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Bonnet F, Balkau B, Lambert O, Diawara Y, Combe C, Frimat L, Laville M, Liabeuf S, Massy ZA, Metzger M, Stengel B, Alencar de Pinho N, Fouque D. The number of nephroprotection targets attained is associated with cardiorenal outcomes and mortality in patients with diabetic kidney disease. The CKD-REIN cohort study. Diabetes Obes Metab 2024; 26:1908-1918. [PMID: 38418407 DOI: 10.1111/dom.15507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
AIM The risk of cardiorenal events remains high among patients with diabetes and chronic kidney disease (CKD), despite the prescription of recommended treatments. We aimed to determine whether the attainment of a combination of nephroprotection targets at baseline (glycated haemoglobin <7.0%, urinary albumin-creatinine ratio <300 mg/g, blood pressure <130/80 mmHg, renin-angiotensin system inhibition) was associated with better cardiorenal outcomes and lower mortality. MATERIALS AND METHODS From the prospective French CKD-REIN cohort, we studied 1260 patients with diabetes and CKD stages 3-4 (estimated glomerular filtration rate: 15-60 ml/min/1.73 m2); 69% were men, and at inclusion, mean ± SD age: 70 ± 10 years; estimated glomerular filtration rate: 33 ± 11 ml/min/1.73 m2. The median follow-up was 4.9 years. RESULTS In adjusted Cox regression models, the attainment of two nephroprotection targets was consistently associated with a lower risk of cardiorenal events [hazard ratio 0.70 (95% confidence interval 0.57-0.85)], incident kidney failure with replacement therapy [0.58 (0.43-0.77)], four major adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure) [0.75 (0.57-0.99)] and all-cause mortality [0.59 (0.42-0.82)] when compared with the attainment of zero or one target. For patients with a urinary albumin-creatinine ratio ≥300 mg/g, those who attained at least two targets had lower hazard ratios for cardiorenal events [0.61 (0.39-0.96)], four major adverse cardiovascular events [0.53 (0.28-0.98)] and all-cause mortality [0.35 (0.17-0.70)] compared with those who failed to attain any targets. CONCLUSIONS These findings suggest that the attainment of a combination of nephroprotection targets is associated with better cardiorenal outcomes and a lower mortality rate in people with diabetic kidney disease.
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Affiliation(s)
- Fabrice Bonnet
- Department of Diabetology, CHU de Rennes, Université de Rennes 1, Rennes, France
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Beverley Balkau
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Yakhara Diawara
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Christian Combe
- Department of Nephrology, transplantation, dialysis, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
- Inserm U1026, Biotis, Bordeaux University, France
| | - Luc Frimat
- Department of Nephrology, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
- Inserm CIC 1433, Clinical Epidemiology Unit, Vandoeuvre-lès-Nancy, France
| | | | - Sophie Liabeuf
- Department of Pharmacology, CHU Amiens-Picardie, MP3CV Unit, Université Picardie Jules Verne, Amiens, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
- Department of Nephrology, AP-HP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Natalia Alencar de Pinho
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Denis Fouque
- Université de Lyon, Lyon, France
- Inserm U1060, CARMEN, Lyon, France
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Laville SM, Gras-Champel V, Hamroun A, Moragny J, Lambert O, Metzger M, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Robinson BM, Bieber B, Stengel B, Alencar De Pinho N, Massy ZA, Liabeuf S. Kidney Function Decline and Serious Adverse Drug Reactions in Patients With CKD. Am J Kidney Dis 2024; 83:601-614.e1. [PMID: 37951340 DOI: 10.1053/j.ajkd.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/16/2023] [Accepted: 09/11/2023] [Indexed: 11/13/2023]
Abstract
RATIONALE & OBJECTIVE Adverse drug reactions (ADRs) are common in patients with chronic kidney disease (CKD). The impact of kidney function decline on serious ADR risk has been poorly investigated. We comprehensively describe ADRs and assess the relationship between estimated glomerular filtration rate (eGFR) and serious ADR risk. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,033 participants in French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study, a nationwide sample of nephrology outpatients with moderate to advanced CKD. PREDICTORS Demographic and biological data (including eGFR), medication prescriptions. OUTCOME ADRs (preventable or not) were prospectively identified from hospital discharge reports, medical records, and patient interviews. Expert pharmacologists used validated tools to adjudicate ADRs. ANALYTICAL APPROACH Restricted cubic splines in fully adjusted cause-specific Cox proportional hazard models were used to evaluate the relationship between eGFR and the risk of serious ADRs (overall and by subtype). RESULTS During a median follow-up period of 4.7 years, 360 patients experienced 488 serious ADRs. Kidney and urinary disorders (n=170) and hemorrhage (n=170) accounted for 70% of serious ADRs. The most common medications classes were antithrombotics and renin-angiotensin system inhibitors. The majority of those serious ADRs were associated with hospitalization (n=467), with 32 directly or indirectly associated with death and 22 associated with a life-threatening event. More than 27% of the 488 serious ADRs were preventable or potentially preventable. The eGFR is a major risk factor for serious ADRs. The risk of acute kidney injury was 2.2% higher and risk of bleeding ADRs was 8% higher for each 1mL/min/1.73m2 lower baseline eGFR. LIMITATIONS The results cannot be extrapolated to patients who are not being treated by a nephrologist. CONCLUSIONS ADRs constitute a major cause of hospitalization in CKD patients for whom lower eGFR level is a major risk factor. PLAIN-LANGUAGE SUMMARY Patients with chronic kidney disease (CKD) have complex clinical presentations, take multiple medications, and often receive inappropriate prescriptions. Using data from a large, prospective CKD cohort, we found a high incidence of serious adverse drug reactions (ADRs). The 2 most common serious ADRs were drug-induced acute kidney injury and bleeding. A large proportion of serious ADRs required hospital admission, and 11% led to death or were life threatening. Lower kidney function was a major risk factor for serious ADRs. Many of these serious ADRs were determined to be partly preventable through greater adherence to prescription guidelines. This report enhances our understanding of the potential toxicity of drugs taken by patients with moderate to advanced CKD. It emphasizes the importance of monitoring kidney function when prescribing drugs, particularly for high-risk medications such as antithrombotic agents.
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Affiliation(s)
- Solène M Laville
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens; MP3CV Laboratory, Jules Verne University of Picardie, Amiens
| | - Valérie Gras-Champel
- Pharmacovigilance Center, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens
| | - Aghilès Hamroun
- Nephrology Department, Lille Regional University Medical Center, Lille; Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Julien Moragny
- Pharmacovigilance Center, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif; Biomedecine Agency, Saint Denis La Plaine
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux; INSERM, U1026, Université Bordeaux Segalen, Bordeaux
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite; Université de Lyon, Carmen INSERM 1060, Lyon
| | | | - Luc Frimat
- Nephrology Department, CHRU de Nancy, Vandoeuvre-lès-Nancy; Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | | | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Natalia Alencar De Pinho
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif; Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt/Paris
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens; MP3CV Laboratory, Jules Verne University of Picardie, Amiens.
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Le Gall L, Harambat J, Combe C, Philipps V, Proust-Lima C, Dussartre M, Drüeke T, Choukroun G, Fouque D, Frimat L, Jacquelinet C, Laville M, Liabeuf S, Pecoits-Filho R, Massy ZA, Stengel B, Alencar de Pinho N, Leffondré K, Prezelin-Reydit M. Haemoglobin trajectories in chronic kidney disease and risk of major adverse cardiovascular events. Nephrol Dial Transplant 2024; 39:669-682. [PMID: 37935529 DOI: 10.1093/ndt/gfad235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The trajectories of haemoglobin in patients with chronic kidney disease (CKD) have been poorly described. In such patients, we aimed to identify typical haemoglobin trajectory profiles and estimate their risks of major adverse cardiovascular events (MACE). METHODS We used 5-year longitudinal data from the CKD-REIN cohort patients with moderate to severe CKD enrolled from 40 nationally representative nephrology clinics in France. A joint latent class model was used to estimate, in different classes of haemoglobin trajectory, the competing risks of (i) MACE + defined as the first event among cardiovascular death, non-fatal myocardial infarction, stroke or hospitalization for acute heart failure, (ii) initiation of kidney replacement therapy (KRT) and (iii) non-cardiovascular death. RESULTS During the follow-up, we gathered 33 874 haemoglobin measurements from 3011 subjects (median, 10 per patient). We identified five distinct haemoglobin trajectory profiles. The predominant profile (n = 1885, 62.6%) showed an overall stable trajectory and low risks of events. The four other profiles had nonlinear declining trajectories: early strong decline (n = 257, 8.5%), late strong decline (n = 75, 2.5%), early moderate decline (n = 356, 11.8%) and late moderate decline (n = 438, 14.6%). The four profiles had different risks of MACE, while the risks of KRT and non-cardiovascular death consistently increased from the haemoglobin decline. CONCLUSION In this study, we observed that two-thirds of patients had a stable haemoglobin trajectory and low risks of adverse events. The other third had a nonlinear trajectory declining at different rates, with increased risks of events. Better attention should be paid to dynamic changes of haemoglobin in CKD.
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Affiliation(s)
- Lisa Le Gall
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Jérôme Harambat
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Bordeaux University Hospital, Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Sorare, Pellegrin-Enfants Hospital, Bordeaux, France
| | - Christian Combe
- Bordeaux University Hospital, Department of Nephrology, transplantation, dialysis, Bordeaux, France
- University Bordeaux, INSERM U1026, Bordeaux, France
| | - Viviane Philipps
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Cécile Proust-Lima
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Maris Dussartre
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Tilman Drüeke
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Gabriel Choukroun
- Amiens Picardie University Hospital, Department of Nephrology Dialysis Transplantation, Amiens, France
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
| | - Denis Fouque
- Hopital Lyon Sud, Département de néphrologie, Lyon, France
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Luc Frimat
- CHRU de Nancy, Department of Nephrology, Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, Nancy, France
| | - Christian Jacquelinet
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Agence de la biomedecine, La Plaine-Saint-Denis, France
| | - Maurice Laville
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Sophie Liabeuf
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
- Amiens-Picardie University Medical Center, Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens, France
| | - Roberto Pecoits-Filho
- DOPPS Program Area, Arbor Research Collaborative for Health, Ann Arbor, MI, USA
- School of Medicine, Pontificia Universidade Catolica do Parana, Cutitiba, PR, Brazil
| | - Ziad A Massy
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Ambroise Paré University Hospital, APHP, Department of Nephrology, Boulogne-Billancourt/Paris, France
| | - Bénédicte Stengel
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Natalia Alencar de Pinho
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Karen Leffondré
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Mathilde Prezelin-Reydit
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Maison du REIN AURAD Aquitaine, Néphrologie, Gradignan, Nouvelle-Aquitaine, FR
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El Chamieh C, Larabi IA, Alencar De Pinho N, Lambert O, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Laville S, Lange C, Alvarez JC, Massy ZA, Liabeuf S. Study of the association between serum levels of kynurenine and cardiovascular outcomes and overall mortality in chronic kidney disease. Clin Kidney J 2024; 17:sfad248. [PMID: 38186868 PMCID: PMC10768787 DOI: 10.1093/ckj/sfad248] [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: 06/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background Kynurenine is a protein-bound uremic toxin. Its circulating levels are increased in chronic kidney disease (CKD). Experimental studies showed that it exerted deleterious cardiovascular effects. We sought to evaluate an association between serum kynurenine levels and adverse fatal or nonfatal cardiovascular events and all-cause mortality in CKD patients. Methods The CKD-REIN study is a prospective cohort of people with CKD having an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Baseline frozen samples of total and free fractions of kynurenine and tryptophan were measured using a validated liquid chromatography tandem mass spectrometry technique. Cause-specific Cox models were used to estimate hazard ratios (HRs) for each outcome. Results Of the 2406 included patients (median age: 68 years; median eGFR: 25 ml/min/1.73 m2), 52% had a history of cardiovascular disease. A doubling of serum-free kynurenine levels was associated with an 18% increased hazard of cardiovascular events [466 events, HR (95%CI):1.18(1.02,1.33)], independently of eGFR, serum-free tryptophan level or other uremic toxins, cardioprotective drugs, and traditional cardiovascular risk factors. Serum-free kynurenine was significantly associated with non-atheromatous cardiovascular events [HR(95%CI):1.26(1.03,1.50)], but not with atheromatous cardiovascular events [HR(95%CI):1.15(0.89,1.50)]. The association of serum-free kynurenine with cardiovascular mortality was also independently significant [87 events; adjusted HR(95%CI):1.64(1.10,2.40)]. However, the association of serum-free kynurenine with all-cause mortality was no more significant after adjustment on serum-free tryptophan [311 events, HR(95%CI):1.12(0.90, 1.40)]. Conclusions Our findings imply that serum-free kynurenine, independently of other cardiovascular risk factors (including eGFR), is associated with fatal or nonfatal cardiovascular outcomes, particularly non-atheromatous cardiovascular events; in patients with CKD. Strategies to reduce serum kynurenine levels should be evaluated in further studies.
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Affiliation(s)
- Carolla El Chamieh
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Islam Amine Larabi
- Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, AP-HP, Garches, France
- UVSQ, Université Paris-Saclay, Inserm U1018, CESP, Équipe MOODS, MasSpecLab, Montigny-le-Bretonneux, France
| | - Natalia Alencar De Pinho
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, University Bordeaux, Bordeaux, France
| | - Denis Fouque
- Nephrology Dept, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
- Université de Lyon, CarMeN INSERM 1060, Lyon, France
| | - Luc Frimat
- Nephrology Department, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Biomedecine Agency, Saint Denis La Plaine, France
| | | | - Solène Laville
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Céline Lange
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Jean-Claude Alvarez
- Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, AP-HP, Garches, France
- UVSQ, Université Paris-Saclay, Inserm U1018, CESP, Équipe MOODS, MasSpecLab, Montigny-le-Bretonneux, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
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Levassort H, Boucquemont J, de Pinho NA, Lambert O, Helmer C, Metzger M, Teillet L, Frimat L, Combe C, Fouque D, Laville M, Jacquelinet C, Liabeuf S, Stengel B, Massy ZA, Pépin M. A New Approach for Cognitive Impairment Pattern in Chronic Kidney Disease. Nephrol Dial Transplant 2023:gfad244. [PMID: 37950574 DOI: 10.1093/ndt/gfad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS Chronic kidney disease (CKD) is associated with an elevated risk of neurocognitive disorders (NCDs). It remains unclear whether CKD-related NCDs have specific cognitive pattern or are earlier-onset phenotypes of the main NCDs (vascular NCDs and Alzheimer's disease). METHODS We used the Mini Mental State Examination score (MMSE) to assess cognitive pattern in 3003 CKD patients (stage 3 to 4) followed up over 5 years in the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort. After normalizing MMSE scores to a 0-to-100 scale, the associations between the baseline estimated glomerular filtration rate (eGFR, using the CKD-EPI-creatinine formula) and changes in each MMSE domain score were assessed in linear mixed models. RESULTS Patients (age: 67±13 years old; males: 65%, mean eGFR: 33±12 ml/min/1.73 m²) had a good baseline cognitive functions: the mean MMSE score was 26.9/30 ±2.9. After adjustment for age, sex, educational level, depression (past or present), cardiovascular risk factors, cerebrovascular disease, a lower baseline eGFR (per 10 ml/min/1.73 m²) was associated with a 0.53-point decrement (p<0.001; 95%CI [-0.98,-0.08]) for orientation, a 1.04-point decrement (p=0.03; 95%CI [-1.96,-0.13]) for attention and calculation, a 0.78-point decrement (p=0.003; 95%CI [-1.30,-0.27]) for language, and a 0.94-point decrement (p=0.02; 95%CI [-1.75,-0.13]) for praxis. Baseline eGFR was not, however, associated with significant changes over time in MMSE domain scores. CONCLUSION A lower eGFR in CKD patients was associated with early impairments in certain cognitive domains: praxis, language and attention domains before an obvious cognitive decline. Early detection of NCD in CKD patients must be perform before clinically cognitive decline using preferably tests assessing executive, attentional functions and language than memory test. This could lead to a better management of cognitive impairment and their consequences on CKD management.
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Affiliation(s)
- Hélène Levassort
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
- Department of Nephrology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Julie Boucquemont
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Natalia Alencar de Pinho
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Oriane Lambert
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Catherine Helmer
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR U1219, Bordeaux, France
| | - Marie Metzger
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Laurent Teillet
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Luc Frimat
- Department of Nephrology, CHRU-Nancy, Lorraine University, Vandoeuvre, France
- EA 4360, INSERM CIC-EC CIE6, Medicine Faculty, Lorraine University, Apemac, France
| | - Christian Combe
- Department of Nephrology, Bordeaux University Hospital, INSERM U1026 Biotis, Univ. Bordeaux, Bordeaux, France
| | - Denis Fouque
- Department of Nephrology, LyonSud hospital - Hospices Civils de Lyon, Claude Bernard Lyon1 University, Pierre Benite, France
| | - Maurice Laville
- Carmen INSERM U1060, Claude Bernard Lyon 1 University, Pierre-Bénite, France
| | - Christian Jacquelinet
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Medical and Scientific Department, Agence de la biomédecine, Saint-Denis la Plaine, France
| | - Sophie Liabeuf
- Pharmacology Department, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
| | - Bénédicte Stengel
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Ziad A Massy
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Nephrology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Marion Pépin
- Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
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6
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Rossello N, Decullier É, Marolho C, Jolivot A, Laville M. Impact of physical activity in non-dialysis CKD patients followed in a multidisciplinary care network on the progression of chronic renal failure – PHYSALYS study. Nephrol Ther 2023; 19:507-519. [PMID: 37915199 DOI: 10.1684/ndt.2023.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Physical activity (PA), has a proven effect on overall health. The study assessed the difference in glomerular filtration rate (GFR) over one year in non-dialysis renal failure patients between those who practiced exercise (P) and those who did not (NP). Patients were categorised as P or not P using the Global Physical Activity Questionnaire (GPAQ2), completed by telephone, at inclusion and at 12 months. Among the 259 patients included, 195 (75.3%) practiced a PA and 64 (24.7%) did not practiced. There was no significant difference in the slope of GFR decline from inclusion to month 12 between the two groups, p = 0.4107. Only the type of kidney seemed to be significantly associated with the slope of GFR decline over the 12 months (p = 0.0039). These results may be explained by a follow-up time too short to identify an effect of behavioural change on the progression of kidney disease.
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Affiliation(s)
- Noémie Rossello
- Service de recherche et épidémiologie cliniques, Hospices civils de Lyon, Pôle de santé publique, 69003 Lyon, France
- Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Évelyne Decullier
- Service de recherche et épidémiologie cliniques, Hospices civils de Lyon, Pôle de santé publique, 69003 Lyon, France
- Réseau TIRCEL, Hôpital Édouard Herriot, 69437 Lyon, France
| | - Christelle Marolho
- Service de recherche et épidémiologie cliniques, Hospices civils de Lyon, Pôle de santé publique, 69003 Lyon, France
- Réseau TIRCEL, Hôpital Édouard Herriot, 69437 Lyon, France
| | - Anne Jolivot
- Service de néphrologie, Hospices civils de Lyon, Hôpital Édouard Herriot, 69003 Lyon, France
- Réseau TIRCEL, Hôpital Édouard Herriot, 69437 Lyon, France
| | - Maurice Laville
- Réseau TIRCEL, Hôpital Édouard Herriot, 69437 Lyon, France
- Université Claude Bernard Lyon 1, Carmen Inserm U1060, 69310 Pierre-Bénite, France
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7
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Alencar de Pinho N, Metzger M, Hamroun A, Laville S, Prezelin-Reydit M, Combe C, Fouque D, Laville M, Massy Z, Herpe YÉ, Untas A, Jacquelinet C, Liabeuf S, Frimat L, Stengel B. Chronic kidney disease and nephrological practices in France: lessons from the CKD-REIN cohort, 2013-2023. Nephrol Ther 2023; 19:1-18. [PMID: 37533268 DOI: 10.1684/ndt.2023.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Launched in 2013 supported by the Program “Cohorts – Investments for the Future”, the CKD-REIN (Chronic Kidney Disease – Renal Epidemiology and Information Network) study is a prospective cohort that included and followed for 5 years more than 3000 patients with moderate or advanced chronic kidney disease (CKD), from 40 nationally representative nephrology clinics. A large amount of data was collected on CKD and its treatments, patient social characteristics and reported outcomes, and nephrology practices and services. A total of 170,000 blood and urine samples were collected and stored in a central biobank. Coordinated with the CKD outcomes and practice pattern study (CKDopps) and collaborating with the international Network of CKD cohorts (iNETCKD), CKD-REIN contributes to the understanding of CKD and the positioning of France with respect to CKD epidemiology and care in the world. This review highlights major findings from the cohort, and their potential implications for clinical practices and the health system, grouped into the following themes: (1) the complexity of patients with CKD; (2) adherence to clinical guidelines; (3) treatment practices and drug risk; (4) acute on chronic kidney disease; (5) CKD metabolic complications; (6) prediction of kidney failure; (7) sex differences in CKD; (8) patient perspective on CKD; (9) transition to kidney failure and replacement therapy; (10) conservative care.
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Affiliation(s)
- Natalia Alencar de Pinho
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
| | - Marie Metzger
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
| | - Aghilès Hamroun
- Santé publique, épidémiologie, néphrologie, Inserm UMR1167 RIDAGE, Institut Pasteur de Lille, Université de Lille, CHU Lille, France
| | - Solène Laville
- CHU Amiens-Picardie, unité de pharmaco-épidémiologie, département de pharmacologie clinique, Amiens, France
| | | | - Christian Combe
- CHU de Bordeaux, service de néphrologie, transplantation, dialyse, aphérèse, Bordeaux, France
- Inserm U1026, Université de Bordeaux Segalen, Bordeaux, France
| | - Denis Fouque
- CHU Lyon Sud, service de néphrologie, Pierre-Bénite, France
- Université de Lyon, CarMeN Inserm 1060, Lyon, France
| | | | - Ziad Massy
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
- CHU Ambroise Paré, AP-HP, service de néphrologie, Boulogne-Billancourt, France
| | | | - Aurélie Untas
- Université Paris Cité, Laboratoire de psychopathologie et processus de santé, Boulogne-Billancourt, France
| | - Christian Jacquelinet
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
- Agence de la biomédecine, Saint-Denis-La-Plaine, France
| | - Sophie Liabeuf
- CHU Amiens-Picardie, unité de pharmaco-épidémiologie, département de pharmacologie clinique, Amiens, France
| | - Luc Frimat
- CHRU de Nancy, service de néphrologie, Vandœuvre-lès-Nancy, France
| | - Bénédicte Stengel
- Centre de recherche en épidemiologie et santé des populations (CESP), Université Paris-Saclay, Inserm U1018, Équipe Épidémiologie clinique, Villejuif, France
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8
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El Chamieh C, Larabi IA, Laville SM, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Pecoits-Filho R, Lange C, Stengel B, Alencar De Pinho N, Alvarez JC, Massy ZA, Liabeuf S. Proton-Pump Inhibitors and Serum Concentrations of Uremic Toxins in Patients with Chronic Kidney Disease. Toxins (Basel) 2023; 15:toxins15040276. [PMID: 37104214 PMCID: PMC10143607 DOI: 10.3390/toxins15040276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
Use of proton-pump inhibitors (PPIs) is common in patients with chronic kidney disease (CKD). PPIs and many uremic toxins (UTs) are eliminated by the kidney's tubular organic anion transporter system. In a cross-sectional study, we sought to evaluate the association between PPI prescription and serum concentrations of various UTs. We studied a randomly selected sub-group of participants in the CKD-REIN cohort (adult patients with a confirmed diagnosis of CKD and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2) with available frozen samples collected at baseline. PPI prescription was recorded at baseline. Serum concentrations of 10 UTs were measured using a validated liquid chromatography tandem mass spectrometry technique. Multiple linear regression was performed, with the log UT concentration as the dependent variable. Of the 680 included patients (median age: 68 years; median eGFR: 32 mL/min/1.73 m2), 31% had PPI prescriptions at baseline. Patients using PPIs had higher levels of certain UTs in comparison to other patients, including total and free indoxyl sulfate (IS), total and free p-cresylsulfate, total and free p-cresylglucuronide (PCG), phenylacetylglutamine (PAG), free kynurenine, and free hippuric acid. After adjustment for baseline co-morbidities, number of co-prescribed drugs, and laboratory data, including eGFR, associations between PPI prescription and elevated serum concentrations of free and total IS, free and total PCG, and PAG remained significant. Our results indicate that PPI prescription is independently associated with serum UT retention. These findings are interesting to better understand the factors that may modulate serum UT concentration in CKD patients, however, they will need to be confirmed by longitudinal studies.
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Affiliation(s)
- Carolla El Chamieh
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
| | - Islam Amine Larabi
- Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France
- UVSQ, Université Paris-Saclay, Inserm U1018, CESP, Équipe MOODS, MasSpecLab, 78180 Montigny-le-Bretonneux, France
| | - Solène M Laville
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, 80054 Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, F-80054 Amiens, France
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
- Biomedecine Agency, 93210 Saint Denis La Plaine, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
- INSERM, U1026, Univ. Bordeaux, 33076 Bordeaux, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, 69495 Pierre-Bénite, France
- Université de Lyon, CarMeN INSERM 1060, 69008 Lyon, France
| | | | - Luc Frimat
- Nephrology Department, CHRU de Nancy, 54000 Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, 54000 Vandoeuvre-lès-Nancy, France
| | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, MI 48108, USA
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba 80215-901, Brazil
| | - Céline Lange
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
| | - Natalia Alencar De Pinho
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
| | - Jean-Claude Alvarez
- Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France
- UVSQ, Université Paris-Saclay, Inserm U1018, CESP, Équipe MOODS, MasSpecLab, 78180 Montigny-le-Bretonneux, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, 94807 Villejuif, France
- Department of Nephrology, Ambroise Paré University Hospital, APHP, 92104 Boulogne-Billancourt, France
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, 80054 Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, F-80054 Amiens, France
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9
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Pépin M, Levassort H, Boucquemont J, Lambert O, Alencar de Pinho N, Turinici M, Helmer C, Metzger M, Cheddani L, Frimat L, Combe C, Fouque D, Laville M, Ayav C, Liabeuf S, Jacquelinet C, Teillet L, Stengel B, Massy ZA. Cognitive performance is associated with glomerular filtration rate in patients with chronic kidney disease: results from the CKD-REIN cohort. J Neurol Neurosurg Psychiatry 2023; 94:457-466. [PMID: 36693722 DOI: 10.1136/jnnp-2022-330347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with cognitive impairment in general population. We assessed the association between kidney and cognitive functions in patients with CKD and the influence of cardiovascular (CV) risk factors, and depression on this association. METHODS The CKD-Renal Epidemiology and Information Network cohort included 3033 patients with CKD stages 3-4, followed for 5 years. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) and estimated glomerular filtration rate (eGFR) with the CKD-Epidemiology Collaboration equation-creatinin formula. Evolution of the MMSE score over time and its association with baseline eGFR were investigated with linear mixed models. We assessed the risk of incident cognitive outcome (hospitalisation or death with relevant International Classification of Disease-10 codes), with a Cox proportional hazard model. RESULTS The mean age was 66.8, the mean eGFR was 33 mL/min/1.73 m2 and 387 patients (13.0%) had an MMSE score below 24 at baseline. A 10 mL/min/1.73 m2 decrement of baseline eGFR was associated with a mean MMSE decrease of 0.12 (95% CI 0.04 to 0.19) after adjustment for demographic characteristics, depression, CV risk factors and disease; but baseline eGFR was not associated with MMSE temporal evolution. HR for cognitive outcome during follow-up (median 2.01 years) associated with a 10 mL/min/1.73 m2 decrement of baseline eGFR was 1.35 (1.07, 1.70) (p=0.01) after adjustment. CONCLUSIONS In patients with CKD, lower eGFR was associated with worse cognitive performance and incident cognitive events, independently of demographics, CV risk factors and depression. TRIAL REGISTRATION NUMBER NCT03381950.
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Affiliation(s)
- Marion Pépin
- Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France .,Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Hélène Levassort
- Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.,Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Julie Boucquemont
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Oriane Lambert
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | | | - Monica Turinici
- Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.,LIRAES ED 262, Universite de Paris, Paris, France
| | - Catherine Helmer
- Bordeaux Population Health Center, INSERM U1219, Bordeaux, France
| | - Marie Metzger
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Lynda Cheddani
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Luc Frimat
- Nephrology, Lorraine University, CHRU de Nancy, Vandoeuvre, France.,EA 4360, Lorraine University, INSERM CIC-EC, Apemac, France
| | - Christian Combe
- Nephrology, Bordeaux University Hospital, Bordeaux, France.,Biotis, INSERM U1026, Bordeaux, France
| | - Denis Fouque
- Nephrology, Claude Bernard Lyon 1 University, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Maurice Laville
- Carmen, INSERM U1060, University Claude Bernard Lyon 1, Pierre Benite, France
| | - Carole Ayav
- Clinical Epidemiology, INSERM, Lorraine University, CHRU de Nancy, Nancy, France
| | - Sophie Liabeuf
- Pharmacology, Amiens University, Amiens, France.,MP3CV Laboratory EA7517, Université de Picardie Jules Verne, Amiens, France
| | - Christian Jacquelinet
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Medical and Scientific Departement, Agence de la Biomedecine, La Plaine Saint-Denis, France
| | - Laurent Teillet
- Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.,Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Bénédicte Stengel
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Ziad A Massy
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
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10
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Hamroun A, Speyer E, Ayav C, Combe C, Fouque D, Jacquelinet C, Laville M, Liabeuf S, Massy ZA, Pecoits-Filho R, Robinson BM, Glowacki F, Stengel B, Frimat L. Barriers to conservative care from patients' and nephrologists' perspectives: the CKD-REIN study. Nephrol Dial Transplant 2022; 37:2438-2448. [PMID: 35026014 DOI: 10.1093/ndt/gfac009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Conservative care is increasingly considered an alternative to kidney replacement therapy for kidney failure management, mostly among the elderly. We investigated its status and the barriers to its implementation from patients' and providers' perspectives. METHODS We analysed data from 1204 patients with advanced chronic kidney disease (CKD) [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2] enrolled at 40 nationally representative nephrology clinics (2013-16) who completed a self-administered questionnaire about the information they received and their preferred treatment option, including conservative care, if their kidneys failed. Nephrologists (n = 137) also reported data about their clinics' resources and practices regarding conservative care. RESULTS All participating facilities reported they were routinely able to offer conservative care, but only 37% had written protocols and only 5% had a person or team primarily responsible for it. Overall, 6% of patients were estimated to use conservative care. Among nephrologists, 82% reported they were fairly or extremely comfortable discussing conservative care, but only 28% usually or always offered this option for older (>75 years) patients approaching kidney failure. They used various terminology for this care, with conservative management and non-dialysis care mentioned most often. Among patients, 5% of those >75 years reported receiving information about this option and 2% preferring it. CONCLUSIONS Although reported by nephrologists to be widely available and easily discussed, conservative care is only occasionally offered to older patients, most of whom report they were not informed of this option. The lack of a person or team responsible for conservative care and unclear information appear to be key barriers to its implementation.
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Affiliation(s)
- Aghilès Hamroun
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France.,Lille University, University Hospital of Lille, Nephrology Department, Lille, France
| | - Elodie Speyer
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France
| | - Carole Ayav
- CHRU-Nancy, INSERM, CIC 1433, Epidémiologie Clinique, Nancy, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Inserm U1026, Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Service de Néphrologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | | | - Maurice Laville
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Sophie Liabeuf
- Service de Pharmacologie Clinique, Département de recherche clinique CHU Amiens-Picardie, Amiens, France.,Laboratoire MP3CV, EA7517, Université de Picardie Jules Verne, Amiens, France
| | - Ziad A Massy
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France.,Service de néphrologie, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | | | | | - François Glowacki
- Lille University, University Hospital of Lille, Nephrology Department, Lille, France
| | - Bénédicte Stengel
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France
| | - Luc Frimat
- Service de Néphrologie, CHRU de Nancy, Vandoeuvre-lès-Nancy, France.,Université de Lorraine, APEMAC, Nancy, France
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11
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Faye M, Legrand K, Le Gall L, Leffondre K, Omorou AY, Alencar de Pinho N, Combe C, Fouque D, Jacquelinet C, Laville M, Liabeuf S, Massy ZA, Speyer E, Pecoits Filho R, Stengel B, Frimat L, Ayav C. Five-Year Symptom Trajectories in Nondialysis-Dependent CKD Patients. Clin J Am Soc Nephrol 2022; 17:1588-1597. [PMID: 36307136 PMCID: PMC9718050 DOI: 10.2215/cjn.06140522] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Late stages of CKD are characterized by significant symptom burden. This study aimed to identify subgroups within the 5-year trajectories of symptom evolution in patients with CKD and to describe associated patient characteristics and outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 2787 participants (66% men) with eGFR <60 ml/min per 1.73 m2 enrolled in the CKD-Renal Epidemiology and Information Network (CKD-REIN) cohort study from July 2013 to May 2016, we assessed symptoms annually using the Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire until December 2020. A total of 9121 measures were reported over follow-up; all participants had symptoms scored for at least one time point. We used a joint latent class-mixed model to distinguish profiles of symptom trajectories. RESULTS Patient mean age (±SD) at baseline was 67±13 years, and mean eGFR was 33±13 ml/min per 1.73 m2. The prevalence of each symptom ranged from 24% (chest pain) to 83% (fatigue), and 98% of participants reported at least one symptom. After a median (interquartile range) follow-up of 5.3 (3.4-6.0) years, 690 participants initiated KRT, and 490 died before KRT. We identified two profiles of symptom trajectories: a "worse symptom score and worsening trajectory" in 31% of participants, characterized by a low initial symptom score that worsened more than ten points over time, and a "better symptom score and stable trajectory" in 69% of participants, characterized by a high initial score that remained stable. Participants in the worse symptom score and worsening trajectory group had more risk factors for CKD progression at baseline, worse quality of life, and a higher risk of KRT and death before KRT than other participants. CONCLUSIONS This study highlights a significant worsening of symptoms in about one third of the participants, whereas the majority reported low symptom severity throughout the study.
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Affiliation(s)
| | - Karine Legrand
- CHRU-Nancy, Nancy, France
- Université de Lorraine, Nancy, France
| | - Lisa Le Gall
- University of Bordeaux, Bordeaux, France
- INSERM, Bordeaux, France
| | - Karen Leffondre
- University of Bordeaux, Bordeaux, France
- INSERM, Bordeaux, France
| | - Abdou Y Omorou
- CHRU-Nancy, Nancy, France
- Université de Lorraine, Nancy, France
| | - Natalia Alencar de Pinho
- Paris-Saclay University, Villejuif, France
- Nephrology Department, Amboise Paré Hospital, Boulogne-Billancourt, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Bordeaux, France
- University of Bordeaux Segalen, Bordeaux, France
| | - Denis Fouque
- Service de Néphrologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | | | | | - Ziad A Massy
- Paris-Saclay University, Villejuif, France
- Nephrology Department, Amboise Paré Hospital, Boulogne-Billancourt, France
| | - Elodie Speyer
- Paris-Saclay University, Villejuif, France
- Nephrology Department, Amboise Paré Hospital, Boulogne-Billancourt, France
| | | | | | - Luc Frimat
- Université de Lorraine, Nancy, France
- Service de Néphrologie, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
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12
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Levassort H, Pépin M, Boucquemont J, Lambert O, Alencar De Pinho N, Turinici M, Helmer C, Metzger M, Teillet L, Frimat L, Combe C, Fouque D, Laville M, Ayav C, Jacquelinet C. Evolution du profil cognitive des patients ayant une maladie rénale chronique : étude longitudinale de la cohorte CKD REIN. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Laville S, Gras-Champel V, Jacquelinet C, Laville M, Fouque D, Frimat L, Alencar De Pinho N, Stengel B, Massy Z, Liabeuf S. Effets indésirables médicamenteux chez les patients atteints de maladie rénale chronique : bilan de 5 ans de suivi dans la cohorte CKD-REIN. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Lemoine S, Rouveure AC, Dubourg L, Pelletier S, Marolho C, Decullier E, Laville M. Point of care creatinine derived eGFR measurement in capillary blood for identifying patients at risk. Pract Lab Med 2022; 31:e00296. [PMID: 35860391 PMCID: PMC9289727 DOI: 10.1016/j.plabm.2022.e00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The aim of the study was to assess the clinical reliability of eGFR values estimated with a creatinine measurement from a point of care (StatSensor®) compared with measured GFR (mGFR) by a gold standard method. Methods We prospectively included 113 patients undergoing renal function assessment. We compared eGFR using creatinine from capillary blood or venous blood measured by StatSensor® and measured GFR (mGFR) by Passing Bablok regression. Performance of eGFR was estimated by biais, precision and accuracy. Results A total of 113 subjects were included. Median eGFR values were 59 (10–132), 52 (10–123) and 51 (10–131) ml/min/1.73 m2 for enzymatic, capillary and venous measurements, respectively. There was no difference between P30 and P10 for the three eGFR values (p = 0.11 and p = 0.1 respectively). StatSensor® eGFR tended to be underestimated compared to mGFR. For CKD stage 4/5 patients, concordance was 79 and 84% for eGFR with capillary creatinine and venous creatinine respectively. For mGFR< 60 ml/min/1.73 m2, concordance was 84 and 88% with capillary creatinine and venous creatinine respectively. Conclusion The use of a handheld blood creatinine monitoring system with eGFR calculation provides a good estimation of GFR and allow to identify patients at high risk of acute kidney injury.
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Affiliation(s)
- Sandrine Lemoine
- Department of Nephrology and Renal Function, Edouard Herriot Hospital, Hospices Civils de Lyon, France.,INSERM U1060 CarMeN, Lyon, France
| | | | - Laurence Dubourg
- Department of Nephrology and Renal Function, Edouard Herriot Hospital, Hospices Civils de Lyon, France
| | | | - Christelle Marolho
- Hospices Civils de Lyon, Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Lyon, France
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Lyon, France
| | - Maurice Laville
- Department of Nephrology, Lyon Sud University Hospital, France.,INSERM U1060 CarMeN, Lyon, France
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Pepin M, Boucquemont J, Turinici M, Levassort H, Cheddani L, Frimat L, Combe C, Fouque D, Laville M, Ayav C, Liabeuf S, Jacquelinet C, Stengel B, Massy Z. MO503: Cognitive Performance in Patients With Chronic Kidney Disease: Results From the CKD-Rein Cohort Study. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Chronic kidney disease (CKD) is a risk factor for cognitive impairment. In the general population, many risk factors have been reported in association with incident major neurocognitive disorders. The link between CKD and cognitive dysfunction is not completely understood; it may involve different mechanisms such as vascular dysfunction or uremic toxin toxicity. We aimed to assess the influence of cardiovascular risk factors, cardiovascular disease and depression on the association between kidney function and cognitive function in patients with CKD.
METHOD
We analyzed baseline data from 3033 patients with CKD stage 3–5 included in the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort between 2013 and 2016. Cognitive function was assessed with the Mini Mental State Examination (MMSE), and the glomerular filtration rate was estimated with the CKD EPI formula. We applied unadjusted and adjusted linear and logistic regression models, with the MMSE score as a continuous or categorical variable (at a cut-off point at 24/30).
RESULTS
The mean patient age was 66.8, the mean estimated glomerular filtration rate (eGFR) was 33 mL/min/1.73 m2 and 393 patients (13.0%) had a MMSE score <24. We observed that, relative to patients with an MMSE score of 24 or more, patients with a score <24 were older and more likely to be female and dependent on activities of daily living (ADL) and/or instrumental ADL. They were taking more medications and they were more affected by depressive symptoms as measured by the CES-D-10 (10 item Centre for Epidemiological Studies-Depression scale). Patients with a score <24 were also more likely to present cardiovascular (CV) risk factors and CV comorbidities. They had a significantly higher parathyroid hormone level, lower haemoglobin, lower albumin and lower eGFR.
The eGFR was positively associated with the MMSE score before and after adjustment for age, sex, education level, cardiovascular risk factors, cardiovascular disease and depression, giving point increases in the MMSE score of 0.24 (0.15–0.33; P < .001) and 0.14 (0.04–0.23; P = .006) for a 10 mL/min/1.73 m2 increment in the eGFR, respectively. Other risk factors significantly associated with a lower MMSE score in multivariate analysis were age, female sex, lower educational level, diabetes, obesity, cerebrovascular disease, atrial fibrillation and CES-D-10 score. The eGFR was associated with a low MMSE score (defined as MMSE score <24/30) with a crude odds ratio (OR) of 0.82 (0.75–0.90), which remained significant at 0.88 (0.78–0.98) after adjustment for age, sex, educational level, cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidaemia, obesity and smoking), cardiovascular comorbidities (cerebrovascular disease, atrial fibrillation and heart failure), history of depression, laboratory parameters (haemoglobin and phosphate) and CES-D score (after imputation of missing values).
CONCLUSION
In a cohort of well-phenotyped patients with CKD, lower eGFR is associated with worse cognitive function, independent of age, sex, educational level, cardiovascular injury and depression.
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Affiliation(s)
- Marion Pepin
- Geriatrics, AP-HP A Paré Hospital, Boulogne-Billancourt, France
- INSERM, CESP Clinical Epidemiology, Villejuif, France
| | | | - Monica Turinici
- Nephrology, AP-HP A Paré Hospital, Boulogne-Billancourt, France
- Paris University, LIRAES—ED 262, Paris, France
| | - Hélène Levassort
- Geriatrics, AP-HP A Paré Hospital, Boulogne-Billancourt, France
- INSERM, CESP Clinical Epidemiology, Villejuif, France
| | - Lynda Cheddani
- INSERM, CESP Clinical Epidemiology, Villejuif, France
- Nephrology, AP-HP A Paré Hospital, Boulogne-Billancourt, France
| | - Luc Frimat
- INSERM, EA 4360, Apemac, France
- Nephrology, CHRU Nancy Lorraine University, Nancy, France
| | - Christian Combe
- Nephrology, Bordeaux University Hospital, Bordeaux, France
- INSERM, U1026 Biotis, Bordeaux, France
| | - Denis Fouque
- Nephrology, LyonSud Hospital–Hospices Civils de Lyon-Claude Bernard Lyon1 University, Pierre Benite, France
| | - Maurice Laville
- INSERM Claude Bernard Lyon 1 University, Carmen U1060, Pierre-Bénite, France
| | - Carole Ayav
- Clinical Epidemiology, CHRU Nancy Lorraine University, Nancy, France
| | - Sophie Liabeuf
- Pharmacology Department, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, University of Picardie Jules Verne, EA7517, Amiens, France
| | - Christian Jacquelinet
- INSERM, CESP Clinical Epidemiology, Villejuif, France
- Medical and Scientific Department, Agence de la biomédecine, Saint-Denis la Plaine, France
| | | | - Ziad Massy
- INSERM, CESP Clinical Epidemiology, Villejuif, France
- Nephrology, AP-HP A Paré Hospital, Boulogne-Billancourt, France
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16
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Laville S, Couturier A, Lambert O, Metzger M, Nicolas M, Jacquelinet C, Laville M, Frimat L, Fouque D, Combe C, Robinson B, Stengel B, Liabeuf S, Massy Z. MO496: Serum Urea Levels and Cardiovascular Disease in Patients With Chronic Kidney Disease. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Elevated serum urea levels are common in moderate-to-advanced CKD. Several studies have shown that urea is a direct and indirect uremic toxin, especially with regard to cardiovascular disease. We sought to determine whether serum urea levels are associated with adverse cardiovascular events and death before kidney replacement therapy (KRT) in patients with CKD.
METHOD
CKD-REIN is a prospective cohort of CKD nephrology outpatients not receiving maintenance dialysis. The 2507 patients included in the analysis were divided into three groups according to the baseline serum urea level (T1 < 10.5, T2:10.5–15.1 and T3 ≥ 15.1 mmol/L). Cause-specific Cox proportional hazard models were used to estimate hazard ratios (HRs) for the first atheromatous or nonatheromatous cardiovascular (CV) events and all-cause mortality before KRT. The models were adjusted for baseline comorbidities, laboratory data, and medications. Cardiovascular events of the first 3 years of follow-up in the CKD-REIN study were assessed carefully according to the Cardiovascular and Stroke Endpoint Definitions for Clinical Trials. Each death before KRT occurring during the 5-year follow-up period was used in the all-cause mortality model.
RESULTS
Of the 2507 included patients {median [first quartile–third quartile (Q1–Q3)] age: 69 (61–77); mean (standard deviation) eGFR 33.5(11.6) mL/min/1.73 m²}, 54% had a history of cardiovascular disease.
Over a median follow-up of 3.0 years [Q1–Q3, 2.2–3.1], 451 experienced their first atheromatous or nonatheromatous cardiovascular event (fatal or nonfatal), leading to an incidence rate (IR) [95% confidence interval (95% CI)] of 7.1 (6.4–7.7)/100 person-years (PYs) (Fig. 1).
Over a median follow-up period of 4.8 (3.3–5.1) years, 407 patients died before KRT, leading to an IR of 4.0 (3.6–4.3)/100 PYs.
After multiple adjustments for cardiovascular risk factors (including eGFR), patients in T3 had a higher risk of atheromatous and nonatheromatous cardiovascular events than patients in T1 [HR (95% CI), 2.08 (1.50–2.88), Fig. 1]. A nonsignificant trend towards a higher risk was also noted for patients in T2 [1.28 (0.96–1.71)]. The adjusted HRs for death before KRT were 1.30 (0.96–1.75] and 1.73 (1.22–2.45) for patients in T2 and those in T3, respectively.
CONCLUSION
Beyond CV risk factors including eGFR, this hypothesis-generating study suggests that serum urea level is a predictor of cardiovascular outcomes in patients with moderate to advanced CKD. Further research is needed to confirm current findings and explore mechanisms.
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Affiliation(s)
- Solene Laville
- Clinical Pharmacology—Pharmacoepidemiology, CHU Amiens-Picardie, Amiens, France
- MP3CV Laboratory, University of Picarie Jules Vernes, Amiens, France
| | - Aymeric Couturier
- Department of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France
| | - Oriane Lambert
- Clinical Epidemiology, CESP—INSERM U1018, Villejuif, France
| | - Marie Metzger
- Clinical Epidemiology, CESP—INSERM U1018, Villejuif, France
| | - Mansencal Nicolas
- Clinical Epidemiology, CESP—INSERM U1018, Villejuif, France
- Department of cardiology, Ambroise Paré University Hospital, Boulogne-Billancourt, France
| | - Christian Jacquelinet
- Clinical Epidemiology, CESP—INSERM U1018, Villejuif, France
- Biomedecine Agency, Saint-Denis, France
| | | | - Luc Frimat
- Department of Nephrology, CHRU de Nancy, Vandœuvre-lès-Nancy, France
- APEMAC, Lorraine University, Vandœuvre-lès-Nancy, France
| | - Denis Fouque
- Université de Lyon, CarMeN INSERM, Lyon, France
- Department of Nephrology, CHU Lyon Sud, Pierre-Bénite, France
| | - Christian Combe
- Service de Néphrologie, Transplantation, Dialyse et Aphérèse, CHU de Bordeaux, Bordeaux, France
- Université Bordeaux Segalen, Inserm, Bordeaux, France
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, UK
| | | | - Sophie Liabeuf
- Clinical Pharmacology—Pharmacoepidemiology, CHU Amiens-Picardie, Amiens, France
- MP3CV Laboratory, University of Picarie Jules Vernes, Amiens, France
| | - Ziad Massy
- Department of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France
- Clinical Epidemiology, CESP—INSERM U1018, Villejuif, France
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17
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Faucon AL, Lambert O, Alencar de Pinho N, Ayav C, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Liabeuf S, Massy Z, Nicolas M, Stengel B. MO499: Incidence of Cause-Specific Cardiovascular Events in Men and Women With CKD. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Men are at higher risk of cardiovascular disease (CVD) than women in the general population, and chronic kidney disease (CKD) is a well-established cardiovascular (CV) risk factor [1–4]. However, the incidence of cause-specific CV events in men and women with CKD is poorly documented.
METHOD
All hospitalization and death reports for CV events of the 3033 patients (1983 men and 1050 women) with non-dialysis CKD (stage 3–5) included in the French CKD-REIN Cohort were reviewed and classified by cause using criteria from the Cardiovascular and Stroke Endpoint Definitions for Clinical Trials [5]. Cause-specific Cox proportional hazard models were used to estimate hazard ratios for death and each fatal or nonfatal CV event according to gender.
RESULTS
At baseline, in men (mean age: 68 years; mean eGFR 33 mL/min/1.73 m²), the prevalence of atheromatous CVD was 30% for coronary artery disease, 14% for cerebrovascular disease and 17% for lower limb artery disease, and that of non-atheromatous CVD was 14% for heart failure and 13% for atrial fibrillation. In women (65 years old, 32 mL/min/1.73 m²), these prevalences were 15%, 7%, 9%, 11% and 9%, respectively.
During a median follow-up of 5 (IQR: 3–5) years, 98 men and 43 women died from CVD {i.e. 1.3 [95% confidence interval (95% CI): 1.0–1.5] versus 1.0 (0.7–1.3)/100 person-years}, including 53% versus 46% from heart failure, 31% versus 19% from sudden death, and 16% versus 35% from other cardiovascular causes, respectively.
Crude incidence rates of death or hospitalization for coronary artery disease and lower limb artery disease were higher in men than in women, slightly higher for CV death, cerebrovascular disease and atrial fibrillation, but similar for both genders for heart failure (Fig. 1). History of CVD was strongly associated with subsequent CV events of any type.
In multivariable analyses, gender was no longer associated with any cause-specific CV event, whereas a lower eGFR was significantly associated with an increased risk of coronary artery disease and heart failure, but not with other CV events (Table 1).
CONCLUSION
In patients with moderate or advanced CKD, the burden of atheromatous CVD is higher in men than in women and explained by their higher prevalence of cardiovascular risk factors, but that for heart failure and atrial fibrillation appears to be similar for both genders.
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Affiliation(s)
- Anne-Laure Faucon
- Centre for Research in Epidemiology and Population Health, Inserm U1018, Clinical Epidemiology, Villejuif, France
- Paris-Saclay University, France
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health, Inserm U1018, Clinical Epidemiology, Villejuif, France
| | - Natalia Alencar de Pinho
- Centre for Research in Epidemiology and Population Health, Inserm U1018, Clinical Epidemiology, Villejuif, France
| | - Carole Ayav
- Centre Hospitalier Régional Universitaire de Nancy, Center for Clinical Investigations, Vandoeuvre-Les-Nancy, France
| | - Christian Combe
- Department of Nephrology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Universitaire Lyon-Sud, Lyon, France
- Universite de Lyon, Lyon, France
| | - Luc Frimat
- Department of Nephrology, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-Les-Nancy, France
- Universite de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health, Inserm U1018, Clinical Epidemiology, Villejuif, France
- Agence de la Biomedecine, Renal Epidemiology and Information Network Registry, Saint-Denis, France
| | - Maurice Laville
- Department of Nephrology, Centre Hospitalier Universitaire Lyon-Sud, Lyon, France
- Universite de Lyon, Lyon, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Centre hospitalier Universitaire d'Amiens, Amiens, France
- Universite de Picardie, Amiens, France
| | - Ziad Massy
- Centre for Research in Epidemiology and Population Health, Inserm U1018, Clinical Epidemiology, Villejuif, France
- Department of Nephrology, Centre Hospitalier Universitaire Ambroise Pare, Boulogne-Billancourt, France
- Paris-Saclay University, Villejuif, France
| | - Mansencal Nicolas
- Centre for Research in Epidemiology and Population Health, Inserm U1018, Clinical Epidemiology, Villejuif, France
- Paris-Saclay University, Villejuif, France
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Pare, Boulogne-Billancourt, France
| | - Benedicte Stengel
- Centre for Research in Epidemiology and Population Health, Inserm U1018, Clinical Epidemiology, Villejuif, France
- Paris-Saclay University, France
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18
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Wagner S, Merkling T, Metzger M, Koppe L, Laville M, Boutron-Ruault MC, Frimat L, Combe C, Massy ZA, Stengel B, Fouque D. Probiotic Intake and Inflammation in Patients With Chronic Kidney Disease: An Analysis of the CKD-REIN Cohort. Front Nutr 2022; 9:772596. [PMID: 35433774 PMCID: PMC9005823 DOI: 10.3389/fnut.2022.772596] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/07/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Aims Little is known about the effects of probiotics on inflammation in the context of chronic kidney disease (CKD). We investigated the association between probiotic intake and inflammation in patients with moderate-to-advanced CKD. Methods We performed a cross-sectional study of 888 patients with stage 3–5 CKD and data on serum C-reactive protein (CRP) levels and a concomitant food frequency questionnaire. We estimated the odds ratios (ORs) [95% confidence interval (CI)] for various CRP thresholds (>3, >4, >5, >6, and >7 mg/L) associated with three intake categories (no yoghurt, ordinary yoghurt, and probiotics from yoghurts or dietary supplements) and two frequency categories (daily or less than daily). Results The 888 study participants (median age: 70; men: 65%) had a median estimated glomerular filtration rate of 28.6 mL/min/1.73 m2 and a median [interquartile range] CRP level of 3.0 [1.6, 7.0] mg/L. Fifty-seven percent consumed ordinary yoghurt and 30% consumed probiotic yoghurt. The median intake frequency for yoghurt and probiotics was 7 per week. Relative to participants not consuming yoghurt, the ORs [95% CI] for CRP > 6 or >7 mg/L were significantly lower for participants consuming ordinary yoghurt (0.58 [0.37, 0.93] and 0.57 [0.35, 0.91], respectively) and for participants consuming probiotics (0.54 [0.33, 0.9] and 0.48 [0.28, 0.81], respectively), independently of age, sex, body mass index, CKD stage, cardiovascular disease, and fibre, protein and total energy intakes. The ORs were not significantly lower for CRP thresholds >3, >4, and >5 mg/L and were not significantly greater in daily consumers than in occasional consumers. Conclusion We observed independent associations between the consumption of yoghurt or probiotics and lower levels of inflammation in patients with CKD. There was no evidence of a dose-effect relationship. Clinical Trial Registration [https://www.clinicaltrials.gov/ct2/show/NCT03381950], identifier [NCT03381950].
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Affiliation(s)
- Sandra Wagner
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, Nancy, France
- FCRIN INI-CRCT, Nancy, France
- *Correspondence: Sandra Wagner,
| | - Thomas Merkling
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, Nancy, France
| | - Marie Metzger
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Univ Paris-Saclay, UVSQ, INSERM, Equipe Epidémiologie Clinique, Villejuif, France
| | - Laetitia Koppe
- Département de Néphrologie, Hopital Lyon Sud – HCL, Pierre-Bénite, France
- Université de Lyon, CarMeN Laboratory, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Maurice Laville
- Université de Lyon, CarMeN Laboratory, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Marie-Christine Boutron-Ruault
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Saclay, UVSQ, INSERM, Gustave Roussy, Equipe Exposome-Hérédité, Villejuif, France
| | - Luc Frimat
- EA4360 APEMAC, Université de Lorraine, Université Paris Descartes, Nancy, France
- Département de Néphrologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Christian Combe
- Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, Université Bordeaux Segalen, Bordeaux, France
| | - Ziad A. Massy
- FCRIN INI-CRCT, Nancy, France
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Univ Paris-Saclay, UVSQ, INSERM, Equipe Epidémiologie Clinique, Villejuif, France
- Service de Néphrologie, Hôpital Ambroise Paré, APHP, Paris, France
| | - Bénédicte Stengel
- FCRIN INI-CRCT, Nancy, France
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Univ Paris-Saclay, UVSQ, INSERM, Equipe Epidémiologie Clinique, Villejuif, France
| | - Denis Fouque
- Département de Néphrologie, Hopital Lyon Sud – HCL, Pierre-Bénite, France
- Université de Lyon, CarMeN Laboratory, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
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19
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Laville SM, Couturier A, Lambert O, Metzger M, Mansencal N, Jacquelinet C, Laville M, Frimat L, Fouque D, Combe C, Robinson BM, Stengel B, Liabeuf S, Massy ZA. Urea levels and cardiovascular disease in patients with chronic kidney disease. Nephrol Dial Transplant 2022; 38:gfac045. [PMID: 35544273 PMCID: PMC9869852 DOI: 10.1093/ndt/gfac045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Elevated serum urea levels are common in moderate-to-advanced CKD. Several studies have shown that urea is a direct and indirect uremic toxin, especially with regard to cardiovascular disease. We sought to determine whether serum urea levels are associated with adverse cardiovascular events and death before renal replacement therapy (RRT) in patients with CKD. METHODS CKD-REIN is a prospective cohort of CKD nephrology outpatients not receiving maintenance dialysis. The 2507 patients included in the analysis were divided into three groups according to the baseline serum urea level (T1 < 10.5, T2:10.5 to 15.1, and T3 ≥ 15.1 mmol/L). Cox proportional hazard models were used to estimate hazard ratios (HRs) for first atheromatous or nonatheromatous cardiovascular (CV) events, and all-cause mortality before RRT. The models were adjusted for baseline comorbidities, laboratory data, and medications. FINDINGS Of the 2507 included patients (median [interquartile range (IQR)] age: 69[61-77]; mean (standard deviation) eGFR 33.5(11.6) mL/min/1.73 m²), 54% had a history of cardiovascular disease. After multiple adjustments for cardiovascular risk factors (including eGFR), patients in T3 had a higher risk of atheromatous and nonatheromatous cardiovascular events than patient in T1 (n events = 451, HR[95%CI]: 1.93[1.39-2.69]). The adjusted HRs for death before RRT (n events = 407) were 1.31[0.97; 1.76] and 1.73[1.22; 2.45] for patients T2 and those in T3, respectively. INTERPRETATION Our data suggested that urea is a predictor of cardiovascular outcomes beyond CV risk factors including eGFR.
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Affiliation(s)
- Solène M Laville
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
| | - Aymeric Couturier
- Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
| | - Nicolas Mansencal
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
- Department of Cardiology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France
| | | | | | - Luc Frimat
- Nephrology Department, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | - Denis Fouque
- Université de Lyon, CarMeN INSERM, Lyon, France
- Nephrology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, Univ Bordeaux Segalen, Bordeaux, France
| | | | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
| | - Ziad A Massy
- Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS, 1018 Villejuif, France
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Ranaivo H, Zhang Z, Alligier M, Lambert-Porcheron S, Feugier-Favier N, Cuerq C, Machon C, Neyrinck A, Seethaler B, Rodriguez J, Muccioli G, Maquet V, Laville M, Bischoff S, Walter J, Delzenne N, Nazare JA. Impact de la supplémentation en chitine-glucane chez le sujet à risque cardiométabolique : focus sur le métabolisme postprandial et le microbiote intestinal. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Delage P, Ségrestin B, Meugnier E, Chanon S, Durand A, Achaintre D, Scalbert A, Vidal H, Laville M. Étude de l’effet des polyphénols sur les mécanismes précoces de prise de poids chez des sujets sains soumis à un mois de surnutrition : focus sur le tissu adipeux. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Rodriguez J, Neyrinck A, Zhang Z, Bindels L, Cani P, Nazare JA, Maquet V, Laville M, Bischoff S, Walter J, Delzenne N. Identification of the breath-signature of chitin-glucan insoluble fiber in healthy volunteers. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Villain C, Metzger M, Liabeuf S, Hamroun A, Laville S, Mansencal N, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Ayav C, Briançon S, Pecoits-Filho R, Hannedouche T, Stengel B, Massy ZA. Effectiveness and Tolerance of Renin-Angiotensin System Inhibitors With Aging in Chronic Kidney Disease. J Am Med Dir Assoc 2021; 23:998-1004.e7. [PMID: 34856172 DOI: 10.1016/j.jamda.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Renin-angiotensin system inhibitors (RASi) are recommended for slowing chronic kidney disease (CKD) progression to kidney failure. Their effectiveness and tolerance as patients age remain uncertain because older patients have often been excluded from clinical trials. DESIGN CKD-REIN cohort study. SETTING AND PARTICIPANTS We studied 2762 patients with CKD stages 3 and 4 and a clinical indication for RASi enrolled between 2013 and 2016 in 40 nephrology clinics nationally representative in France. METHODS The primary outcome was the occurrence of kidney failure or death. The secondary outcomes were the occurrence of cardiovascular events and hospitalizations with acute kidney injury (AKI) or hyperkalemia. A propensity score analysis was performed. We used Cox models to estimate hazard ratios (HRs) for each outcome associated with RASi prescription and tested interactions with age. RESULTS Patients' mean age was 67 years, including 841 (30%) aged 75 years and older; 2178 (79%) were prescribed RASi's. During a median follow-up of 4.6 years, 33% of patients reached kidney failure or died. RASi prescription was associated with a lower risk of kidney failure or death (HR 0.79, 95% CI 0.66, 0.95), an association not modified by age (P for interaction = .72). It was not significantly associated with cardiovascular events. During the first 3 years of follow-up, 14% of patients were hospitalized with AKI or hyperkalemia, but risk was not higher among those prescribed RASi's (HR 0.75, 95% CI 0.55-1.02) and age did not modify its effect (P for interaction = .28). CONCLUSIONS AND IMPLICATIONS This study shows that aging does not appear to modify either RASi's beneficial effects on major CKD outcomes or their potential adverse effects.
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Affiliation(s)
- Cédric Villain
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Service de Gériatrie, CHU de Caen, Normandie Université UNICAEN, Caen, France.
| | - Marie Metzger
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France
| | - Sophie Liabeuf
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Service de Pharmacologie Clinique, Département de Recherche Clinique, CHU d'Amiens, Université de Picardie Jules Verne, INSERM U-1088, Amiens, France
| | - Aghilès Hamroun
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France
| | - Solene Laville
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France
| | - Nicolas Mansencal
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Service de Cardiologie, CHU Ambroise Paré, APHP, Boulogne-Billancourt, Université de Versailles-Saint Quentin (UVSQ), France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèses, CHU de Bordeaux, Bordeaux, France; INSERM Unité 1026, Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Université de Lyon, Service de Néphrologie, CarMeN INSERM 1060, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Luc Frimat
- Service de Néphrologie, Université de Lorraine, APEMAC, CHRU de Nancy-Hôpitaux de Brabois, Nancy, France
| | - Christian Jacquelinet
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Agence de Biomédecine, La Plaine Saint-Denis, France
| | - Maurice Laville
- Université de Lyon, Service de Néphrologie, CarMeN INSERM 1060, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Carole Ayav
- CIC 1433 Epidémiologie Clinique, INSERM, CHRU, Université de Lorraine, CHRU de Nancy-Hôpitaux de Brabois, Nancy, France
| | - Serge Briançon
- CIC 1433 Epidémiologie Clinique, INSERM, CHRU, Université de Lorraine, CHRU de Nancy-Hôpitaux de Brabois, Nancy, France
| | | | - Thierry Hannedouche
- Service de Néphrologie-Hémodialyse, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine de Strasbourg, Strasbourg, France
| | - Bénédicte Stengel
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France
| | - Ziad A Massy
- Université Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, CESP (Centre de recherche en Epidémiologie et Santé des Populations), Villejuif, France; Service de Néphrologie-Dialyse, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
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24
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Hamroun A, Frimat L, Laville M, Metzger M, Combe C, Fouque D, Jacquelinet C, Ayav C, Liabeuf S, Lange C, Herpe YE, Zee J, Glowacki F, Massy ZA, Robinson B, Stengel B. New Insights into Acute-on-Chronic Kidney Disease in Nephrology Patients: The CKD-REIN Study. Nephrol Dial Transplant 2021; 37:1700-1709. [PMID: 34473306 DOI: 10.1093/ndt/gfab249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Acute-on-chronic kidney disease (ACKD) is poorly understood and often overlooked. We studied its incidence, circumstances, determinants, and outcomes in patients with CKD. METHODS We used the Kidney Disease Improving Global Outcomes criteria to identify all-stage acute kidney injury (AKI) events in 3033 nephrology outpatients with CKD stage 3-5 participating in the CKD-REIN cohort study (2013-2020), and cause-specific Cox models to estimate hazard ratios (HR, 95% confidence intervals [CI]) of AKI-associated risk factors. RESULTS At baseline, 22% of the patients (mean age 67 years, 65% men, mean eGFR 32 ml/min/1.73m2) had a history of AKI. Over a 3-year follow-up, 443 had at least one AKI event: 27% were stage 2 or 3, and 11% required dialysis; 74% involved hospitalization including 47% acquired as hospital inpatients; a third were not reported in hospital discharge reports. Incidence rates were 10.1 and 4.8 per 100 person-years in patients with and without an AKI history, respectively. In 2375 patients without this history, male sex, diabetes, cardiovascular disease, cirrhosis, several drugs, low eGFR, and serum albumin levels were significantly associated with a higher risk of AKI, as were low birth weight (<2500 g) (adjusted HR, 1.98; 95%CI, 1.35 to 2.91) and hemoglobin level (HR 1.21; 1.12 to 1.32 per 1 g/dl decrease). Within one year, only 63% of the patients had recovered their previous kidney function, 13.7% had started kidney replacement therapy, and 12.7% had died. CONCLUSIONS The study highlights the high rate of hospital-acquired AKI events in patients with CKD, and their underreporting at hospital discharge. It also reveals low birth weight and anemia as possible new risk factors in CKD patients.
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Affiliation(s)
- Aghilès Hamroun
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France.,Department of Nephrology, Dialysis, and Transplantion, Regional University Hospital Centre of Lille, F-59037 Lille, France
| | - Luc Frimat
- Department of Nephrology, Nancy University Hospital, F-54000 Vandoeuvre-lès-Nancy, France.,Lorraine University, APEMAC, F-54000 Nancy, France
| | - Maurice Laville
- Department of Nephrology, Lyon Sud Hospital, F-69495 Pierre Bénite, France.,Lyon University, INSERM U1060, CarMeN, F-69495 Pierre Bénite, France
| | - Marie Metzger
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France
| | - Christian Combe
- Nephrology Transplantation, Dialysis, Bordeaux University Hospital, F-33076 Bordeaux, France.,Inserm U1026, Bordeaux Segalen University, F-33076 Bordeaux, France
| | - Denis Fouque
- Department of Nephrology, Lyon Sud Hospital, F-69495 Pierre Bénite, France.,Lyon University, INSERM U1060, CarMeN, F-69495 Pierre Bénite, France
| | | | - Carole Ayav
- Department of Clinical Epidemiology, INSERM CIC-EC 1433, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Sophie Liabeuf
- Amiens University Hospital, Clinical Research Centre, Avenue R.Laennec, AMIENS, Picardie, FR 80000
| | - Céline Lange
- Agence de la Biomédecine, La Plaine Saint-Denis, France
| | | | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
| | - François Glowacki
- Department of Nephrology, Dialysis, and Transplantion, Regional University Hospital Centre of Lille, F-59037 Lille, France
| | - Ziad A Massy
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France.,Department of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, Paris, France
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
| | - Bénédicte Stengel
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France
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25
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Massy Z, Liabeuf S, Frimat L, Ayav C, Lange C, Laville M. Prévalence de l’hyperkaliémie au cours de la MRC : une étude de cohorte prospective nationale. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Laville SM, Lambert O, Hamroun A, Metzger M, Jacquelinet C, Laville M, Frimat L, Fouque D, Combe C, Ayav C, Pecoits-Filho R, Stengel B, Massy ZA, Liabeuf S. Consequences of oral antithrombotic use in patients with chronic kidney disease. Clin Transl Sci 2021; 14:2242-2253. [PMID: 34080321 PMCID: PMC8604253 DOI: 10.1111/cts.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/07/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Abstract
We assessed the risks of bleeding, acute kidney injury (AKI), and kidney failure associated with the prescription of antithrombotic agents (oral anticoagulants and/or antiplatelet agents) in patients with moderate‐to‐advanced chronic kidney disease (CKD). CKD‐REIN is a prospective cohort of 3022 nephrology outpatients with CKD stages 2–5 at baseline. We used cause‐specific Cox proportional hazard models to estimate hazard ratios (HRs) for bleeding (identified through hospitalizations), AKI, and kidney failure. Prescriptions of oral antithrombotics were treated as time‐dependent variables. At baseline, 339 (11%) patients (65% men; 69 [60–76] years) were prescribed oral anticoagulants only, 1095 (36%) antiplatelets only, and 101 (3%) both type of oral antithrombotics. Over a median (interquartile range [IQR]) follow‐up period of 3.0 (IQR, 2.8–3.1) years, 152 patients experienced a bleeding event, 414 patients experienced an episode of AKI, and 270 experienced kidney failure. The adjusted HRs (95% confidence interval [95% CI]) for bleeding associated with prescriptions of antiplatelets only, oral anticoagulants only, and antiplatelet + oral anticoagulant were, respectively, 0.74 (95% CI, 0.46–1.19), 2.38 (95% CI, 1.45–3.89), and 3.96 (95% CI, 2.20–7.12). An increased risk of AKI risk was associated with the prescription of oral anticoagulants (adjusted HR, 1.90, 95% CI, 1.47–2.45) but not the prescription of antiplatelets (HR, 1.24, 95% CI, 0.98–1.56). Kidney failure was not associated with the prescription of oral antithrombotics of any type. This study confirms the high risk of AKI associated with oral anticoagulants prescription in patients with CKD and also highlights the potential aggravating effect of combining vitamin K antagonist (VKA) and antiplatelets on the risk of bleeding.
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Affiliation(s)
- Solène M Laville
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France
| | - Aghiles Hamroun
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France.,Nephrology Department, CHRU Lille, University of Lille, Lille, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France
| | | | - Maurice Laville
- CarMeN INSERM 1060, et AURAL, Université de Lyon, Lyon, France
| | - Luc Frimat
- Nephrology Department, CHRU de Nancy, Vandoeuvre-lès-Nancy, France.,APEMAC, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,INSERM, U1026, Univ Bordeaux Segalen, Bordeaux, France
| | - Carole Ayav
- APEMAC, Lorraine University, Vandoeuvre-lès-Nancy, France
| | | | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France.,Department of Nephrology, APHP, Ambroise Paré University Hospital, Boulogne-Billancourt/Paris, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
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27
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Laville S, Lambert O, Hamroun A, Metzger M, Jacquelinet C, Laville M, Frimat L, Fouque D, Combe C, Ayav C, Pecoits-Filho R, Stengel B, Massy Z, Liabeuf S. MO484ADVERSE OUTCOMES ASSOCIATED WITH ORAL ANTITHROMBOTIC USE IN PATIENTS WITH MODERATE-TO-ADVANCED CHRONIC KIDNEY DISEASE*. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab087.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
The use of oral antithrombotics in patients with chronic kidney disease (CKD) is challenging because of altered pharmacodynamics/pharmacokinetics. Patients prescribed oral anticoagulant are at high risk of bleeding, and possibly also acute kidney injury (AKI) and progression to kidney failure. We assessed bleeding, AKI, and kidney failure risks associated with oral anticoagulant and/or antiplatelet agent prescription in patients with moderate-to-advanced CKD.
Method
CKD-REIN is a prospective cohort of 3022 nephrology outpatients with CKD stages 2-5 at inclusion. Drug prescriptions and their duration were collected prospectively. We used cause-specific Cox proportional hazard models to estimate hazard ratios (HR) for bleeding (identified through hospitalizations), AKI (as defined according to KDIGO 2012), and kidney failure. Prescriptions of oral antithrombotics were treated as a time dependent variable and models were adjusted for baseline comorbidities, laboratory data, and other medications.
Results
At baseline, 339 (11%) patients (65% men; median age 69 [interquartile range (IQR), 60-76] years; median eGFR 32 [IQR, 23-41] were prescribed oral anticoagulants only, 1095 (36%) antiplatelet only, and 101 (3%) both anticoagulant and antiplatelet.
Over a median follow-up of 3 years (IQR, 2.8-3.1), 152 patients experienced a bleeding event requiring hospital visit/stay (crude incidence rate (IR): 1.9% person-years [95%CI,1.6-2.2]), 414 patients experienced AKI (crude IR: 5.4 % person-years [4.9-5.9]), and 270 experienced kidney failure (crude IR: 3.4 % person-years [3.0-3.8]).
A significant interaction was found between oral antithrombotics and eGFR (interaction p=0.03). The adjusted HRs [95%CI] for bleeding associated with prescriptions of antiplatelets only, oral anticoagulants only, and antiplatelet + oral anticoagulant were respectively 0.58 [0.30; 1.11], 2.62 [1.39; 4.93], and 5.76 [2.85; 11.66] in patients with a baseline eGFR < 30 mL/min/1.73m2. In patients with baseline eGFR ≥ 30 mL/min/1.73m2, the adjusted HRs [95%CI] for bleeding associated with prescriptions of antiplatelets only, oral anticoagulants .......only, and antiplatelet + oral anticoagulant were respectively 0.98 [0.48; 1.98], 1.91 [0.87; 4.20], and 1.54 [0.46; 5.12] (Figure 1A).
An increased risk of AKI risk was associated with the prescription of oral anticoagulants (adjusted HR [95%CI]: 1.91[1.48; 2.46]) but not the prescription of antiplatelets (1.24[0.98; 1.56], Figure 1B). No significant interactions were found between oral anticoagulants and eGFR or antiplatelet agents.
Kidney failure was not associated with the prescription of oral antithrombotics of any type (Figure 1C). No significant interactions were found with eGFR and antiplatelet agents.
Conclusion
This study confirms the risk of AKI in CKD patients prescribed oral anticoagulants. It also highlights the potential aggravating effect of combining anticoagulants and antiplatelet on the risk of bleeding in this population.
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Affiliation(s)
- Solene Laville
- INSERM U1018 - CESP, Paris-Saclay University, Versailles Saint-Quentin University, Clinical epidemiology, Villejuif Cedex, France
| | - Oriane Lambert
- INSERM U1018 - CESP, Paris-Saclay University, Versailles Saint-Quentin University, Clinical epidemiology, Villejuif Cedex, France
| | - Aghiles Hamroun
- INSERM U1018 - CESP, Paris-Saclay University, Versailles Saint-Quentin University, Clinical epidemiology, Villejuif Cedex, France
- CHRU Lille, University of Lille, Nephrology Department, Lille, France
| | - Marie Metzger
- INSERM U1018 - CESP, Clinical epidemiology, Villejuif Cedex, France
| | | | | | - Luc Frimat
- Lorraine University, APEMAC, France
- CHRU Nancy, Nephrology Department, France
| | - Denis Fouque
- CH Lyon, Lyon University, Nephrology Department, France
| | - Christian Combe
- CHU Bordeaux, Néphrologie, Transplantation, Dialyse et Aphérèse, France
- INSERM U1026, Bordeaux Segalen University, France
| | | | | | - Benedicte Stengel
- INSERM U1018 - CESP, Paris-Saclay University, Versailles Saint-Quentin University, Clinical epidemiology, Villejuif Cedex, France
| | - Ziad Massy
- INSERM U1018 - CESP, Paris-Saclay University, Versailles Saint-Quentin University, Clinical epidemiology, Villejuif Cedex, France
- Ambroise Paré University Hospital, Nephrology Department, France
| | - Sophie Liabeuf
- Amiens University Hospital, Department of Clinical Pharmacology, France
- University of Picardie Jules Verne, MP3CV Laboratory, EA7517, France
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28
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Fages V, de Pinho NA, Hamroun A, Lange C, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Ayav C, Liabeuf S, Pecoits-Filho R, Massy ZA, Boucquemont J, Stengel B. Urgent-start dialysis in patients referred early to a nephrologist-the CKD-REIN prospective cohort study. Nephrol Dial Transplant 2021; 36:1500-1510. [PMID: 33944928 DOI: 10.1093/ndt/gfab170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The lack of a well-designed prospective study of the determinants of urgent dialysis start led us to investigate its individual- and provider-related factors in patients seeing nephrologists. METHODS The Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort study that included 3033 patients with CKD [mean age 67 years, 65% men, mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] from 40 nationally representative nephrology clinics from 2013 to 2016 who were followed annually through 2020. Urgent-start dialysis was defined as that 'initiated imminently or <48 hours after presentation to correct life-threatening manifestations' according to the Kidney Disease: Improving Global Outcomes 2018 definition. RESULTS Over a 4-year (interquartile range 3.0-4.8) median follow-up, 541 patients initiated dialysis with a known start status and 86 (16%) were identified with urgent starts. The 5-year risks for the competing events of urgent and non-urgent dialysis start, pre-emptive transplantation and death were 4, 17, 3 and 15%, respectively. Fluid overload, electrolytic disorders, acute kidney injury and post-surgery kidney function worsening were the reasons most frequently reported for urgent-start dialysis. Adjusted odds ratios for urgent start were significantly higher in patients living alone {2.14 [95% confidence interval (CI) 1.08-4.25] or with low health literacy [2.22 (95% CI 1.28-3.84)], heart failure [2.60 (95% CI 1.47-4.57)] or hyperpolypharmacy [taking >10 drugs; 2.14 (95% CI 1.17-3.90)], but not with age or lower eGFR at initiation. They were lower in patients with planned dialysis modality [0.46 (95% CI 0.19-1.10)] and more nephrologist visits in the 12 months before dialysis [0.81 (95% CI 0.70-0.94)] for each visit. CONCLUSIONS This study highlights several patient- and provider-level factors that are important to address to reduce the burden of urgent-start dialysis.
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Affiliation(s)
- Victor Fages
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Service de Néphrologie, Dialyse, Transplantation Rénale et Aphérèse, CHU de Lille, Lille, France
| | - Natalia Alencar de Pinho
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France
| | - Aghilès Hamroun
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Service de Néphrologie, Dialyse, Transplantation Rénale et Aphérèse, CHU de Lille, Lille, France
| | - Céline Lange
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Agence de Biomédecine, La Plaine Saint-Denis, France
| | - Christian Combe
- Service de Néphrologie, Transplantation, Dialyse, Aphérèses, CHU de Bordeaux, Bordeaux, France.,INSERM Unité 1026, Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Université Claude Bernard Lyon1, CarMeN INSERM 1060, Lyon, France.,Service de Néphrologie, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Luc Frimat
- Service de Néphrologie, Université de Lorraine, APEMAC, CHRU de Nancy - Hôpitaux de Brabois, Nancy, France
| | - Christian Jacquelinet
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Agence de Biomédecine, La Plaine Saint-Denis, France
| | - Maurice Laville
- Université Claude Bernard Lyon1, CarMeN INSERM 1060, Lyon, France.,Association Utilisation Rein Artificiel Région Lyonnaise, Lyon, France
| | - Carole Ayav
- CHRU de Nancy, Université de Lorraine, INSERM, CIC Epidémiologie Clinique, Hôpitaux de Brabois, Nancy, France
| | - Sophie Liabeuf
- Département de Recherche Clinique, Service de Pharmacologie Clinique, CHU d'Amiens, Université de Picardie Jules Verne, INSERM U-1088, Amiens, France
| | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA.,Pontificia Universidade Catolica do Prana, Curitiba, Brazil
| | - Ziad A Massy
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Service de Néphrologie-Dialyse, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Julie Boucquemont
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France
| | - Bénédicte Stengel
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France
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Liabeuf S, Laville M. Drug prescription in patients with chronic kidney disease: a true challenge. Nephrol Dial Transplant 2021; 36:385-386. [PMID: 32901290 DOI: 10.1093/ndt/gfaa164] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
| | - Maurice Laville
- Nephrology Department, Lyon Sud Hospital, Pierre Benite, France.,Lyon University, INSERM U1060, CarMeN, Pierre Bénite, France
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Luce M, Bres E, Yi D, Pastural M, Granjon S, Szelag JC, Laville M, Arkouche W, Bouchara A, Fouque D, Soulage CO, Koppe L. Natriuretic Peptides as Predictors of Protein-Energy Wasting in Hemodialysis Population. J Ren Nutr 2021; 32:234-242. [PMID: 33888408 DOI: 10.1053/j.jrn.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/18/2020] [Accepted: 03/07/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Imbalance between anabolism and catabolism is linked to cachexia and protein-energy wasting (PEW), especially in frail populations such as patients with chronic kidney disease. PEW is responsible of poor outcomes with increased morbidity and mortality. Several causes are involved in PEW such as insulin resistance, acidosis, or hyperparathyroidism. Natriuretic peptides (NPs) have recently been described as activators of resting energy expenditure through the induction of browning of white adipose tissue in rodents with chronic kidney disease. The present study was therefore implemented to investigate whether NPs could be associated with PEW criteria and predict clinical outcomes. METHODS We quantified serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) in a prospective cohort of 231 patients undergoing maintenance hemodialysis and atrial natriuretic peptide in a subgroup of 35 patients. Body composition parameters were measured with bioimpedance spectroscopy. RESULTS NT-proBNP was inversely associated with serum albumin, prealbumin, and body mass index and, conversely, positively associated with age and C-reactive protein. NT-proBNP as well as atrial natriuretic peptide were significantly higher in patients with PEW criteria. NT-proBNP was negatively associated with body fat mass. In multiple linear regression, NT-proBNP remained associated with body mass index. Kaplan-Meier analysis revealed a significant correlation between serum NT-proBNP concentrations and all-cause mortality and cardiovascular events. This association remained significant after multivariable Cox regression models adjusted for demographic factors and cardiovascular risk factors. CONCLUSION Accumulation of NPs seems to be associated with poor nutritional status and reduced survival among hemodialysis patients. Further studies are needed to confirm this association using resting energy expenditure measurement and adipose tissue biopsy.
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Affiliation(s)
- Mathilde Luce
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France; University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Emilie Bres
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France; University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Dan Yi
- University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Myriam Pastural
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL), Lyon, France
| | - Samuel Granjon
- Laboratoire d'Analyse Médicale Cerballiance Rhône alpes, Lyon, France
| | - Jean Christophe Szelag
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL), Lyon, France
| | - Maurice Laville
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Walid Arkouche
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL), Lyon, France
| | - Anais Bouchara
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Denis Fouque
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France; University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Christophe O Soulage
- University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Laetitia Koppe
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France; University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France.
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31
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Laville M. Back off to better blow up: acute GFR decrease at SGLT-2 inhibitor initiation. Kidney Int 2021; 99:814-816. [PMID: 33745548 DOI: 10.1016/j.kint.2020.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 10/21/2022]
Abstract
The drop in glomerular filtration rate often observed in the first weeks of nephroprotective treatment, whether because of protein restriction or renin-angiotensin system blockade, can be interpreted as a marker of the relationship between the intensity of baseline glomerular anomalies and the potential treatment benefit. In this issue, Oshima et al. reported a post hoc analysis of the Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation (CREDENCE) study, the results of which confirm that such a relationship is also observed under sodium-glucose cotransporter 2 inhibition in diabetic patients with chronic kidney disease.
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Affiliation(s)
- Maurice Laville
- INSERM U1060 CarMeN, Université Claude Bernard Lyon 1, Lyon, France.
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32
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Meiller L, Sauvinet V, Louche-Pélissier C, Cestre A, Breyton AE, Lambert-Porcheron S, Meynier A, Alligier M, Laville M, Delzenne N, Vinoy S, Nazare JA. Suivi de la cinétique de production d’acides gras à chaîne courte après ingestion de fibre : intérêt des isotopes stables chez l’humain. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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Wagner S, Merkling T, Metzger M, Bankir L, Laville M, Frimat L, Combe C, Jacquelinet C, Fouque D, Massy ZA, Stengel B. Water intake and progression of chronic kidney disease: the CKD-REIN cohort study. Nephrol Dial Transplant 2021; 37:730-739. [DOI: 10.1093/ndt/gfab036] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Optimal daily water intake to prevent chronic kidney disease (CKD) progression is unknown. Taking the kidney’s urine-concentrating ability into account, we studied the relation of kidney outcomes in patients with CKD to total and plain water intake and urine volume.
Methods
Including 1265 CKD patients [median age 69 years; mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] from the Chronic Kidney Disease–Renal Epidemiology and Information Network cohort (2013–19), we assessed fluid intake at baseline interviews, collected 24-h urine volumes and estimated urine osmolarity (eUosm). Using Cox and then linear mixed models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for kidney failure and eGFR decline associated with hydration markers, adjusting for CKD progression risk factors and eUosm.
Results
Patients’ median daily intake was 2.0 L [interquartile range (IQR) 1.6–2.6] for total water and 1.5 L (1–1.7) for plain water, median urine volume was 1.9 L/24 h (IQR 1.6–2.4) and mean eUosm was 374 ± 104 mosm/L. Neither total water intake nor urine volume was associated with either kidney outcome. Kidney failure risk increased significantly with decreasing eUosm ˂292 mosm/L. Adjusted HRs (95% CIs) for kidney failure associated with plain water intake were 1.88 (1.02–3.47), 1.59 (1.06–2.38), 1.76 (0.95–3.24) and 1.55 (1.03–2.32) in patients drinking <0.5, 0.5–1.0, 1.5–2.0 and >2.0 L/day compared with those drinking 1.0–1.5 L/day. High plain water intake was also significantly associated with faster eGFR decline.
Conclusions
In patients with CKD, the relation between plain water intake and progression to kidney failure appears to be U-shaped. Both low and high intake may not be beneficial in CKD.
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Affiliation(s)
- Sandra Wagner
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Thomas Merkling
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Marie Metzger
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Lise Bankir
- Sorbonne Université, INSERM, Centre de Recherche des Cordeliers, Paris, France
| | - Maurice Laville
- Département de Néphrologie, Centre Hospitalier Lyon-Sud, Université de Lyon, UCBL, Carmen, Pierre-Bénite, France
| | - Luc Frimat
- EA4360 Apemac, Université de Lorraine, Université Paris-Descartes, Nancy, France
- Département de Néphrologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Christian Combe
- Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, Université Bordeaux Segalen, Bordeaux, France
| | - Christian Jacquelinet
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Agence de Biomédecine, Saint Denis la Plaine, France
| | - Denis Fouque
- Département de Néphrologie, Centre Hospitalier Lyon-Sud, Université de Lyon, UCBL, Carmen, Pierre-Bénite, France
| | - Ziad A Massy
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Service de Néphrologie, Hôpital Ambroise Paré, AP-HP, Paris, France
| | - Bénédicte Stengel
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
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Alessi S, Merkling T, Girerd N, Boivin JM, Chau K, Lopez-Sublet M, Laville M, Zannad F, Rossignol P, Wagner S. Étude de trajectoires d’indice de masse corporelle et de tour de taille sur 18 ans et leur impact sur les marqueurs de la fonction et atteinte rénale dans la cohorte STANISLAS. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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35
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Liabeuf S, Lambert O, Metzger M, Hamroun A, Laville M, Laville SM, Frimat L, Pecoits-Filho R, Fouque D, Massy ZA, Jacquelinet C, Stengel B. Adverse outcomes of proton pump inhibitors in patients with chronic kidney disease: The CKD-REIN cohort study. Br J Clin Pharmacol 2021; 87:2967-2976. [PMID: 33368448 DOI: 10.1111/bcp.14713] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Long-term use of proton pump inhibitors (PPIs) has been associated with adverse kidney events in the general population, but their impact among chronic kidney disease (CKD) patients is unclear. We studied the prevalence and incidence (new users) of PPI prescriptions and their relation to kidney outcomes and mortality in CKD patients. METHODS We collected drug prescriptions prospectively in a cohort of 3023 nephrology outpatients with CKD stages 2-5 at inclusion. Hazard ratios (HR, 95% confidence intervals [95% CI]) for acute kidney injury (AKI), end-stage kidney disease (ESKD), and mortality associated with new PPI prescriptions as a time-dependent variable were estimated with cause-specific Cox models in 1940 non-users with eGFR ≥ 15 mL/min/1.73 m2 at baseline, adjusted for comorbidities, laboratory data and drugs. RESULTS There were 981/3023 (32%) prevalent users (67 ± 13 years, 65% men) at baseline, and 366/3023 (12%) were prescribed PPI (new users) over a median follow-up of 3.9 years (interquartile range, 3-4.2). Among these new users, their median cumulative duration of prescription was 1 year (interquartile range: 0.4-2.3). During follow-up, 354 patients developed ESKD and 216 died before ESKD. The adjusted HRs associated with PPI prescription were 1.74 (95% CI, 1.26-2.40) for ESKD and 2.42 (95% CI, 1.73-3.39) for all-cause mortality. Over the first 3 years of follow-up, 211 AKI events had occurred. The adjusted HR for AKI associated with PPI prescription was 2.89 (95% CI, 1.91-4.38). CONCLUSIONS Long-term PPI prescription was common in CKD patients. Our results call attention to its potential risks of both acute and chronic kidney failure.
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Affiliation(s)
- Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,Laboratory, EA7517, University of Picardie Jules Verne, Amiens, Amiens, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Aghiles Hamroun
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Maurice Laville
- Nephrology Department, Lyon Sud Hospital, Pierre Benite, France.,Lyon University, INSERM U1060, CarMeN, Pierre Benite, France
| | - Solène M Laville
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Luc Frimat
- Nephrology Department, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.,Laboratory, EA4360, Lorraine University, Nancy, France
| | | | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France.,Biomedecine Agency, Saint Denis La Plaine, France
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM, France
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36
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Rodriguez J, Neyrinck A, Zhang Z, Seethaler B, Nazare JA, Robles Sánchez C, Roumain M, Muccioli G, Bindels L, Cani P, Maquet V, Laville M, Bischoff S, Walter J, Delzenne N. Identification of new biomarkers reflecting the interaction between chitin-glucan dietary fiber and the gut microbiota in healthy volunteers. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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37
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Seethaler B, Basrai M, Engel C, Siniatchkin M, Halle M, Laville M, Walter J, Marion K, Delzenne N, Bischoff S. Adherence to the mediterranean diet is associated with changes in serum amino acid levels in women at high risk of developing breast cancer (libre study). Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Poux JM, Laville M. Devenir des patients atteints de polykystose rénale traités par dialyse péritonéale en première intention. Expérience de notre centre depuis 1997. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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Coliche V, Koppe L, Laville M, Nouvier M, Pelletier S, Trolliet P, Fouque D. Metformin misuse in chronic kidney disease. Diabetes Metab 2020; 46:337-339. [PMID: 30145030 DOI: 10.1016/j.diabet.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Affiliation(s)
- V Coliche
- Department of nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France.
| | - L Koppe
- Department of nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - M Laville
- Department of nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - M Nouvier
- Department of nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - S Pelletier
- Department of nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - P Trolliet
- Department of nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - D Fouque
- Department of nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
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40
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O'Lone E, Viecelli AK, Craig JC, Tong A, Sautenet B, Herrington WG, Herzog CA, Jafar TH, Jardine M, Krane V, Levin A, Malyszko J, Rocco MV, Strippoli G, Tonelli M, Wang AYM, Wanner C, Zannad F, Winkelmayer WC, Wheeler DC, Craig JC, Tong A, Manns B, Pecoits-Filho R, Harris T, Wheeler DC, Winkelmayer W, Levin A, O'Lone E, Herrington WG, Herzog CA, Rocco MV, Strippoli G, Jardine M, Kleinpeter M, Ju A, Cho Y, Gutman T, Bernier-Jean A, James L, Hamiwka L, Viecelli AK, Jardine A, Bello A, Stengel B, Schiller B, Johnson D, Bavlovlenkov E, Caskey F, Gillespie B, Block G, Phan HA, Heerspink HL, Madero M, Ruospo M, Unruh M, Laville M, Bansal N, Mark P, Blankestijn P, Roy-Chaudhury P, Perlman R, Agarwal R, Mehrotra R, Seliger S, Shafi T, Hiemstra T, Jassal V, Perkovic V, Simplice A, White D, Eilers D, Alexander H, Landry Y, Landry G, Wilkie C. Establishing Core Cardiovascular Outcome Measures for Trials in Hemodialysis: Report of an International Consensus Workshop. Am J Kidney Dis 2020; 76:109-120. [DOI: 10.1053/j.ajkd.2020.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/17/2020] [Indexed: 01/08/2023]
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41
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Laville SM, Gras-Champel V, Moragny J, Metzger M, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Robinson BM, Stengel B, Massy ZA, Liabeuf S. Adverse Drug Reactions in Patients with CKD. Clin J Am Soc Nephrol 2020; 15:1090-1102. [PMID: 32611662 PMCID: PMC7409761 DOI: 10.2215/cjn.01030120] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the burden of adverse drug reactions in CKD. We estimated the incidence of overall and serious adverse drug reactions and assessed the probability of causation, preventability, and factors associated with adverse drug reactions in patients seen by nephrologists. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Chronic Kidney Disease-Renal Epidemiology and Information Network cohort included 3033 outpatients (65% men) with CKD and eGFR<60 ml/min per 1.73 m2, with follow-up for 2 years. Adverse drug reactions were identified from hospitalization reports, medical records, and participant interviews and finally assessed for causality, preventability, and immediate therapeutic management by experts in pharmacology. RESULTS Median (interquartile range) age was 69 (60-76) years old; 55% had eGFR≥30 ml/min per 1.73 m2, and 45% had eGFR<30 ml/min per 1.73 m2. Participants were prescribed a median (range) of eight (five to ten) drugs. Over 2 years, 536 patients had 751 adverse drug reactions, 150 (in 125 participants) classified as serious, for rates of 14.4 (95% confidence interval, 12.6 to 16.5) and 2.7 (95% confidence interval, 1.7 to 4.3) per 100 person-years, respectively. Among the serious adverse drug reactions, 32% were considered preventable or potentially preventable; 16 caused death, directly or indirectly. Renin-angiotensin system inhibitors (15%), antithrombotic agents (14%), and diuretics (10%) were the drugs to which the most adverse drug reactions were imputed, but antithrombotic agents caused 34% of serious adverse drug reactions. The drug was discontinued in 71% of cases, at least temporarily. Adjusted hazard ratios for serious adverse drug reaction were significantly higher in patients with eGFR<30 versus ≥30 ml/min per 1.73 m2 (1.8; 95% confidence interval, 1.3 to 2.6), in those prescribed more than ten versus less than five medications (2.4; 95% confidence interval, 1.1 to 5.2), or in those with poor versus good adherence (1.6; 95% confidence interval, 1.4 to 2.4). CONCLUSIONS Adverse drug reactions are common and sometimes serious in patients with CKD. Many serious adverse drug reactions may be preventable. Some specific pharmacologic classes, particularly antithrombotic agents, are at risk of serious adverse drug reactions. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN), NCT03381950.
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Affiliation(s)
- Solène M Laville
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | | | - Julien Moragny
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Marie Metzger
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Christian Jacquelinet
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France.,Renal Epidemiology and Information Network Registry, Biomedicine Agency, Saint Denis, France
| | - Christian Combe
- Department of Nephrology Transplantation Dialysis, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Inserm Unit 1026, University of Bordeaux Segalen, Bordeaux, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Maurice Laville
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Luc Frimat
- Nephrology Department, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France.,Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | | | - Bénédicte Stengel
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Ziad A Massy
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France.,Division of Nephrology, Ambroise Paré University Hospital, Assistance publique - Hôpitaux de Paris, Boulogne-Billancourt/Paris, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
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42
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Florens N, Calzada C, Lemoine S, Boulet MM, Guillot N, Barba C, Roux J, Delolme F, Page A, Poux JM, Laville M, Moulin P, Soulère L, Guebre-Egziabher F, Juillard L, Soulage CO. CKD Increases Carbonylation of HDL and Is Associated with Impaired Antiaggregant Properties. J Am Soc Nephrol 2020; 31:1462-1477. [PMID: 32518085 DOI: 10.1681/asn.2019111205] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/22/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND CKD is associated with increased oxidative stress that correlates with occurrence of cardiovascular events. Modifications induced by increased oxidative stress particularly affect circulating lipoproteins such as HDL that exhibit antiatheromatous and antithrombotic properties in vitro. METHODS To explore the specific role of oxidative modifications of HDL in CKD and their effect on the platelet-targeting antiaggregant properties of HDL, we used a CKD (5/6 nephrectomy) rabbit model. For ex vivo assessment of the antiaggregant properties of HDL, we collected blood samples from 15 healthy volunteers, 25 patients on hemodialysis, and 20 on peritoneal dialysis. We analyzed malondialdehyde, 4-hydroxynonenal (HNE), and 4-hydroxy-2-hexenal protein adduct levels. Platelet aggregation and activation were assessed by aggregometry, thromboxane B2 assay, or FACS. We modified HDL from controls by incubating it overnight at 37°C with 100 µM of HNE. RESULTS HDL from CKD rabbits and patients on hemodialysis had HNE adducts. The percentage of platelet aggregation or activation induced by collagen was significantly higher when platelets were incubated with HDL from CKD rabbit and hemodialysis groups than with HDL from the control group. In both rabbits and humans, platelet aggregation and activation were significantly higher in the presence of HNE-modified HDL than with HDL from their respective controls. Incubation of platelets with a blocking antibody directed against CD36 or with a pharmacologic inhibitor of SRC kinases restored the antiaggregative phenotype in the presence of HDL from CKD rabbits, patients on hemodialysis and peritoneal dialysis, and HNE-modified HDL. CONCLUSIONS HDL from CKD rabbits and patients on hemodialysis exhibited an impaired ability to inhibit platelet aggregation, suggesting that altered HDL properties may contribute to the increased cardiovascular risk in this population.
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Affiliation(s)
- Nans Florens
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France .,Department of Nephrology, University Hospital of Lyon, E. Herriot Hospital, Lyon, France
| | - Catherine Calzada
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France
| | - Sandrine Lemoine
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France.,Department of Nephrology, University Hospital of Lyon, E. Herriot Hospital, Lyon, France
| | - Marie Michèle Boulet
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France
| | - Nicolas Guillot
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France
| | - Christophe Barba
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France
| | - Julie Roux
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France
| | - Fréderic Delolme
- Protein Science Facility, SFR BioSciences, Centre National de la Recherche Scientifique (CNRS) UMS3444, INSERM US8, Claude Bernard University Lyon 1, École Normale Supérieure de Lyon (ENS de Lyon), Lyon, France
| | - Adeline Page
- Protein Science Facility, SFR BioSciences, Centre National de la Recherche Scientifique (CNRS) UMS3444, INSERM US8, Claude Bernard University Lyon 1, École Normale Supérieure de Lyon (ENS de Lyon), Lyon, France
| | - Jean Michel Poux
- Association Pour l'Utilisation du Rein Artificiel dans la Région Lyonnaise (AURAL), Lyon, France
| | - Maurice Laville
- Association Pour l'Utilisation du Rein Artificiel dans la Région Lyonnaise (AURAL), Lyon, France
| | - Philippe Moulin
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France.,Department of Endocrinology, University Hospital of Lyon, L. Pradel Hospital, Bron, France
| | - Laurent Soulère
- Institute for Molecular and Supramolecular Chemistry and Biochemistry, University of Lyon, INSA-Lyon, UMR 5246 CNRS, Villeurbanne, France
| | - Fitsum Guebre-Egziabher
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France.,Department of Nephrology, University Hospital of Lyon, E. Herriot Hospital, Lyon, France
| | - Laurent Juillard
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France.,Department of Nephrology, University Hospital of Lyon, E. Herriot Hospital, Lyon, France
| | - Christophe O Soulage
- CarMeN Laboratory, University of Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1060, Institut National des Sciences Appliquées de Lyon (INSA-Lyon), Claude Bernard University Lyon 1, Institut National de la Recherche Agronomique (INRA) U1397, Villeurbanne, France
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43
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Legrand K, Speyer E, Stengel B, Frimat L, Ngueyon Sime W, Massy ZA, Fouque D, Laville M, Combe C, Jacquelinet C, Durand AC, Edet S, Gentile S, Briançon S, Ayav C. Perceived Health and Quality of Life in Patients With CKD, Including Those With Kidney Failure: Findings From National Surveys in France. Am J Kidney Dis 2020; 75:868-878. [DOI: 10.1053/j.ajkd.2019.08.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023]
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44
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Luce M, Barba C, Yi D, Mey A, Roussel D, Bres E, Benoit B, Pastural M, Granjon S, Szelag JC, Laville M, Arkouche W, Bouchara A, Nyam E, Fouque D, Soulage CO, Koppe L. Accumulation of natriuretic peptides is associated with protein energy wasting and activation of browning in white adipose tissue in chronic kidney disease. Kidney Int 2020; 98:663-672. [PMID: 32739210 DOI: 10.1016/j.kint.2020.03.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 02/26/2020] [Accepted: 03/09/2020] [Indexed: 12/29/2022]
Abstract
Protein energy wasting is a common feature of patients with chronic kidney disease (CKD) and is associated with poor outcomes. Protein energy wasting and cachexia, a severe form of protein energy wasting, are characterized by increased resting energy expenditure but the underlying mechanisms are unclear. Browning corresponds to the activation of inducible brown adipocytes in white adipose tissue and occurs in states of cachexia associated with hypermetabolic disease such as cancer. Here we tested the hypothesis that CKD-associated protein energy wasting could result from browning activation as a direct effect of the uremic environment on adipocytes. In a murine model of CKD (5/6 nephrectomy), there was increased resting energy expenditure, expression of uncoupling protein 1 (a thermogenic protein uncoupling oxidative phosphorylation in mitochondria) and citrate synthase activity (a proxy of mitochondrial density in white adipose tissue). Mice with CKD also exhibited increased levels of atrial natriuretic peptide, a well known activator of browning. The incubation of primary adipose cells with plasma from patients receiving dialysis treatment and having signs of protein energy wasting led to an increased synthesis of uncoupling protein 1. Similarly, primary adipose cells exposed to atrial natriuretic peptide at concentrations relevant of CKD led to a significant increase of uncoupling protein 1 content. Thus, accumulation of cardiac natriuretic peptides during CKD could contribute to the browning of white adipose tissue and protein energy wasting.
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Affiliation(s)
- Mathilde Luce
- Department of Nephrology, Civil Hospices of Lyon, Lyon Sud Hospital Center, Pierre Benite, France; University of Lyon, CarMeN lab, National Institute of Applied Sciences of Lyon (INSA-Lyon), French National Institute of Health and Medical Research (INSERM) U1060, National Institute of Agricultural Research (INRA), Claude Bernard University Lyon 1, Villeurbanne, France
| | - Christophe Barba
- Department of Nephrology, Civil Hospices of Lyon, Lyon Sud Hospital Center, Pierre Benite, France; University of Lyon, CarMeN lab, National Institute of Applied Sciences of Lyon (INSA-Lyon), French National Institute of Health and Medical Research (INSERM) U1060, National Institute of Agricultural Research (INRA), Claude Bernard University Lyon 1, Villeurbanne, France
| | - Dan Yi
- Department of Nephrology, Civil Hospices of Lyon, Lyon Sud Hospital Center, Pierre Benite, France
| | - Anne Mey
- University of Lyon, CarMeN lab, National Institute of Applied Sciences of Lyon (INSA-Lyon), French National Institute of Health and Medical Research (INSERM) U1060, National Institute of Agricultural Research (INRA), Claude Bernard University Lyon 1, Villeurbanne, France
| | - Damien Roussel
- Natural and Anthropic Hydrosystems Ecology Laboratory, University of Lyon, Claude Bernard Lyon University 1, National School of Public Works of the State (ENTPE), Villeurbanne, France
| | - Emilie Bres
- Department of Nephrology, Civil Hospices of Lyon, Lyon Sud Hospital Center, Pierre Benite, France; University of Lyon, CarMeN lab, National Institute of Applied Sciences of Lyon (INSA-Lyon), French National Institute of Health and Medical Research (INSERM) U1060, National Institute of Agricultural Research (INRA), Claude Bernard University Lyon 1, Villeurbanne, France
| | - Bérengère Benoit
- University of Lyon, CarMeN lab, National Institute of Applied Sciences of Lyon (INSA-Lyon), French National Institute of Health and Medical Research (INSERM) U1060, National Institute of Agricultural Research (INRA), Claude Bernard University Lyon 1, Villeurbanne, France
| | - Myriam Pastural
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL), Lyon, France
| | - Samuel Granjon
- Laboratoire d'Analyse Médicale Cerballiance Rhône alpes, Lyon, France
| | - Jean Christophe Szelag
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL), Lyon, France
| | - Maurice Laville
- Department of Nephrology, Civil Hospices of Lyon, Lyon Sud Hospital Center, Pierre Benite, France
| | - Walid Arkouche
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL), Lyon, France
| | - Anais Bouchara
- Department of Nephrology, Civil Hospices of Lyon, Lyon Sud Hospital Center, Pierre Benite, France
| | - Elsa Nyam
- Montreal Diabetes Research Center, CRCHUM, Montréal, Quebec, Canada; Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Denis Fouque
- Department of Nephrology, Civil Hospices of Lyon, Lyon Sud Hospital Center, Pierre Benite, France; University of Lyon, CarMeN lab, National Institute of Applied Sciences of Lyon (INSA-Lyon), French National Institute of Health and Medical Research (INSERM) U1060, National Institute of Agricultural Research (INRA), Claude Bernard University Lyon 1, Villeurbanne, France
| | - Christophe O Soulage
- University of Lyon, CarMeN lab, National Institute of Applied Sciences of Lyon (INSA-Lyon), French National Institute of Health and Medical Research (INSERM) U1060, National Institute of Agricultural Research (INRA), Claude Bernard University Lyon 1, Villeurbanne, France
| | - Laetitia Koppe
- Department of Nephrology, Civil Hospices of Lyon, Lyon Sud Hospital Center, Pierre Benite, France; University of Lyon, CarMeN lab, National Institute of Applied Sciences of Lyon (INSA-Lyon), French National Institute of Health and Medical Research (INSERM) U1060, National Institute of Agricultural Research (INRA), Claude Bernard University Lyon 1, Villeurbanne, France.
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45
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Drareni K, Dougkas A, Laville M, Souquet P, Fournel P, Nazare JA, Giboreau A, Bensafi M. Influence de la baisse de la fonction olfactive sur le comportement alimentaire de patients sous chimiothérapie à base de Cisplatine. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Ranaivo H, Guilly S, Sothier M, Van Den Berghe L, Lambert-Porcheron S, Feugier-Favier N, Blond E, Dussous I, Roger L, Béra-Maillet C, Roume H, Galleron N, Pons N, Le Chatelier E, Ehrlich D, Laville M, Doré J, Nazare JA. La consommation pendant deux mois d’un pain enrichi en mix de fibres modifie la composition du microbiote intestinal et améliore le profil lipidique et d’insulino-sensibilité chez les sujets à risque cardiométabolique. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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47
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Neyrinck AM, Rodriguez J, Vinoy S, Maquet V, Walter J, Bischoff SC, Laville M, Delzenne NM. The FiberTAG project: Tagging dietary fibre intake by measuring biomarkers related to the gut microbiota and their interest for health. NUTR BULL 2020; 45:59-65. [PMID: 32194343 PMCID: PMC7074038 DOI: 10.1111/nbu.12416] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 12/13/2022]
Abstract
The scientific rationale for dietary fibre intake recommendations comes from the recognition of their benefits for health based on studies first published many years ago. It remains unclear which are the key physiological effects generated by dietary fibre in view of the diversity of the food components considered as dietary fibre, of the relevance of their classification (soluble and insoluble) and from the recent discoveries putting forward their interactions with the gut microbiota. The project FiberTAG (Joint Programming Initiative 'A Healthy Diet for a Healthy Life' 2017-2020 https://www.fibertag.eu/) aims to establish a set of biomarkers (markers of gut barrier function and bacterial co-metabolites including volatile compounds and lipid derivatives), measured in different biological compartments (faeces, blood or breath) linking dietary fibre intake and gut microbiota-related health effects. The FiberTAG consortium brings together academic and industrial partners from Belgium, France, Germany and Canada to share data and samples obtained from existing as well as new intervention studies in order to evaluate the relevance of such biomarkers. The FiberTAG consortium is currently working on five existing cohorts (prospective observational or nutritional interventions in healthy or obese patients), and a number of new intervention studies to analyse the effect of insoluble dietary fibre (wheat bran and chitin-glucan, provided by the industrial partners) in healthy individuals or in obese patients at high cardiometabolic risk.
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Affiliation(s)
- A. M. Neyrinck
- Metabolism and Nutrition Research GroupLouvain Drug Research InstituteUCLouvainUniversité Catholique de LouvainBrusselsBelgium
| | - J. Rodriguez
- Metabolism and Nutrition Research GroupLouvain Drug Research InstituteUCLouvainUniversité Catholique de LouvainBrusselsBelgium
| | | | | | - J. Walter
- Department of AgriculturalFood & Nutritional Science and Department of Biological SciencesUniversity of AlbertaEdmontonABCanada
| | - S. C. Bischoff
- Institute of Nutritional MedicineUniversity of HohenheimStuttgartGermany
| | - M. Laville
- Centre de Recherche en Nutrition Humaine Rhône‐AlpesUniv‐LyonUniversité Claude Bernard LyonHospices Civils de LyonCENSFCRIN/FORCE NetworkCarMeN LaboratoryLyonFrance
| | - N. M. Delzenne
- Metabolism and Nutrition Research GroupLouvain Drug Research InstituteUCLouvainUniversité Catholique de LouvainBrusselsBelgium
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48
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Wagner S, Merkling T, Metzger M, Bankir L, Laville M, Frimat L, Combe C, Jacquelinet C, Fouque D, Bénédicte S, Massy Z. SAT-095 URINE OSMOLARITY AND CHRONIC KIDNEY DISEASE PROGRESSION IN THE CKD-REIN COHORT. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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49
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Carney B, Zhan C, Li C, Zhu Y, Weinberger H, Horn C, Aaltonen E, Dagher N, Laville M, Olsen S, Sista A, Hickey R, Taslakian B. 3:27 PM Abstract No. 320 Management of portal vein thrombosis in cirrhotic patients. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Nineteen patients treated by continuous ambulatory peritoneal dialysis (CAPD) were studied according to clinical outcome parameters: insomnia, asthenia, pruritus, arterial hypertension, anorexia, nausea and/or vomiting, anemia, and rate of hospitalization. Using clinical scores, three groups were defined: poor clinical outcome (P), intermediate (I), and good (G). The quantity of treatment by PD was evaluated monthly with urea kinetic tests (weekly Kt/V, weekly urea clearance/1.73 m2 of body surface area (BSA), index of dialysis by Teehan), and with the weekly creatinine clearance/1.73 m2 of BSA. The metabolic index was analyzed: normalized protein catabolic rate (NPCR), serum albumin (Alb) and prealbumin, and reabsorption of glucose. There was good correlation between clinical scores and quantity of dialysis. The Alb was lower in group P. Group G was differentiated from group I and from group P by quantification tests and NPCR, with lower levels as follows: weekly Kt/V=2.06, urea clearance 70 L/week/1.73 m2, index of dialysis = 0.87, and creatinine clearance = 60 L/week/1.73 m2. We conclude that the qualitative clinical approach is not sufficient to predict deleterious signs, and the quantitative approach is predictive of the good clinical outcome and good nutritional status. We think that levels proposed to now are insufficient, and we suggest the following: weekly urea clearance >70 L, weekly Kt/V >2, weekly creatinine clearance >60 L, and index of dialysis >0.85.
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Affiliation(s)
| | | | - Horn My
- Hôpital St.-Joseph, Service de Néphrologie, Lyon, France
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