamm Res 2024; 73:447-457. [PMID: 38291238 PMCID: PMC10894174 DOI: 10.1007/s00011-023-01848-3] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE AND DESIGN Immunoglobulin A nephropathy (IgAN) is a kidney disease characterized by the accumulation of IgA deposits in the glomeruli of the kidney, leading to inflammation and damage to the kidney. The inflammatory markers involved in IgAN remain to be defined. Gene expression analysis platforms, such as the NanoString nCounter system, are promising screening and diagnostic tools, especially in oncology. Still, their role as a diagnostic and prognostic tool in IgAN remains scarce. In this study, we aimed to validate the use of NanoString technology to identify potential inflammatory biomarkers involved in the progression of IgAN. SUBJECTS A total of 30 patients with biopsy-proven IgAN and 7 cases of antineutrophil cytoplasmic antibody (ANCA)-associated pauci-immune glomerulonephritis were included for gene expression measurement. For the immunofluorescence validation experiments, a total of 6 IgAN patients and 3 controls were included. METHODS Total RNA was extracted from formalin-fixed paraffin-embedded kidney biopsy specimens, and a customized 48-plex human gene CodeSet was used to study 29 genes implicated in different biological pathways. Comparisons in gene expression were made between IgAN and ANCA-associated pauci-immune glomerulonephritis patients to delineate an expression profile specific to IgAN. Gene expression was compared between patients with low and moderate risk of progression. Genes for which RNA expression was associated with disease progression were analyzed for protein expression by immunofluorescence and compared with controls. RESULTS IgAN patients had a distinct gene expression profile with decreased expression in genes IL-6, INFG, and C1QB compared to ANCA patients. C3 and TNFRSF1B were identified as potential biomarkers for IgAN progression in patients early in their disease course. Protein expression for those 2 candidate genes was upregulated in IgAN patients compared to controls. Expression of genes implicated in fibrosis (PTEN, CASPASE 3, TGM2, TGFB1, IL2, and TNFRSF1B) was more pronounced in IgAN patients with severe fibrosis compared to those with none. CONCLUSIONS Our findings validate our NanoString mRNA profiling by examining protein expression levels of two candidate genes, C3 and TNFRSF1B, in IgAN patients and controls. We also identified several upregulated mRNA transcripts implicated in the development of fibrosis that may be considered fibrotic markers within IgAN patients.
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Affiliation(s)
- Laurence Gaumond
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Caroline Lamarche
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Department of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Nathalie Henley
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Naoual Elftouh
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Casimiro Gerarduzzi
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.
- Department of Medicine, University of Montreal, Montreal, QC, Canada.
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada.
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.
- Department of Medicine, University of Montreal, Montreal, QC, Canada.
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Morin C, Pichette M, Elftouh N, Imbeault B, Laurin LP, Lafrance JP, Goupil R, Nadeau-Fredette AC. Is health-related quality of life trajectory associated with dialysis modality choice in advanced chronic kidney disease? Perit Dial Int 2024:8968608231217807. [PMID: 38186013 DOI: 10.1177/08968608231217807] [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: 01/09/2024] Open
Abstract
BACKGROUND Patients with advanced chronic kidney disease have lower health-related quality of life (HRQOL) than the general population. There is uncertainty regarding patterns of HRQOL changes before dialysis initiation. This study aimed to characterise HRQOL trajectory and assess its potential association with intended dialysis modality. METHODS This prospective single-centre cohort study followed adults with an estimated glomerular filtration rate ≤15 mL/min/1.73 m2 for one year. Patients were allocated into one of two groups based on their intended treatment modality, 'home dialysis' (peritoneal dialysis or home haemodialysis (HD)) and 'other' (in-centre HD or conservative care). Follow-up was for up to 1 year or earlier if initiated on kidney replacement therapy or died. Kidney Disease Quality of Life - Short Form (KDQOL-SF) was completed every 6 months. Predictors of changes in KDQOL-SF components were modelled using mixed effect multivariable linear regressions. RESULTS One hundred and nine patients were included. At baseline, crude physical composite summary (PCS) (45 ± 10 vs. 39 ± 8) was higher in patients choosing home dialysis (n = 41), while mental composite summary (MCS) was similar in both groups. After adjustment, patients choosing home dialysis had an increase in MCS (B = 8.4 per year, p = 0.007) compared to those selecting in-centre HD/conservative care. This translates into an annual increase in MSC by 3 points for the 'home dialysis' group, compared to an annual decline by 5.4 points in the 'other' group. There was no difference in PCS trajectory through time. CONCLUSIONS Patients choosing home dialysis had improved MCS over time compared to those not selecting home dialysis. More work is needed to determine how differences in processes of care and/or unmeasured patient characteristics modulate this association.
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Affiliation(s)
- Catherine Morin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Maude Pichette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Naoual Elftouh
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Benoit Imbeault
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Department of pharmacology and physiology, Université de Montréal, Montreal, QC, Canada
| | - Rémi Goupil
- Research Center, Sacré-Cœur Hospital, Montreal, QC, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
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Naipaul R, Marques C, Ng J, Barbour S, Lo C, Hildebrand AM, Siu V, Prasad B, Laurin LP, Wazny LD, Armstrong S, Tran J, Sheffield M, Jauhal A, Hladunewich MA. Focused Jurisdictional Scan of Glomerulonephritis Medication Access in Canada: A Program Report. Can J Kidney Health Dis 2023; 10:20543581231190227. [PMID: 37581108 PMCID: PMC10423446 DOI: 10.1177/20543581231190227] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/23/2023] [Indexed: 08/16/2023] Open
Abstract
Purpose of Program Glomerulonephritis (GN) is a group of rare kidney diseases that is increasingly being managed with higher cost immunosuppressive (IS) agents in Canada. Ontario Health's Ontario Renal Network (ORN) oversees the management and delivery of GN services in the province. Stakeholder surveys previously conducted by ORN identified that both clinicians and patients do not perceive access to GN medications as comprehensive or timely. The program conducted a focused jurisdictional scan among 7 provinces to inform ORN initiatives to improve access to GN medications. Specifically, the program examined clinician experience with GN access, public drug coverage criteria, and timelines for public coverage for select IS agents (ie, tacrolimus, cyclosporine, mycophenolate mofetil [MMF], mycophenolate sodium, rituximab, and eculizumab) used to manage GN in adults who live in Canada. Methods For the selected IS agents, a focused jurisdictional scan on medication access was conducted by ORN in 2018 and updated in July 2022. Information was obtained by searching the gray literature and/or credible online sources for public funding policies and eligibility criteria. Findings were supplemented by personal communications with provincial drug programs and consulting GN clinical experts from 7 provinces (ie, Alberta, British Columbia, Saskatchewan, Manitoba, Ontario, Nova Scotia, and Quebec). Key Findings Clinicians from different provinces prescribe IS agents similarly for GN indications, despite distinctions in public drug funding policies. While patients can obtain public funding for many IS agents, for GN, most provinces rely on case-by-case review processes. In addition, provinces can vary in their funding criteria and which IS agents are listed on the public formulary. For IS agents that require prior authorization or case-by-case review, timelines vary by province with decisions taking a few days to weeks. British Columbia, with a GN-specific drug formulary, had the most integrated and efficient system for patients and prescribers. Limitations This scan primarily relied on publicly available information for drug coverage criteria and clinician experience with access in their province. Since this scan was conducted, public drug coverage criteria and/or application processes may have changed. Implications While patients in most provinces have similar needs and nephrologists similar prescribing patterns, gaps still exist for publicly funded GN medications. Interprovincial differences in the drugs funded, funding criteria, and application process may affect timely and equitable access to GN medications across Canada. Given the rarity of GN, a pan-Canadian funding approach may be warranted to improve the current state.
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Affiliation(s)
| | | | - Jenny Ng
- Division of Nephrology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Nanji Family Kidney Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Sean Barbour
- Division of Nephrology, Department of Medicine, University of British Columbia, BC Renal, Vancouver, BC, Canada
| | - Clifford Lo
- Division of Nephrology, Department of Medicine, University of British Columbia, BC Renal, Vancouver, BC, Canada
| | - Ainslie M. Hildebrand
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Valerie Siu
- Pharmacy Services, Alberta Health Services, University of Alberta Hospital, Edmonton, AB, Canada
| | - Bhanu Prasad
- Division of Nephrology, Department of Medicine, Regina General Hospital, Regina, SK, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Department of Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QB, Canada
| | - Lori D. Wazny
- Manitoba Renal Program and Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Sean Armstrong
- Manitoba Renal Program and Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Jaclyn Tran
- Central Zone, Nova Scotia Health Renal Program, Halifax, NS, Canada
| | - Maneka Sheffield
- Central Zone, Nova Scotia Health Renal Program, Halifax, NS, Canada
| | - Arenn Jauhal
- Division of Nephrology, Department of Medicine, University Health Network, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle A. Hladunewich
- Ontario Health (Ontario Renal Network), Toronto, Canada
- Division of Nephrology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Nanji Family Kidney Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada
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Roy G, Iordachescu I, Royal V, Lamarche C, Ahmad I, Nadeau-Fredette AC, Laurin LP. Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series. Kidney Med 2023; 5:100674. [PMID: 37492111 PMCID: PMC10363560 DOI: 10.1016/j.xkme.2023.100674] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Rationale and Objective The incidence of kidney disease is high in patients after allogeneic hematopoietic cell transplantation (aHCT). Although rarely performed, kidney biopsy may be useful to make a precise diagnosis because several mechanisms and risk factors can be involved, and to adjust the treatment accordingly. This case series aimed to report the spectrum of biopsy findings from patients with kidney injury after aHCT. Study Design Single-center retrospective case series. Setting and Participants All individuals who underwent a native kidney biopsy, among all adult patients who received aHCT in a tertiary hospital in Montreal (Canada) from January 1, 2010, to December 31, 2020, were identified, and the clinical data were extracted from their medical records. Results A total of 17 patients were included. Indications for biopsy included acute kidney injury (n=6), chronic kidney disease (n=5), nephrotic syndrome (n=4), and subnephrotic proteinuria (n=2). Pathologic findings from the kidney biopsy were heterogenous: 10 patients showed evidence of thrombotic microangiopathy (TMA), 5 of acute tubular injury, and 4 of membranous nephropathy. Cases of acute interstitial nephritis, BK virus nephropathy, immune complex nephropathy, focal and segmental glomerulosclerosis, minimal change disease, and karyomegalic-like interstitial nephritis were also described. Limitations There was no systematic kidney biopsy performed for all patients with kidney injury after aHCT. Only a small proportion of patients with kidney damage underwent biopsy, making the results less generalizable. Conclusions Kidney biopsy is useful in patients with kidney disease after aHCT to make a precise diagnosis and tailor therapy accordingly. This series is one of the few published studies describing pathologic findings of biopsies performed after aHCT in the context of acute kidney injury and chronic kidney disease. TMA was widely present on biopsy even when there was no clinical suspicion of such a diagnosis, suggesting that the current clinical criteria for a diagnosis of TMA are not sensitive enough for kidney-limited TMA.
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Affiliation(s)
- Guillaume Roy
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Ilinca Iordachescu
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Virginie Royal
- Department of Pathology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Caroline Lamarche
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Imran Ahmad
- Division of Hematology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
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Harvey B, Lafrance JP, Elftouh N, Vallée M, Laurin LP, Nadeau-Fredette AC. Single-Bolus Tinzaparin Anticoagulation in Extended Hemodialysis Session: A Feasibility Study. Kidney360 2023; 4:641-647. [PMID: 36921585 PMCID: PMC10278850 DOI: 10.34067/kid.0000000000000098] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/07/2023] [Indexed: 03/17/2023]
Abstract
Key Points A single bolus of tinzaparin is effective for 8-hour hemodialysis session. Eight-hour simulation sessions with anti-Xa monitoring are useful to adjust tinzaparin dose. Background Few studies have assessed the use of low-molecular weight heparins for anticoagulation during extended hemodialysis (HD) sessions. This study aimed to evaluate the efficacy of a single bolus of tinzaparin for anticoagulation of the extracorporeal circuit and dialyzer in 8-hour HD sessions. Methods This single-center study included all patients who underwent a single 8-hour simulation session as part of their nocturnal home HD training between 2009 and 2020. Tinzaparin was delivered as a single-bolus injection at time 0 with dosing on the basis of doubling of standard 4-hour session dose. Tinzaparin efficacy was examined using visual observations (score 1–4) of the dialyzer and venous bubble trap at the end of dialysis and using anti-Xa measured at 15 and 30 minutes and 1, 2, 4, 6, and 8 hours after HD start. Results Forty-seven patients were included. The mean tinzaparin dose was 107±20 IU/kg. Anti-Xa levels peaked at 15 minutes with 1.3±0.4 IU/ml and progressively declined reaching 0.9±0.3 IU/ml at 1 hour, 0.4±0.21 IU/ml at 4 hours, and 0.15±0.15 IU/ml at 8 hours. After the 8-hour session, none of the patients had severe clotting of their dialyzer or venous chamber. Moderate blood clotting was observed in the dialyzer of 6 patients (20%) and in the venous chamber of 22 patients (61%). On the basis of the simulation results, tinzaparin dose was increased in 27 patients (58%) with a mean home-discharge dose of 123±28 IU/kg. Conclusions This study shows that anti-Xa levels stabilized rapidly after administration of tinzaparin for 8-hour HD. Administration of a single-bolus tinzaparin at the start of an 8-hour dialysis session seemed effective, although dose adjustment may be required.
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Affiliation(s)
- Benoît Harvey
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Naoual Elftouh
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Michel Vallée
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
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Barratt J, Lafayette R, Kristensen J, Stone A, Cattran D, Floege J, Tesar V, Trimarchi H, Zhang H, Eren N, Paliege A, Rovin BH, Karl A, Losisolo P, Trimarchi H, Hoyos IG, Lampo MG, Monkowski M, De La Fuente J, Alvarez M, Stoppa D, Chiurchiu C, Novoa PA, Orias M, Barron MB, Giotto A, Arriola M, Cassini E, Maldonado R, Dionisi MP, Ryan J, Toussaint N, Luxton G, Peh CA, Levidiotis V, Francis R, Phoon R, Fedosiuk E, Toropilov D, Yakubtsevich R, Mikhailova E, Bovy C, Demoulin N, Hougardy JM, Maes B, Speeckaert M, Laurin LP, Barbour S, Masse M, Hladunewich M, Reich H, Cournoyer S, Tennankore K, Barbour S, Lv J, Liu Z, Wang C, Li S, Luo Q, Ni Z, Yan T, Fu P, Cheng H, Liu B, Lu W, Wang J, Chen Q, Wang D, Xiong Z, Chen M, Xu Y, Wei J, Pai P, Chen L, Rehorova J, Maixnerova D, Safranek R, Rychlik I, Hruby M, Makela S, Vaaraniemi K, Ortiz F, Alamartine E, Daroux M, Cartery C, Vrtovsnik F, Serre JE, Stamellou E, Vielhauer V, Hugo C, Budde K, Otte B, Nitschke M, Ntounousi E, Boletis I, Papagianni A, Goumenos D, Stylianou K, Zermpala S, Esposito C, Cozzolino MG, Viganò SM, Gesualdo L, Nowicki M, Stompor T, Kurnatowska I, Kim SG, Kim YL, Na KR, Kim DK, Kim SH, Porras LQ, Garcia ER, Pamplona IA, Segarra A, Goicoechea M, Fellstrom B, Lundberg S, Hemmingsson P, Guron G, Sandell A, Chen CH, Tokgoz B, Duman S, Altiparmak MR, Ergul M, Maxwell P, Mark P, McCafferty K, Khwaja A, Cheung CK, Hall M, Power A, Kanigicherla D, Baker R, Moriarty J, Mohamed A, Aiello J, Canetta P, Ayoub I, Robinson D, Thakar S, Mottl A, Sachmechi I, Fischbach B, Singh H, Mulhern J, Kamal F, Linfert D, Rizk D, Wadhwani S, Sarav M, Campbell K, Coppock G, Luciano R, Sedor J, Avasare R, Lau WL. Results from part A of the multi-center, double-blind, randomized, placebo-controlled NefIgArd trial, which evaluated targeted-release formulation of budesonide for the treatment of primary immunoglobulin A nephropathy. Kidney Int 2023; 103:391-402. [PMID: 36270561 DOI: 10.1016/j.kint.2022.09.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [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: 07/01/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
The therapeutic potential of a novel, targeted-release formulation of oral budesonide (Nefecon) for the treatment of IgA nephropathy (IgAN) was first demonstrated by the phase 2b NEFIGAN trial. To verify these findings, the phase 3 NefigArd trial tested the efficacy and safety of nine months of treatment with Nefecon (16 mg/d) versus placebo in adult patients with primary IgAN at risk of progressing to kidney failure (ClinicalTrials.gov: NCT03643965). NefIgArd was a multicenter, randomized, double-blind, placebo-controlled two-part trial. In Part A, 199 patients with IgAN were treated with Nefecon or placebo for nine months and observed for an additional three months. The primary endpoint for Part A was 24-hour urine protein-to-creatinine ratio (UPCR) after nine months. Secondary efficacy outcomes evaluated included estimated glomerular filtration rate (eGFR) at nine and 12 months and the UPCR at 12 months. At nine months, UPCR was 27% lower in the Nefecon group compared with placebo, along with a benefit in eGFR preservation corresponding to a 3.87 ml/min/1.73 m2 difference versus placebo (both significant). Nefecon was well-tolerated, and treatment-emergent adverse events were mostly mild to moderate in severity and reversible. Part B is ongoing and will be reported on later. Thus, NefIgArd is the first phase 3 IgA nephropathy trial to show clinically important improvements in UPCR and eGFR and confirms the findings from the phase 2b NEFIGAN study.
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Affiliation(s)
- Jonathan Barratt
- College of Medicine Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - Richard Lafayette
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California, USA
| | | | | | - Daniel Cattran
- Division of Nephrology, Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, Rheinisch Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Vladimir Tesar
- Department of Nephrology, 1st School of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Hernán Trimarchi
- Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Necmi Eren
- Department of Nephrology, Kocaeli University, Kocaeli, Turkey
| | - Alexander Paliege
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Brad H Rovin
- Division of Nephrology, the Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
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7
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Mottl AK, Bomback AS, Mariani LH, Coppock G, Jennette JC, Almaani S, Gipson DS, Kelley S, Kidd J, Laurin LP, Mucha K, Oliverio A, Palmer M, Rizk D, Sanghani N, Stokes MB, Susztak K, Wadhwani S, Nast CC. CureGN-Diabetes Study: Rationale, Design, and Methods of a Prospective Observational Study of Glomerular Disease Patients with Diabetes. Glomerular Dis 2023; 3:155-164. [PMID: 37901700 PMCID: PMC10601908 DOI: 10.1159/000531679] [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] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/15/2023] [Indexed: 10/31/2023]
Abstract
Glomerular diseases (GDs) represent the third leading cause of end-stage kidney disease (ESKD) in the US Diabetes was excluded from the CureGN Study, an NIH/NIDDK-sponsored observational cohort study of four leading primary GDs: IgA nephropathy (IgAN), membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), and minimal change disease (MCD). CureGN-Diabetes, an ancillary study to CureGN, seeks to understand how diabetes influences the diagnosis, treatment, and outcomes of GD. It is a multicenter, prospective cohort study, targeting an enrollment of 300 adults with prevalent type 1 or type 2 diabetes and MCD, FSGS, MN, or IgAN, with first kidney biopsy obtained within 5 years of enrollment in 80% (20% allowed if biopsy after 2010). CureGN and Transformative Research in DiabEtic NephropaThy (TRIDENT) provide comparator cohorts. Retrospective and prospective clinical data and patient-reported outcomes are obtained. Blood and urine specimens are collected at study visits annually. Kidney biopsy reports and digital images are obtained, and standardized pathologic evaluations performed. Light microscopy images are uploaded to the NIH pathology repository. Outcomes include relapse and remission rates, changes in proteinuria and estimated glomerular filtration rate, infections, cardiovascular events, malignancy, ESKD, and death. Multiple analytical approaches will be used leveraging the baseline and longitudinal data to compare disease presentation and progression across subgroups of interest. With 300 patients and an average of 3 years of follow-up, the study has 80% power to detect a HR of 1.4-1.8 for time to complete remission of proteinuria, a rate ratio for hospitalizations of 1.18-1.56 and difference in eGFR slope of 6.0-8.6 mL/min/year between two groups of 300 participants each. CureGN-Diabetes will enhance our understanding of diabetes as a modifying factor of the pathology and outcomes of GDs and support studies to identify disease mechanisms and improve patient outcomes in this understudied patient population.
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Affiliation(s)
- Amy K Mottl
- UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Andrew S Bomback
- Division of Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Laura H Mariani
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Gaia Coppock
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - J Charles Jennette
- Division of Nephropathology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Salem Almaani
- Division of Nephrology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Debbie S Gipson
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Sara Kelley
- UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jason Kidd
- Division of Nephrology, Virginia Commonwealth University, Richmond, VA, USA
| | - Louis-Philippe Laurin
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l'Université de Montréal, Montréal, QC, Canada
| | - Krzysztof Mucha
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Andrea Oliverio
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Palmer
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dana Rizk
- Division of Nephrology, University of Alabama, Birmingham, AL, USA
| | - Neil Sanghani
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Barry Stokes
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Katalin Susztak
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Shikha Wadhwani
- Division of Nephrology and Hypertension, Northwestern University, Chicago, IL, USA
| | - Cynthia C Nast
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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8
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Melanson J, Kachmar J, Laurin LP, Elftouh N, Nadeau-Fredette AC. Assisted Peritoneal Dialysis Implementation: A Pilot Program From a Large Dialysis Unit in Quebec. Can J Kidney Health Dis 2022; 9:20543581221113387. [PMID: 35875413 PMCID: PMC9305165 DOI: 10.1177/20543581221113387] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Kidney failure prevalence is increasing in older patients for whom dialysis initiation can be challenging. Assisted peritoneal dialysis (PD), where PD is performed with the help of a healthcare worker, can facilitate PD for frailer patients who may not be candidate otherwise. Objectives: This study aimed to assess the feasibility of implementing the first pilot assisted PD program in Quebec (Canada) and to evaluate the characteristics and outcomes of the PD cohort before and after assisted PD availability. Design: Observational retrospective cohort study. Setting and Population: All adult patients initiating PD between 2015 and 2020 in a single-center dialysis unit were included. Measurements: Incidence, characteristics, and outcomes of patients with PD were compared between (1) the “pre” (2015-2017) and the “post” assisted PD era (2018-2020) and (2) patients with assisted PD and independent PD in the more recent period. Methods: The primary outcome was peritonitis rate over the first year. Secondary outcomes included hospitalization, transfers to in-center hemodialysis (HD) and mortality. Results: Overall, 124 patients initiated PD with an annual incidence of 17 ± 3 patients during the “pre” and 24 ± 8 patients during the “post” assisted PD era (P = .18). First-year peritonitis rate was similar over the 2 eras. Years of PD initiation and use of assisted PD were not associated with risk peritonitis (over total follow-up) after adjustment. Adjusted hazard of transfer to HD or death was higher during the “post” era (hazard ratio [HR]: 2.77; 95% confidence interval [CI]: 1.42-5.58). Seventeen patients received assisted PD including 13 (18%) of the 72 patients initiated between 2018 and 2020. Patients with assisted PD were older than those with independent PD (72 [64-84] vs. 59 [47-67], P = .006) and received assistance for 0.8 (0.4-1.5) years. When comparing assisted and independent cohorts, there were no differences in crude rates of peritonitis or hospitalization. Limitations: Single-center study with small sample size. Conclusion: This study shows the feasibility of implementing an assisted PD program, with favorable overall outcomes including similar rates of peritonitis during the first year after PD initiation.
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Affiliation(s)
- Julien Melanson
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Jessica Kachmar
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Naoual Elftouh
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
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9
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Feng D, Gao P, Henley N, Dubuissez M, Chen N, Laurin LP, Royal V, Pichette V, Gerarduzzi C. SMOC2 promotes an epithelial-mesenchymal transition and a pro-metastatic phenotype in epithelial cells of renal cell carcinoma origin. Cell Death Dis 2022; 13:639. [PMID: 35869056 PMCID: PMC9307531 DOI: 10.1038/s41419-022-05059-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 01/21/2023]
Abstract
Renal Cell Carcinoma (RCC) is the most common form of all renal cancer cases, and well-known for its highly aggressive metastatic behavior. SMOC2 is a recently described non-structural component of the extracellular matrix (ECM) that is highly expressed during tissue remodeling processes with emerging roles in cancers, yet its role in RCC remains elusive. Using gene expression profiles from patient samples, we identified SMOC2 as being significantly expressed in RCC tissue compared to normal renal tissue, which correlated with shorter RCC patient survival. Specifically, de novo protein synthesis of SMOC2 was shown to be much higher in the tubular epithelial cells of patients with biopsy-proven RCC. More importantly, we provide evidence of SMOC2 triggering kidney epithelial cells into an epithelial-to-mesenchymal transition (EMT), a phenotype known to promote metastasis. We found that SMOC2 induced mesenchymal-like morphology and activities in both RCC and non-RCC kidney epithelial cell lines. Mechanistically, treatment of RCC cell lines ACHN and 786-O with SMOC2 (recombinant and enforced expression) caused a significant increase in EMT-markers, -matrix production, -proliferation, and -migration, which were inhibited by targeting SMOC2 by siRNA. We further characterized SMOC2 activation of EMT to occur through the integrin β3, FAK and paxillin pathway. The proliferation and metastatic potential of SMOC2 overexpressing ACHN and 786-O cell lines were validated in vivo by their significantly higher tumor growth in kidneys and systemic dissemination into other organs when compared to their respective controls. In principle, understanding the impact that SMOC2 has on EMT may lead to more evidence-based treatments and biomarkers for RCC metastasis.
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Affiliation(s)
- Daniel Feng
- grid.14848.310000 0001 2292 3357Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec Canada
| | - Peng Gao
- grid.14848.310000 0001 2292 3357Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec Canada
| | - Nathalie Henley
- grid.14848.310000 0001 2292 3357Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec Canada
| | - Marion Dubuissez
- grid.14848.310000 0001 2292 3357Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec Canada
| | - Nan Chen
- grid.17091.3e0000 0001 2288 9830Faculty of Science, University of British Columbia, Vancouver, British Columbia Canada
| | - Louis-Philippe Laurin
- grid.14848.310000 0001 2292 3357Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec Canada
| | - Virginie Royal
- grid.14848.310000 0001 2292 3357Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec Canada
| | - Vincent Pichette
- grid.14848.310000 0001 2292 3357Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, Québec Canada
| | - Casimiro Gerarduzzi
- grid.14848.310000 0001 2292 3357Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, Québec Canada
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10
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Leclerc S, Benkirane K, Nadeau-Fredette AC, Elftouh N, Lafrance JP, Pichette V, Royal V, Lamarche C, Laurin LP. Qualitative and Quantitative Dosage of the Anti M-Type Phospholipase A2 Receptor Autoantibody: One-Year Experience in Quebec's Reference Center. Can J Kidney Health Dis 2021; 8:20543581211052729. [PMID: 34721885 PMCID: PMC8552399 DOI: 10.1177/20543581211052729] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Quantification of the M-type phospholipase A2 receptor antibodies (anti-PLA2R) is now an essential tool for diagnosis and management of primary membranous nephropathy (MN). Since October 2018, Hôpital Maisonneuve-Rosemont (HMR) has been designated as Quebec’s reference center for serum anti-PLA2R antibody testing by the Institut National d’Excellence en Santé et Services Sociaux (INESSS), the regulatory body on drugs and tests usage in Quebec. Objectives: To describe the 2-step method of serum qualitative and quantitative anti-PLA2R antibody testing during its first year of use in Quebec and analyze its diagnostic value in the province’s population. Design: Retrospective cohort study. Setting: Single-center academic teaching hospital in Quebec, Canada. Patients: All patients who had a serum anti-PLA2R antibody test analyzed at HMR from October 1, 2018, to October 1, 2019, were included in the study. Measurements: Serum anti-PLA2R antibodies were screened by indirect immunofluorescence tests. If results were positive or undetermined, it was followed by a quantitative enzyme-linked immunosorbent assay (ELISA) test. Both tests were based on a commercial kit developed by the same company. Methods: We calculated sensitivity, specificity, predictive value, and likelihood ratio for both tests, using kidney biopsy findings performed at HMR as the gold standard. Results: In Quebec, a total of 1690 tests were performed among 1025 patients during the study year. A small proportion of these patients (8%) were followed at HMR. Patients tested at HMR and in the rest of Quebec had similar characteristics. Test validity was only characterized for patients tested at HMR. Sensitivity and specificity were, respectively, 58% and 100% for the qualitative test, and 71% and 100% for the quantitative test. The combined net sensitivity was 42% and the net specificity 100%. The net positive and negative predictive value were 100% and 84% respectively, whereas the net negative likelihood ratio was 0.58. Limitations: As the detailed analysis was only possible in the small proportion of patients clinically followed at HMR, there is a possible selection bias. Another potential selection bias was the focus on patients who were selected to have a kidney biopsy, probably because of more severe disease, higher probability of glomerulonephritis, or lesser number of comorbidities. Given the retrospective nature of this study, there was no systematic kidney biopsy or serum PLA2R antibody testing performed. Finally, we were unable to provide detailed information on the timing between immunosuppressive therapy and anti-PLA2R results. Conclusions: Serum anti-PLA2R antibody testing was widely used in Quebec during its first year of availability. A 2-step approach, using a qualitative test first, followed by a quantitative test if the results are positive or undetermined, appears efficient to avoid useless quantitative testing in negative patients and to better characterize undetermined results on immunofluorescence. Trial registration: Due to the retrospective nature of this study, no trial registration was performed.
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Affiliation(s)
- Simon Leclerc
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Karim Benkirane
- Department of Medical Biochemistry, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - Naoual Elftouh
- Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, University of Montreal, QC, Canada
| | - Vincent Pichette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, University of Montreal, QC, Canada
| | - Virginie Royal
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Pathology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Caroline Lamarche
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada
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11
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Leclerc S, Royal V, Lamarche C, Laurin LP. Minimal Change Disease With Severe Acute Kidney Injury Following the Oxford-AstraZeneca COVID-19 Vaccine: A Case Report. Am J Kidney Dis 2021; 78:607-610. [PMID: 34242687 PMCID: PMC8260495 DOI: 10.1053/j.ajkd.2021.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
Abstract
We report a case of minimal change disease (MCD) with severe acute kidney injury (AKI) following the first injection of the ChAdOx1 nCoV-19 (AZD1222) vaccine from Oxford-AstraZeneca against coronavirus disease 2019 (COVID-19). A 71-year-old man with a history of dyslipidemia and a baseline serum creatinine of 0.7 mg/dL presented with nephrotic syndrome, AKI, and severe hypertension 13 days after receiving the Oxford-AstraZeneca vaccine. Refractory hyperkalemia and hypervolemia with oligoanuria prompted initiation of hemodialysis. His serum albumin was 2.6 g/dL and his urinary protein-creatinine ratio was 2,321 mg/mmol. Given a high suspicion for rapidly progressive glomerulonephritis, empirical glucocorticoid treatment was initiated (3 methylprednisolone pulses followed by high-dose prednisone). A kidney biopsy showed MCD and acute tubular injury. Kidney function and proteinuria subsequently improved, and hemodialysis was discontinued 38 days after the start of therapy. This case describes de novo MCD after the Oxford-AstraZeneca vaccine. It adds to the few published case reports of MCD after the Pfizer-BioNTech COVID-19 vaccine. Further reports and studies will be needed to elucidate whether MCD is truly associated with COVID-19 vaccination.
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Affiliation(s)
- Simon Leclerc
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal
| | - Virginie Royal
- Department of Pathology, Maisonneuve-Rosemont Hospital, Montreal
| | - Caroline Lamarche
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal; Department of Medicine, University of Montreal, QC, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal; Department of Medicine, University of Montreal, QC, Canada.
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12
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Morin C, Gionest I, Laurin LP, Goupil R, Nadeau-Fredette AC. Risk of hospitalization, technique failure, and death with increased training duration in 3-days-a-week home hemodialysis. Hemodial Int 2021; 25:457-464. [PMID: 34169633 DOI: 10.1111/hdi.12956] [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: 11/11/2020] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Quality training is a core component of successful home hemodialysis (HHD) and training duration varies significantly between dialysis centers as well as at the patient level. This study aimed to assess the adverse outcomes associated with HHD training duration. METHODS All HHD patients successfully trained in a single dialysis center between January 2005 and July 2017 were included. A multivariable multiple-events (Andersen-Gill) survival model was built to evaluate the association between training time and main adverse events, including hospitalizations, technique failure, and death on HHD. Potential confounding factors were defined a priori (age, diabetes, coronary artery disease, and year of training start). Adjusted risk of vascular interventions (arteriovenous fistula angioplasties and central venous catheter replacements) was assessed as the secondary outcome in a negative binomial regression. FINDINGS Forty-eight patients were included in the study. Median HHD training duration was 86 (67-108) days, using a thrice weekly training schedule. Over a follow-up median time of 2.0 (0.7-3.3) years, three patients died while on HHD, 10 had a definitive transfer to HD, and 18 experienced a least 1 hospitalization (38 hospitalizations in total). Training duration was associated with a higher risk of hospitalization, technique failure, and death in unadjusted (hazard ratio [HR] 1.16 per month, 95% confidence interval [CI] 1.08-1.24) and adjusted multiple events model (HR 1.21, 95% CI 1.04-1.43). Risk of vascular access intervention was also significantly higher with increased training time (adjusted incidence rate ratio 1.31, 95% CI 1.03-1.64, per training month). DISCUSSION In this single-center observational study, HHD training duration was associated with a higher risk of adverse events including, death, technique failure, hospitalizations, and vascular access intervention. Enhanced clinical follow-up and home support should be offered to these more vulnerable patients to mitigate this heightened risk.
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Affiliation(s)
- Catherine Morin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Isabelle Gionest
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Rémi Goupil
- Hospital and Research Center, Sacré-Coeur de Montreal Hospital, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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13
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Gillespie BW, Laurin LP, Zinsser D, Lafayette R, Marasa M, Wenderfer SE, Vento S, Poulton C, Barisoni L, Zee J, Helmuth M, Lugani F, Kamel M, Hill-Callahan P, Hewitt SM, Mariani LH, Smoyer WE, Greenbaum LA, Gipson DS, Robinson BM, Gharavi AG, Guay-Woodford LM, Trachtman H. Improving data quality in observational research studies: Report of the Cure Glomerulonephropathy (CureGN) network. Contemp Clin Trials Commun 2021; 22:100749. [PMID: 33851061 PMCID: PMC8039553 DOI: 10.1016/j.conctc.2021.100749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/28/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background High data quality is of crucial importance to the integrity of research projects. In the conduct of multi-center observational cohort studies with increasing types and quantities of data, maintaining data quality is challenging, with few published guidelines. Methods The Cure Glomerulonephropathy (CureGN) Network has established numerous quality control procedures to manage the 70 participating sites in the United States, Canada, and Europe. This effort is supported and guided by the activities of several committees, including Data Quality, Recruitment and Retention, and Central Review, that work in tandem with the Data Coordinating Center to monitor the study. We have implemented coordinator training and feedback channels, data queries of questionable or missing data, and developed performance metrics for recruitment, retention, visit completion, data entry, recording of patient-reported outcomes, collection, shipping and accessing of biological samples and pathology materials, and processing, cataloging and accessing genetic data and materials. Results We describe the development of data queries and site Report Cards, and their use in monitoring and encouraging excellence in site performance. We demonstrate improvements in data quality and completeness over 4 years after implementing these activities. We describe quality initiatives addressing specific challenges in collecting and cataloging whole slide images and other kidney pathology data, and novel methods of data quality assessment. Conclusions This paper reports the CureGN experience in optimizing data quality and underscores the importance of general and study-specific data quality initiatives to maintain excellence in the research measures of a multi-center observational study.
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Affiliation(s)
- Brenda W Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Dawn Zinsser
- Arbor Research Collaborative for Health, Ann Arbor, MI, 48104, USA
| | | | - Maddalena Marasa
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Suzanne Vento
- NYU Langone Health, Department of Pediatrics, Division of Nephrology, New York, NY, USA
| | - Caroline Poulton
- Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura Barisoni
- Department of Pathology, Division of AI and Computational Pathology, Department of Medicine, Division of Nephrology, Duke University, Durham, NC, USA
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, 48104, USA
| | - Margaret Helmuth
- Arbor Research Collaborative for Health, Ann Arbor, MI, 48104, USA
| | - Francesca Lugani
- Laboratory of Molecular Nephrology, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Margret Kamel
- Emory University, Department of Pediatrics, Division of Nephrology, Atlanta, GA, USA
| | | | - Stephen M Hewitt
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura H Mariani
- University of Michigan, Division of Nephrology, Ann Arbor, MI, USA
| | - William E Smoyer
- Center for Clinical and Translational Research, the Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Larry A Greenbaum
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Debbie S Gipson
- University of Michigan, Division of Nephrology, Department of Pediatrics, Ann Arbor, MI, USA
| | | | - Ali G Gharavi
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lisa M Guay-Woodford
- Center for Translational Research, Children's National Hospital, Washington, DC, USA
| | - Howard Trachtman
- NYU Langone Health, Department of Pediatrics, Division of Nephrology, New York, NY, USA
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14
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Dupuis MÈ, Laurin LP, Goupil R, Bénard V, Pichette M, Lafrance JP, Elftouh N, Pichette V, Nadeau-Fredette AC. Arteriovenous Fistula Creation and Estimated Glomerular Filtration Rate Decline in Advanced CKD: A Matched Cohort Study. Kidney360 2020; 2:42-49. [PMID: 35368820 PMCID: PMC8785744 DOI: 10.34067/kid.0005072020] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/06/2020] [Indexed: 02/04/2023]
Abstract
Background Kidney failure is associated with a high burden of morbidity and mortality. Previous studies have raised the possibility that arteriovenous fistula (AVF) creation may attenuate eGFR decline. This study aimed to compare eGFR decline in predialysis patients with an AVF, matched to patients oriented toward peritoneal dialysis (PD). Methods Predialysis patients with an AVF and those oriented toward PD were retrospectively matched using a propensity score. Time zero was defined as the "AVF creation date" for the AVF group and the "date when eGFR was closest to the matched patient's eGFR at AVF creation" for the PD group. Crude and predicted eGFR decline in AVF and PD groups were compared before and after time zero using mixed-effect linear regressions. Results In total, 61 pairs were matched. Crude annual eGFR decline before AVF creation/time zero was -4.1 ml/min per m2 per year in the AVF group versus -5.3 ml/min per m2 per year in the PD group (P=0.75) and after time zero, -2.5 ml/min per m2 per year in the AVF group versus -4.5 ml/min per m2 per year in the PD group (P=0.02). The predicted annual decline decreased from -5.1 ml/min per m2 per year in the AVF group before AVF creation to -2.8 ml/min per m2 per year after (P<0.01), whereas there was no difference in the PD group (-5.5 versus -5.1 ml/min per m2 per year respectively, P=0.41). Conclusions In this matched study, AVF creation was associated with a deceleration of kidney function decline compared with a control PD-oriented group. Prospective studies are needed to assess the potential mechanisms between vascular access creation and eGFR slope attenuation.
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Affiliation(s)
- Marie-Ève Dupuis
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Rémi Goupil
- Division of Nephrology, Sacré-Cœur de Montreal Hospital and Research Center, Montreal, Quebec, Canada
| | - Valérie Bénard
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Maude Pichette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada,Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Naoual Elftouh
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Vincent Pichette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada,Division of Nephrology, Sacré-Cœur de Montreal Hospital and Research Center, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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Leclerc S, Nadeau-Fredette AC, Elftouh N, Lafrance JP, Pichette V, Laurin LP. Use of Desmopressin Prior to Kidney Biopsy in Patients With High Bleeding Risk. Kidney Int Rep 2020; 5:1180-1187. [PMID: 32775817 PMCID: PMC7403497 DOI: 10.1016/j.ekir.2020.05.006] [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: 01/27/2020] [Revised: 04/24/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION To prevent bleeding after native kidney biopsy (NKB), nephrologists often prescribe desmopressin, especially for patients with reduced estimated glomerular filtration rate (eGFR) at risk of uremia-related platelet dysfunction. However, only 1 randomized study has suggested a beneficial effect for desmopressin in patients with eGFR ≥60 ml/min per 1.73 m2. This retrospective cohort study aimed to evaluate desmopressin effect on postbiopsy bleeding in all patients, regardless of eGFR and other comorbidities. METHODS In this retrospective cohort study, all adult patients who underwent an NKB from April 1, 2013, to April 30, 2018, in a tertiary hospital were identified. The association between desmopressin use and bleeding complications, including hemoglobin fall, transfusion, hematoma, symptomatic hematoma, urgent radiologic study, and hypotension, was analyzed using multivariable logistic regression models. RESULTS A total of 413 native kidney biopsies were studied, 79% of which were performed after receiving desmopressin. Patients receiving desmopressin had worse chronic kidney disease (eGFR 28 vs. 45 ml/min per 1.73 m2; P < 0.001) and were more often hospitalized (48% vs. 32%; P = 0.009). Despite higher bleeding risk, patients using desmopressin had a similar likelihood of symptomatic hematomas (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.13-1.14) and a lower need for urgent radiologic studies (OR, 0.33; 95% CI, 0.11-0.98). CONCLUSION Patients at higher risk of bleeding using desmopressin before kidney biopsy had bleeding complications similar to those not using desmopressin. These results highlight potential important clinical and financial benefits of desmopressin use before kidney biopsy.
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Affiliation(s)
- Simon Leclerc
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Naoual Elftouh
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, University of Montreal, Montreal, Quebec, Canada
| | - Vincent Pichette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, University of Montreal, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
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16
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Delbarba E, Marasa M, Canetta PA, Piva SE, Chatterjee D, Kil BH, Mu X, Gibson KL, Hladunewich MA, Hogan JJ, Julian BA, Kidd JM, Laurin LP, Nachman PH, Rheault MN, Rizk DV, Sanghani NS, Trachtman H, Wenderfer SE, Gharavi AG, Bomback AS, Ahn W, Appel GB, Babayev R, Batal I, Bomback AS, Brown E, Campenot ES, Canetta P, Chan B, Chatterjee D, D’Agati VD, Delbarba E, Fernandez H, Foroncewicz B, Gharavi AG, Ghiggeri GM, Hines WH, Jain NG, Kil BH, Kiryluk K, Lau WL, Lin F, Lugani F, Marasa M, Markowitz G, Mohan S, Mu X, Mucha K, Nickolas TL, Piva S, Radhakrishnan J, Rao MK, Sanna-Cherchi S, Santoriello D, Stokes MB, Yu N, Valeri AM, Zviti R, Greenbaum LA, Smoyer WE, Al-Uzri A, Ashoor I, Aviles D, Baracco R, Barcia J, Bartosh S, Belsha C, Bowers C, Braun MC, Chishti A, Claes D, Cramer C, Davis K, Erkan E, Feig D, Freundlich M, Gbadegesin R, Hanna M, Hidalgo G, Hunley TE, Jain A, Kallash M, Khalid M, Klein JB, Lane JC, Mahan J, Mathews N, Nester C, Pan C, Patterson L, Patel H, Revell A, Rheault MN, Silva C, Sreedharan R, Srivastava T, Steinke J, Twombley K, Wenderfer SE, Vasylyeva TL, Weaver DJ, Wong CS, Almaani S, Ayoub I, Budisavljevic M, Derebail V, Fatima H, Falk R, Fogo A, Gehr T, Gibson K, Glenn D, Harris R, Hogan S, Jain K, Jennette JC, Julian B, Kidd J, Laurin LP, Massey HD, Mottl A, Nachman P, Nadasdy T, Novak J, Parikh S, Pichette V, Poulton C, Powell TB, Renfrow M, Rizk D, Rovin B, Royal V, Saha M, Sanghani N, Self S, Adler S, Alpers C, Matar RB, Brown E, Cattran D, Choi M, Dell KM, Dukkipati R, Fervenza FC, Fornoni A, Gadegbeku C, Gipson P, Hasely L, Hingorani S, Hladunewich M, Hogan J, Holzman LB, Jefferson JA, Jhaveri K, Johnstone DB, Kaskel F, Kogan A, Kopp J, Lafayette R, Lemley KV, Malaga-Dieguez L, Meyers K, Neu A, O’Shaughnessy MM, O’Toole JF, Parekh R, Reich H, Reidy K, Rondon H, Sambandam KK, Sedor JR, Selewski DT, Sethna CB, Schelling J, Sperati JC, Swiatecka-Urban A, Trachtman H, Tuttle KR, Weisstuch J, Vento S, Zhdanova O, Gillespie B, Gipson DS, Hill-Callahan P, Helmuth M, Herreshoff E, Kretzler M, Lienczewski C, Mansfield S, Mariani L, Nast CC, Robinson BM, Troost J, Wladkowski M, Zee J, Zinsser D, Guay-Woodford LM. Persistent Disease Activity in Patients With Long-Standing Glomerular Disease. Kidney Int Rep 2020; 5:860-871. [PMID: 32518868 PMCID: PMC7270998 DOI: 10.1016/j.ekir.2020.03.017] [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: 12/13/2019] [Revised: 02/11/2020] [Accepted: 03/09/2020] [Indexed: 11/03/2022] Open
Abstract
Introduction Methods Results Conclusion
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O'Shaughnessy MM, Troost JP, Bomback AS, Hladunewich MA, Ashoor IF, Gibson KL, Matar RB, Selewski DT, Srivastava T, Rheault MN, Al-Uzri A, Kogon AJ, Khalid M, Vento S, Sanghani NS, Gillespie BW, Gipson DS, Wang CS, Parsa A, Guay-Woodford L, Laurin LP. Treatment Patterns Among Adults and Children With Membranous Nephropathy in the Cure Glomerulonephropathy Network (CureGN). Kidney Int Rep 2019; 4:1725-1734. [PMID: 31844809 PMCID: PMC6895579 DOI: 10.1016/j.ekir.2019.09.005] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/21/2019] [Accepted: 09/02/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for Glomerulonephritis recommend that patients with membranous nephropathy (MN) at risk for progression receive immunosuppressive therapy (IST), usually after 6 months of observation. A cyclophosphamide (CYC) or calcineurin inhibitor (CNI)–based regimen is recommended as first-line IST. However, the extent to which KDIGO recommendations are adopted in practice remains largely unknown. Methods We evaluated prescribing practice among patients with primary MN (diagnosed 2010–2018) enrolled in the Cure Glomerulonephropathy Network (CureGN) cohort study. We also evaluated the availability of testing for phospholipase A2 receptor (PLA2R) in the contemporary era. Results Among 361 patients (324 adults and 37 children) with MN who were IST-naïve at biopsy and had at least 6 months of follow-up, 55% of adults and 58% of children initiated IST <6 months after biopsy. Of these, 1 in 5 had no indication for (i.e., urine protein-to-creatinine ratio [uPCR] <4 g/g) or an apparent contraindication to (i.e., an estimated glomerular filtration rate [eGFR] <30 ml/min per 1.73 m2) IST. As first-line IST, half of treated patients received either CYC (16% of adults; 0% of children) or a CNI (40% and 46%, respectively), whereas 1 in 5 received corticosteroid monotherapy (20% and 27%, respectively) and 1 in 6 rituximab (15% and 15%, respectively). More than 80% of surveyed centers had access to PLA2R testing. Conclusion These findings suggest that providers are not aware of, or lack confidence in, current KDIGO guidelines for MN. Treatment patterns observed in this cohort might critically inform the drafting of planned updates to KDIGO guidelines.
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Affiliation(s)
| | - Jonathan P Troost
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew S Bomback
- Division of Nephrology, Columbia University, New York, New York, USA
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Isa F Ashoor
- Division of Nephrology, Department of Pediatrics, LSU Health and Children's Hospital, New Orleans, Louisiana, USA
| | - Keisha L Gibson
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Raed Bou Matar
- Center for Pediatric Nephrology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Michelle N Rheault
- Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Amira Al-Uzri
- Division of Pediatric Kidney Services and Hypertension, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Amy J Kogon
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Wynnewood, Pennsylvania, USA
| | - Myda Khalid
- JW Riley Hospital for Children, Indiana University School of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Suzanne Vento
- Division of Nephrology, Department of Pediatrics, New York University School of Medicine, New York, New York, USA
| | - Neil S Sanghani
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brenda W Gillespie
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Chia-Shi Wang
- Division of Pediatric Nephrology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Afshin Parsa
- Division of Kidney, Urologic, and Hematologic Diseases, The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Lisa Guay-Woodford
- Center for Translational Research, Children's National Health System, Washington, DC, USA
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
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Bénard V, Pichette M, Lafrance JP, Elftouh N, Pichette V, Laurin LP, Nadeau-Fredette AC. Impact of Arteriovenous fistula creation on estimated glomerular filtration rate decline in Predialysis patients. BMC Nephrol 2019; 20:420. [PMID: 31760936 PMCID: PMC6876290 DOI: 10.1186/s12882-019-1607-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/29/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Arteriovenous fistula (AVF) is the vascular access of choice for patients on hemodialysis. Recent evidence suggests that AVF creation may slow estimated glomerular filtration rate (eGFR) decline. The study objective was to assess the impact of the AVF creation on eGFR decline, after controlling for key confounding factors. METHODS This retrospective cohort study included adult patients followed in a single-center predialysis clinic between 1999 and 2016. Patients with a patent AVF were followed up to 2 years pre- and post-AVF creation. Estimated GFR trajectory was reported using linear mixed models adjusted for demographic characteristics, comorbidities and use of renin-angiotensin-aldosterone blockade. RESULTS A total of 146 patients were studied with a median age 68.7 (60.5-75.4) years and a median eGFR at time of AVF creation of 12.8 (11.3-13.9) mL/min/1.73m2. The crude annual eGFR decline rates were - 3.60 ± 4.00 mL/min/1.73 m2 pre- and - 2.28 ± 3.56 mL/min/1.73 m2 post-AVF, resulting in a mean difference of 1.28 mL/min/1.73 m2 (95% CI 0.49, 2.07). In a mixed effect linear regression model, monthly eGFR decline was - 0.63 (95% CI -0.81, - 0.46; p < 0.001) mL/min/1.73m2/month. The period after AVF creation was associated with a relatively higher eGFR (β 0.94, 95% CI 0.61-1.26, p < 0.001). There was a significant association between follow-up time and the period pre/post AVF (β 0.19, 95% CI 0.16, 0.22; p < 0.001) such that eGFR decline was more attenuated each month after AVF creation. CONCLUSIONS In this cohort, AVF creation was associated with a significant reduction of eGFR decline. Further prospective studies are needed to confirm this association.
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Affiliation(s)
- Valérie Bénard
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
| | - Maude Pichette
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Department of pharmacology and physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Naoual Elftouh
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
| | - Vincent Pichette
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Department of pharmacology and physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada.
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada.
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Lepeytre F, Royal V, Lavoie PL, Bollée G, Gougeon F, Beauchemin S, Rhéaume M, Brachemi S, Laurin LP, Troyanov S. Estimating the Change in Renal Function During the First Year of Therapy in ANCA-Associated Vasculitis. Kidney Int Rep 2019; 4:594-602. [PMID: 30993234 PMCID: PMC6451086 DOI: 10.1016/j.ekir.2019.02.005] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Studies in antineutrophil cytoplasmic autoantibody (ANCA)–associated vasculitis (AAV) consistently show that the months following diagnosis have the greatest impact on the long-term renal function. Yet, it remains uncertain how much early gain should be expected with treatment. We sought to determine the factors associated with the change in glomerular filtration rate (GFR) throughout the first year. Methods We retrospectively reviewed patients from 3 university hospitals who received treatments. We assessed the proportions of glomeruli with crescents, with global sclerosis, the AAV glomerulonephritis classification, the severity of chronic vascular and tubulo-interstitial disease, and the presence of acute tubular injury (ATI). We used repeated-measures analyses of variance (ANOVAs) to determine factors associated with the change in GFR throughout the first year. Results There were 162 individuals with AAV identified, 96 with a valid renal biopsy and 82 with at least 12 months of follow-up. The initial GFR of 30 ± 25 ml/min per 1.73 m2 rose by 15 ± 20 during the first year. The severity of pathology findings, myeloperoxidase positivity, and those with kidney- and lung-limited disease presented with a lower GFR. Younger patients with a lower initial GFR and the presence of ATI correlated with a greater increase in GFR by 12 months. A higher proportion of crescents did not predict the change in GFR, contrary to global glomerulosclerosis, where each 10% increase added a loss of 2.7 ± 1.3 ml/min per 1.73 m2 per year (P = 0.03). These factors remained independent of each other. Conclusion Multiple factors influence renal recovery during the first year of therapy. Estimating the change in GFR early on will help identify and reassess outliers.
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Affiliation(s)
- Fanny Lepeytre
- Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Virginie Royal
- Pathology Department, Hôpital Maisonneuve-Rosemont, Québec, Canada
| | - Pierre-Luc Lavoie
- Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Guillaume Bollée
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - François Gougeon
- Pathology Department, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | | | - Maxime Rhéaume
- Internal Medicine Division, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Soumeya Brachemi
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | | | - Stéphan Troyanov
- Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
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Mariani LH, Bomback AS, Canetta PA, Flessner MF, Helmuth M, Hladunewich MA, Hogan JJ, Kiryluk K, Nachman PH, Nast CC, Rheault MN, Rizk DV, Trachtman H, Wenderfer SE, Bowers C, Hill-Callahan P, Marasa M, Poulton CJ, Revell A, Vento S, Barisoni L, Cattran D, D'Agati V, Jennette JC, Klein JB, Laurin LP, Twombley K, Falk RJ, Gharavi AG, Gillespie BW, Gipson DS, Greenbaum LA, Holzman LB, Kretzler M, Robinson B, Smoyer WE, Guay-Woodford LM. CureGN Study Rationale, Design, and Methods: Establishing a Large Prospective Observational Study of Glomerular Disease. Am J Kidney Dis 2018; 73:218-229. [PMID: 30420158 PMCID: PMC6348011 DOI: 10.1053/j.ajkd.2018.07.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 03/08/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023]
Abstract
RATIONALE & OBJECTIVES Glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and immunoglobulin A (IgA) nephropathy, share clinical presentations, yet result from multiple biological mechanisms. Challenges to identifying underlying mechanisms, biomarkers, and new therapies include the rarity of each diagnosis and slow progression, often requiring decades to measure the effectiveness of interventions to prevent end-stage kidney disease (ESKD) or death. STUDY DESIGN Multicenter prospective cohort study. SETTING & PARTICIPANTS Cure Glomerulonephropathy (CureGN) will enroll 2,400 children and adults with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy (including IgA vasculitis) and a first diagnostic kidney biopsy within 5 years. Patients with ESKD and those with secondary causes of glomerular disease are excluded. EXPOSURES Clinical data, including medical history, medications, family history, and patient-reported outcomes, are obtained, along with a digital archive of kidney biopsy images and blood and urine specimens at study visits aligned with clinical care 1 to 4 times per year. OUTCOMES Patients are followed up for changes in estimated glomerular filtration rate, disease activity, ESKD, and death and for nonrenal complications of disease and treatment, including infection, malignancy, cardiovascular, and thromboembolic events. ANALYTICAL APPROACH The study design supports multiple longitudinal analyses leveraging the diverse data domains of CureGN and its ancillary program. At 2,400 patients and an average of 2 years' initial follow-up, CureGN has 80% power to detect an HR of 1.4 to 1.9 for proteinuria remission and a mean difference of 2.1 to 3.0mL/min/1.73m2 in estimated glomerular filtration rate per year. LIMITATIONS Current follow-up can only detect large differences in ESKD and death outcomes. CONCLUSIONS Study infrastructure will support a broad range of scientific approaches to identify mechanistically distinct subgroups, identify accurate biomarkers of disease activity and progression, delineate disease-specific treatment targets, and inform future therapeutic trials. CureGN is expected to be among the largest prospective studies of children and adults with glomerular disease, with a broad goal to lessen disease burden and improve outcomes.
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Affiliation(s)
- Laura H Mariani
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI.
| | - Andrew S Bomback
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Pietro A Canetta
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Michael F Flessner
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | | | - Michelle A Hladunewich
- Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jonathan J Hogan
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Patrick H Nachman
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Cynthia C Nast
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michelle N Rheault
- Division of Nephrology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Dana V Rizk
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, New York University Langone Medical Center, New York, NY
| | - Scott E Wenderfer
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Corinna Bowers
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | | | - Maddalena Marasa
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Caroline J Poulton
- Division of Nephrology and Hypertension, Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Adelaide Revell
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Suzanne Vento
- Division of Nephrology, Department of Pediatrics, New York University Langone Medical Center, New York, NY
| | | | - Dan Cattran
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vivette D'Agati
- Department of Pathology, Columbia University Medical Center, New York, NY
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
| | - Jon B Klein
- Department of Medicine, The University of Louisville School of Medicine, and Robley Rex VA Medical Center, Louisville, KY
| | | | - Katherine Twombley
- Pediatric Nephrology, Medical University of South Carolina, Charleston, SC
| | - Ronald J Falk
- Division of Nephrology and Hypertension, Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Ali G Gharavi
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Brenda W Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | | | - Lawrence B Holzman
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthias Kretzler
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Bruce Robinson
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI
| | - William E Smoyer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Lisa M Guay-Woodford
- Center for Translational Science, Children's National Health System, Washington, DC
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René É, Lazrak HH, Laurin LP, Elftouh N, Vallée M, Lafrance JP. Association of erythropoiesis-stimulating agents and the incidence risk of cancer diagnosis among chronic dialysis patients: a nested case-control study. Nephrol Dial Transplant 2018; 32:1047-1052. [PMID: 27448671 DOI: 10.1093/ndt/gfw268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/05/2016] [Accepted: 05/04/2016] [Indexed: 11/14/2022] Open
Abstract
Background Erythropoiesis-stimulating agents (ESAs) are the cornerstone of the treatment for anemia in end-stage renal disease (ESRD) patients. Although a correlation has been established between ESAs and increased tumor growth among patients with cancer-related anemia, an association with a higher incidence of cancer among chronic dialysis patients remains relatively unclear. Methods We completed a nested case-control study in a cohort of 4574 patients who began chronic dialysis treatment between 1 January 2001 and 31 December 2007 in Quebec, Canada, utilizing dialysis registry and administrative databases exclusively to extract our data. We excluded patients with a prior diagnosis of cancer. Eligible cases were identified by the time of initial cancer diagnosis obtained from either the hospital's discharge or physician billing form. We then randomly selected up to 10 controls for each case. ESA exposure was evaluated between 6 and 9 months prior to the initial cancer diagnosis. The mean weekly exposure was used to categorize ESA usage as either a low dose (<30 µg/week), moderate dose (30-70 µg/week) or high dose (>70 µg/week). We estimated the association between ESAs and the risk of developing cancer using a multivariable conditional logistic regression. Results We identified 419 cases of cancer and 3895 matched controls during the study period. The use of ESAs was associated with a higher risk of cancer {odds ratio [OR] 1.04 [95% confidence interval (CI) 1.02-1.07]}. Specifically, patients in the high exposure group (>70 µg/week) had an increased risk of developing cancer [OR 1.77 (95% CI 1.18-2.66)] compared with patients in the unexposed group. Conclusion High-dose ESA was associated with an increased incidence risk of new cancer diagnosis among chronic dialysis patients.
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Affiliation(s)
- Émilie René
- Maisonneuve-Rosemont HospitalResearch Center, Montreal, QC, Canada
| | - Hind H Lazrak
- Maisonneuve-Rosemont HospitalResearch Center, Montreal, QC, Canada
| | - Louis-Philippe Laurin
- Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada
- Department of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415, boul. de l'Assomption, Montreal, QC H1T 2M4, Canada
| | - Naoual Elftouh
- Maisonneuve-Rosemont HospitalResearch Center, Montreal, QC, Canada
| | - Michel Vallée
- Department of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415, boul. de l'Assomption, Montreal, QC H1T 2M4, Canada
| | - Jean-Philippe Lafrance
- Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada
- Department of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415, boul. de l'Assomption, Montreal, QC H1T 2M4, Canada
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Laurin LP, Nachman PH, Foster BJ. Calcineurin Inhibitors in the Treatment of Primary Focal Segmental Glomerulosclerosis: A Systematic Review and Meta-analysis of the Literature. Can J Kidney Health Dis 2017; 4:2054358117692559. [PMID: 28321320 PMCID: PMC5347418 DOI: 10.1177/2054358117692559] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/11/2016] [Indexed: 01/30/2023] Open
Abstract
Purpose of review: Primary focal segmental glomerulosclerosis (FSGS) is the most common cause of nephrotic syndrome in adults. Glucocorticoids have been evaluated in the treatment of primary FSGS in numerous retrospective studies. Evidence suggesting a role for including calcineurin inhibitors (CNIs) in early therapy remains limited. The aim of this study was to systematically review the literature examining the efficacy of CNIs in the treatment of primary FSGS both as first-line therapy and as an adjunctive agent in steroid-resistant patients, with respect to remission in proteinuria and renal survival. Sources of information: PubMed and EMBASE were searched from inception to August 2014 for prospective controlled trials, and case-control and cohort studies. Findings: After systematically applying our inclusion criteria, a total of 152 titles and abstracts were identified. Six randomized controlled trials and 2 cohort studies were reviewed. Three randomized controlled trials compared CNIs with placebo or supportive therapy. The pooled relative “risk” of proteinuria remission associated with cyclosporine was 7.0 (95% confidence interval, 2.9-16.8) compared with placebo/supportive therapy. There was very low heterogeneity among these studies with an I-squared of 0%. Three studies compared CNIs with another immunosuppressive agent. All prospective trials were conducted in patients with primary FSGS deemed steroid-resistant. Limitations: The relatively small number of included studies and their heterogeneity with respect to treatment protocols, and possible publication bias, limit conclusions drawn from this systematic review. Implications: The efficacy of CNIs has been evaluated in steroid-resistant primary FSGS patients. There is no evidence supporting their role as first-line therapy. Further studies are needed to determine this role.
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Affiliation(s)
- Louis-Philippe Laurin
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Patrick H Nachman
- UNC Kidney Center, Division of Nephrology and Hypertension, The University of North Carolina at Chapel Hill, USA
| | - Bethany J Foster
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Montreal Children's Hospital, Quebec, Canada; The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Laurin LP, Gasim AM, Derebail VK, McGregor JG, Kidd JM, Hogan SL, Poulton CJ, Detwiler RK, Jennette JC, Falk RJ, Nachman PH. Renal Survival in Patients with Collapsing Compared with Not Otherwise Specified FSGS. Clin J Am Soc Nephrol 2016; 11:1752-1759. [PMID: 27445167 PMCID: PMC5053801 DOI: 10.2215/cjn.13091215] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 12/10/2015] [Accepted: 06/08/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Idiopathic collapsing FSGS has historically been associated with poor renal outcomes. Minimal clinical data exist on the efficacy of immunosuppressive therapy. Our study sought to provide a comprehensive description of renal survival in patients with collapsing and not otherwise specified FSGS after controlling for factors affecting renal prognosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a retrospective analysis of an inception cohort study of patients diagnosed between 1989 and 2012. All potential patients with collapsing FSGS fulfilling the inclusion criteria were identified and compared with patients with not otherwise specified FSGS (approximately 1:2 ratio) on the basis of biopsy report and record availability. Time to ESRD was analyzed using Cox proportional hazards models. RESULTS In total, 187 patients were studied (61 collapsing and 126 not otherwise specified), with a mean follow-up of 96 months. At baseline, patients with collapsing FSGS had higher median proteinuria (12.2 [5.6-14.8] versus 4.4 [2.3-8.1] g/d, respectively; P<0.001), lower median albuminemia (2.4 [1.9-3.0] versus 2.9 [1.8-3.7] g/dl, respectively; P=0.12), and lower median eGFR (48 [26-73] versus 60 [42-92] ml/min per 1.73 m2, respectively; P=0.01) than patients with not otherwise specified FSGS. The proportion of patients with remission of proteinuria was similar in patients with collapsing FSGS and patients with not otherwise specified FSGS (65.7% [23 of 35] versus 63.2% [72 of 114], respectively; P=0.84). The overall renal outcome (ESRD defined as eGFR<15 ml/min per 1.73 m2, dialysis, or transplantation) of patients with collapsing FSGS was not poorer than that of patients with not otherwise specified FSGS in multivariate analyses after adjusting for baseline characteristics and immunotherapy (hazard ratio, 1.78; 95% confidence interval, 0.92 to 3.45). CONCLUSIONS Compared with not otherwise specified FSGS, idiopathic collapsing FSGS presented with more severe nephrotic syndrome and lower eGFR but had a similar renal survival after controlling for exposure to immunosuppressive treatment. These results highlight the importance of early diagnosis and institution of immunosuppressive therapy in patients with collapsing FSGS.
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Affiliation(s)
- Louis-Philippe Laurin
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension and
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Adil M. Gasim
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Vimal K. Derebail
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension and
| | - JulieAnne G. McGregor
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension and
- Triangle Integrative Medicine Associates, Chapel Hill, North Carolina; and
| | - Jason M. Kidd
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension and
- Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia
| | - Susan L. Hogan
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension and
| | - Caroline J. Poulton
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension and
| | - Randal K. Detwiler
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension and
| | - J. Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Ronald J. Falk
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension and
| | - Patrick H. Nachman
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension and
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Mawad H, Laurin LP, Naud JF, Leblond FA, Henley N, Vallée M, Pichette V, Leblanc M. Changes in Urinary and Serum Levels of Novel Biomarkers after Administration of Gadolinium-based Contrast Agents. Biomark Insights 2016; 11:91-4. [PMID: 27398022 PMCID: PMC4928645 DOI: 10.4137/bmi.s39199] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of our study is to describe the changes in urinary and serum levels of novel biomarkers after gadolinium contrast administration in patients with normal renal function. METHODS We measured four biomarkers in 28 volunteers: interleukin-18 (IL-18), N-acetyl-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin, and cystatin C. Urinary and serum samples were collected at 0, 3, and 24 hours following gadolinium administration. RESULTS Baseline serum creatinine was 57.8 ± 34.5 µmol/L and remained stable. Urinary IL-18 levels increased significantly at three hours (10.7 vs. 7.3 ng/mg creatinine; P < 0.05). Similarly, urinary NAG levels increased significantly at three hours (3.9 vs. 2.2 IU/mg creatinine; P < 0.001). For both these markers, the difference was no longer significant at 24 hours. No statistically significant differences were observed for urinary and serum neutrophil gelatinase-associated lipocalin levels and for serum cystatin C levels. CONCLUSIONS Urinary IL-18 and NAG levels increased transiently after administration of gadolinium-based contrast agents in patients with normal renal function.
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Affiliation(s)
- Habib Mawad
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | | | - Jean-François Naud
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | | | - Nathalie Henley
- Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada
| | - Michel Vallée
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Vincent Pichette
- Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada
| | - Martine Leblanc
- Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada
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Laurin LP, Gasim AM, Poulton CJ, Hogan SL, Jennette JC, Falk RJ, Foster BJ, Nachman PH. Treatment with Glucocorticoids or Calcineurin Inhibitors in Primary FSGS. Clin J Am Soc Nephrol 2016; 11:386-94. [PMID: 26912551 DOI: 10.2215/cjn.07110615] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 06/29/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In primary FSGS, calcineurin inhibitors have primarily been studied in patients deemed resistant to glucocorticoid therapy. Few data are available about their use early in the treatment of FSGS. We sought to estimate the association between choice of therapy and ESRD in primary FSGS. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used an inception cohort of patients diagnosed with primary FSGS by kidney biopsy between 1980 and 2012. Factors associated with initiation of therapy were identified using logistic regression. Time-dependent Cox models were performed to compare time to ESRD between different therapies. RESULTS In total, 458 patients were studied (173 treated with glucocorticoids alone, 90 treated with calcineurin inhibitors with or without glucocorticoids, 12 treated with other agents, and 183 not treated with immunosuppressives). Tip lesion variant, absence of severe renal dysfunction (eGFR≥30 ml/min per 1.73 m(2)), and hypoalbuminemia were associated with a higher likelihood of exposure to any immunosuppressive therapy. Only tip lesion was associated with initiation of glucocorticoids alone over calcineurin inhibitors. With adjusted Cox regression, immunosuppressive therapy with glucocorticoids and/or calcineurin inhibitors was associated with better renal survival than no immunosuppression (hazard ratio, 0.49; 95% confidence interval, 0.28 to 0.86). Calcineurin inhibitors with or without glucocorticoids were not significantly associated with a lower likelihood of ESRD compared with glucocorticoids alone (hazard ratio, 0.42; 95% confidence interval, 0.15 to 1.18). CONCLUSIONS The use of immunosuppressive therapy with calcineurin inhibitors and/or glucocorticoids as part of the early immunosuppressive regimen in primary FSGS was associated with improved renal outcome, but the superiority of calcineurin inhibitors over glucocorticoids alone remained unproven.
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Affiliation(s)
- Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Nephrology and Hypertension, University of North Carolina Kidney Center and
| | - Adil M Gasim
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Caroline J Poulton
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center and
| | - Susan L Hogan
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center and
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Ronald J Falk
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center and
| | - Bethany J Foster
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Montreal Children's Hospital, Montreal, Quebec, Canada; and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Patrick H Nachman
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center and
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Lepage L, Dufour AC, Doiron J, Handfield K, Desforges K, Bell R, Vallée M, Savoie M, Perreault S, Laurin LP, Pichette V, Lafrance JP. Randomized Clinical Trial of Sodium Polystyrene Sulfonate for the Treatment of Mild Hyperkalemia in CKD. Clin J Am Soc Nephrol 2015; 10:2136-42. [PMID: 26576619 DOI: 10.2215/cjn.03640415] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [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: 04/01/2015] [Accepted: 09/02/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Hyperkalemia affects up to 10% of patients with CKD. Sodium polystyrene sulfonate has long been prescribed for this condition, although evidence is lacking on its efficacy for the treatment of mild hyperkalemia over several days. This study aimed to evaluate the efficacy of sodium polystyrene sulfonate in the treatment of mild hyperkalemia. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In total, 33 outpatients with CKD and mild hyperkalemia (5.0-5.9 mEq/L) in a single teaching hospital were included in this double-blind randomized clinical trial. We randomly assigned these patients to receive either placebo or sodium polystyrene sulfonate of 30 g orally one time per day for 7 days. The primary outcome was the comparison between study groups of the mean difference of serum potassium levels between the day after the last dose of treatment and baseline. RESULTS The mean duration of treatment was 6.9 days. Sodium polystyrene sulfonate was superior to placebo in the reduction of serum potassium levels (mean difference between groups, -1.04 mEq/L; 95% confidence interval, -1.37 to -0.71). A higher proportion of patients in the sodium polystyrene sulfonate group attained normokalemia at the end of their treatment compared with those in the placebo group, but the difference did not reach statistical significance (73% versus 38%; P=0.07). There was a trend toward higher rates of electrolytic disturbances and an increase in gastrointestinal side effects in the group receiving sodium polystyrene sulfonate. CONCLUSIONS Sodium polystyrene sulfonate was superior to placebo in reducing serum potassium over 7 days in patients with mild hyperkalemia and CKD.
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Affiliation(s)
| | | | | | | | | | | | - Michel Vallée
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada; Department of Medicine
| | | | | | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada; Department of Medicine
| | - Vincent Pichette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada; Department of Medicine, Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada Department of Pharmacology, University of Montreal, Montreal, Canada; and
| | - Jean-Philippe Lafrance
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada Department of Pharmacology, University of Montreal, Montreal, Canada; and
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Harrak H, Normand I, Grinker R, Elftouh N, Laurin LP, Lafrance JP. Association between acetylsalicylic acid and the risk of dialysis-related infections or septicemia among incident hemodialysis patients: a nested case-control study. BMC Nephrol 2015; 16:115. [PMID: 26215587 PMCID: PMC4517421 DOI: 10.1186/s12882-015-0112-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vascular access-related infections and septicemia are the main causes of infections among hemodialysis patients, the majority of them caused by Staphylococcus species. Acetylsalicylic acid (ASA) has recently been reported with a probable antistaphylococcal activity. This study aimed to evaluate the effect of ASA on the risk of dialysis-related infection and septicemia among incident chronic hemodialysis patients. METHODS In a nested case-control study, we identified 449 cases of vascular access-related infections and septicemia, and 4156 controls between 2001 and 2007 from our incident chronic hemodialysis patients' cohort. Cases were defined as patients hospitalized with a main diagnosis of vascular access-related infection or septicemia on the discharge sheet (ICD-9 codes). Up to ten controls per case were selected by incidence density sampling and matched to cases on age, sex and follow-up time. ASA exposure was measured at the admission and categorized as: no use, low dose (80-324 mg/d), high dose (≥325 mg/d). Odds ratios (OR) for infections were estimated using multivariable conditional logistic regression analysis, adjusting for potential confounders. RESULTS Compared to no use, neither dose of ASA was associated with a decreased risk of infection: low dose (OR 1.03, 95 % CI 0.82-1.28) and high dose (OR 1.30, 95 % CI 0.96-1.75). However, diabetes (OR = 1.32, 95 % CI = 1.07-1.62) and anticoagulant use (OR = 1.62, 95 % CI = 1.30-2.02) were associated with a higher risk. CONCLUSION Among hemodialysis patients, ASA use was not associated with a reduced risk of hospitalizations for dialysis-related infections or septicemia. However, ASA may remain beneficial for its cardiovascular indications.
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Affiliation(s)
- Hind Harrak
- Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada.
| | - Isabelle Normand
- Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada.
| | - Rachel Grinker
- Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada.
| | - Naoual Elftouh
- Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada.
| | | | - Jean-Philippe Lafrance
- Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada.
- Department of Medicine, University of Montreal, Montreal, Canada.
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada.
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Laurin LP, Harrak H, Elftouh N, Ouimet D, Vallée M, Lafrance JP. Outcomes of Infection-Related Hospitalization according to Dialysis Modality. Clin J Am Soc Nephrol 2015; 10:817-24. [PMID: 25818336 PMCID: PMC4422244 DOI: 10.2215/cjn.09210914] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 09/16/2014] [Accepted: 01/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Peritoneal dialysis (PD) is associated with an increased risk of infection-related hospitalization (IRH) compared with hemodialysis. The objective of this study was to compare mortality and overall readmission after an IRH between PD and hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This propensity score-matched retrospective cohort study assessed patients undergoing long-term dialysis patients, derived from the Canadian Organ Replacement Register and Régie de l'assurance maladie du Québec, who had at least one IRH between January 2001 and December 2007. Patients were followed until death, kidney transplantation, or end of the study period. To estimate the probability of receiving PD versus hemodialysis, propensity scores were obtained using multivariable logistic regression. Mortality and overall readmission risks after the initial IRH were compared using a Cox survival model. RESULTS A total of 354 pairs of patients who had at least one IRH were matched for propensity score. During follow-up (median, 1.25 years), 138 hemodialysis patients (24.7/100 patient-years; 95% confidence interval [95% CI], 20.7 to 29.1) and 130 PD patients (21.2/100 patient-years; 95% CI, 17.7 to 25.1) died; 265 hemodialysis patients (144.6/100 patient-years; 95% CI, 127.7 to 163.1) and 299 PD patients (173.2/100 patient-years; 95% CI, 154.1 to 194.0) were readmitted for any cause; and 121 hemodialysis patients (29.7/100 patient-years; 95% CI, 24.7 to 35.5) and 168 PD patients (44.7/100 patient-years; 95% CI, 38.2 to 52.0) were readmitted for an infection. Compared with hemodialysis, PD was not associated with a different mortality risk after an IRH (hazard ratio [HR], 0.87; 95% CI, 0.69 to 1.11). PD was associated with a higher risk of infection-related overall readmission compared with hemodialysis (HR, 1.44; 95% CI, 1.14 to 1.81), but not with the risk of all-cause overall readmission (HR, 1.15; 95% CI, 0.98 to 1.36). CONCLUSIONS PD was not associated with higher mortality or all-cause overall readmission following an IRH compared with hemodialysis, but PD patients were at higher risk of infection-related overall readmission after IRH. IRHs are associated with significant mortality and overall readmissions. Evaluation of strategies to reduce infections in both hemodialysis and PD recipients are needed to improve patient care and outcomes.
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Affiliation(s)
- Louis-Philippe Laurin
- Nephrology Division and Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Hind Harrak
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada; and
| | - Naoual Elftouh
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada; and
| | - Denis Ouimet
- Nephrology Division and Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Michel Vallée
- Nephrology Division and Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean-Philippe Lafrance
- Nephrology Division and Department of Medicine, University of Montreal, Montreal, Quebec, Canada Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada; and
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Lafrance JP, Rahme E, Iqbal S, Elftouh N, Laurin LP, Vallée M. Trends in infection-related hospital admissions and impact of length of time on dialysis among patients on long-term dialysis: a retrospective cohort study. CMAJ Open 2014; 2:E109-14. [PMID: 25077126 PMCID: PMC4084745 DOI: 10.9778/cmajo.20120027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND After cardiovascular disease, infection is the second leading reason for admission to hospital among patients receiving long-term dialysis. We examined whether duration of dialysis treatment influences the rate of infection-related admission to hospital. METHODS Using provincial administrative databases for Quebec, we built a retrospective cohort of all adults receiving long-term dialysis (hemodialysis or peritoneal dialysis) between 2001 and 2007. We evaluated rates of infection-related admission to hospital according to length of time on dialysis. RESULTS A cohort of 9822 patients (mean age 66.3 [standard deviation ± 14.7] yr; 39.7% female) were followed for a median of 2.1 (range 1.0-3.9) years. Between 2001 and 2007, infection-related hospital admissions remained stable (from 0.20 to 0.19 per person-year; p = 0.7). All-cause hospital admission rates decreased by 22.9% (from 1.53 to 1.18 per person-year; p < 0.001), and cardiovascular-related admission rates decreased by 46.7% (from 0.45 to 0.24 per person-year; p < 0.001). The rate of infection-related admission remained stable with increasing time on dialysis (p = 0.1); however, both all-cause and cardiovascular-related admission rates decreased with length of time on dialysis (p < 0.001). Standardization of hospital admission rates by age, sex or length of time on dialysis did not change trends. INTERPRETATION We found a stable rate of infection-related hospital admission between 2001 and 2007 among patients on long-term dialysis, independent of age, sex and length of time on dialysis. A decrease in all-cause and cardiovascular-related admission rates during the same period meant that the proportion of admissions related to infection increased. Because admissions to hospital are potentially preventable, understanding the epidemiology of infection-related admissions may inform future studies on prevention of this serious outcome.
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Affiliation(s)
- Jean-Philippe Lafrance
- Centre de recherche Hôpital Maisonneuve-Rosemont, Montréal, Que
- Département de médecine, Université de Montréal, Montréal, Que
- Service de néphrologie, Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - Elham Rahme
- Department of Medicine, McGill University, Montréal, Que
- Research Institute, McGill University Health Centre, Montréal, Que
| | - Sameena Iqbal
- Department of Medicine, McGill University, Montréal, Que
- Division of Nephrology, McGill University Health Centre, Montréal, Que
| | - Naoual Elftouh
- Centre de recherche Hôpital Maisonneuve-Rosemont, Montréal, Que
| | | | - Michel Vallée
- Département de médecine, Université de Montréal, Montréal, Que
- Service de néphrologie, Hôpital Maisonneuve-Rosemont, Montréal, Que
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Normand I, Elftouh N, Laurin LP, Ouimet D, Harrak H, Lafrance JP. Association between vitamin D receptor activator and the risk of infection-related hospitalizations among incident hemodialysis patients: a nested case-control study. Pharmacoepidemiol Drug Saf 2014; 23:261-7. [PMID: 24470433 DOI: 10.1002/pds.3576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/23/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients suffering from chronic kidney disease are at greater risk of developing infection than the normal population, and infections are the second cause of mortality after cardiovascular complications in this population. Some reports suggest that the intake of active vitamin D might be beneficial to prevent infections. Therefore, we aimed to determine if the oral intake of vitamin D receptor activator (VDRA) is associated with a lower risk of infection-related hospitalization (IRH) among incident chronic hemodialysis patients. METHODS We conducted a nested case-control study in a cohort of 4933 patients initiating chronic hemodialysis between 1 January 2001 and 31 December 2007 in Quebec, Canada, using administrative databases. We identified cases of hospital admission indicating an infection as main diagnosis on the hospital's discharge sheet. Up to 10 controls were randomly selected for each case. Association between oral VDRA use and risk of IRH was estimated using conditional logistic regression. RESULTS We identified 1136 cases of IRH and 10396 controls during the study period. The intake of VDRA was not associated with the risk of being hospitalized due to an infection (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.95-1.20). Using the prior 6-month cumulative dose of VDRA, we also found that a cumulative VDRA dose of less than 45 mcg (OR, 1.05; 95%CI, 0.92-1.19) or greater than 45 mcg (OR, 1.15; 95%CI, 0.96-1.36) was not associated with the IRH risk. CONCLUSIONS The oral intake of VDRA was not associated with the risk of IRH in incident hemodialysis patients.
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Laurin LP, Nachman PH, Desai PC, Ataga KI, Derebail VK. Hydroxyurea is associated with lower prevalence of albuminuria in adults with sickle cell disease. Nephrol Dial Transplant 2013; 29:1211-8. [PMID: 24084325 DOI: 10.1093/ndt/gft295] [Citation(s) in RCA: 52] [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] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Albuminuria is an early manifestation of sickle cell nephropathy. Prior small case series suggests benefit of hydroxyurea in reducing albuminuria, with a similar trend noted in pediatric studies. We aimed to comprehensively evaluate hydroxyurea use and prevalence of albuminuria in adult sickle cell patients. METHODS We performed a cross-sectional study of 149 adult patients followed between 2000 and 2011 in a comprehensive sickle cell clinic. All patients were assessed for albuminuria either by direct measurement or by urinary chemical strip (dipstick) testing. Urinary albumin-to-creatinine ratios (UACRs) were available for 112 patients. Hydroxyurea exposure was defined as ≥3 months of therapy before the assessment of albuminuria. Albuminuria was defined as either UACR ≥30 mg/g or ≥1+ proteinuria on two separate dipsticks. We constructed a multivariate logistic regression model to assess the association between hydroxyurea and albuminuria. RESULTS The prevalence of albuminuria was lower among patients on hydroxyurea (34.7 versus 55.4%; P = 0.01) as was median albumin excretion (17.9 versus 40.5 mg/g; P = 0.04). In multivariate analysis, hydroxyurea was associated with a lower likelihood of albuminuria (odds ratio 0.28, 95% CI: 0.11-0.75, P = 0.01), adjusting for age, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, tricuspid regurgitant jet velocity, hypertension and acute chest syndrome. CONCLUSIONS In our population of sickle cell patients, those using hydroxyurea were less than one-third as likely to exhibit albuminuria. Hydroxyurea use may prevent development of overt nephropathy or the progression of sickle cell disease nephropathy to end-stage renal disease, and its use for this indication merits further investigation.
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Affiliation(s)
- Louis-Philippe Laurin
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patrick H Nachman
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Payal C Desai
- Division of Hematology, Department of Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kenneth I Ataga
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vimal K Derebail
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lafrance JP, Rahme E, Iqbal S, Elftouh N, Vallée M, Laurin LP, Ouimet D. Association of dialysis modality with risk for infection-related hospitalization: a propensity score-matched cohort analysis. Clin J Am Soc Nephrol 2012; 7:1598-605. [PMID: 22904124 DOI: 10.2215/cjn.00440112] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Peritonitis is a well known complication of peritoneal dialysis (PD), whereas in hemodialysis (HD), bacteremia can be life threatening. Whether patients undergoing PD have higher risk than HD patients for infection-related hospitalizations (IRH) remains unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A propensity score-matched retrospective cohort of patients undergoing long-term dialysis between January 2001 and December 2007 was assembled. Propensity scores were calculated using multivariable (demographic characteristics, smoking, body mass index, comorbid conditions, and laboratory data) logistic regression to estimate probability of receiving PD versus HD. A comparison of IRH risk by dialysis modality was estimated using a counting-process survival model. RESULTS A total of 910 pairs of patients were matched by propensity scores. During a median follow-up of 2.1 years (interquartile range, 1.1-3.5 years), 341 patients were hospitalized once for an infection, 123 twice, and 106 at least three times. PD was associated with an increased risk for IRH compared with HD (propensity-matched hazard ratio [HR], 1.52). PD was associated with a reduced risk for septicemia (HR, 0.31) and pneumonia (HR, 0.58) but also an increased risk for dialysis-related infectious hospitalizations (HR, 3.44), defined as all cases of peritonitis and vascular access-related bacteremia, but not all septicemia cases. CONCLUSIONS PD patients are at higher risk for IRH than are HD patients. This risk is mostly explained by dialysis-related infections. However, further studies are needed to evaluate whether the severity of those hospitalizations is similar and whether this increased risk for IRH is associated with worse outcomes.
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Laurin LP, Lévesque R, Roy L. Hemodiafiltration does not improve drug protein binding compared to conventional hemodialysis: an in vitro study. Blood Purif 2012; 33:307-8. [PMID: 22678164 DOI: 10.1159/000337878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Louis-Philippe Laurin
- Department of Medicine, Centre Hospitalier de l'Université de Montréal-Hôpital Saint-Luc, Montréal, Qué., Canada
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Naud J, Laurin LP, Michaud J, Beauchemin S, Leblond FA, Pichette V. Effects of Chronic Renal Failure on Brain Drug Transporters in Rats. Drug Metab Dispos 2011; 40:39-46. [DOI: 10.1124/dmd.111.041145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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