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Blin P, Joubert M, Jourdain P, Zaoui P, Guiard E, Sakr D, Dureau-Pournin C, Bernard MA, Lassalle R, Thomas-Delecourt F, Bineau S, Moore N, Droz-Perroteau C. Cardiovascular and renal diseases in type 2 diabetes patients: 5-year cumulative incidence of the first occurred manifestation and hospitalization cost: a cohort within the French SNDS nationwide claims database. Cardiovasc Diabetol 2024; 23:22. [PMID: 38195491 PMCID: PMC10777660 DOI: 10.1186/s12933-023-02101-1] [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: 10/03/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Myocardial infarction (MI), stroke, peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD) are common cardiovascular renal diseases (CVRD) manifestations for type 2 diabetes. The objective was to estimate the incidence of the first occurring CVRD manifestation and cumulative hospitalization costs of each CVRD manifestation for type 2 diabetes without CVRD history. METHODS A cohort study of all type 2 diabetes free of CVRD as of January 1st 2014, was identified and followed-up for 5 years within the French SNDS nationwide claims database. The cumulative incidence of the first occurring CVRD manifestation was estimated using the cumulative incidence function, with death as a competing risk. Cumulative hospitalization costs of each CVRD manifestations were estimated from the perspective of all payers. RESULTS From 2,079,089 type 2 diabetes without cancer or transplantation, 76.5% were free of CVRD at baseline with a mean age of 65 years, 52% of women and 7% with microvascular complications history. The cumulative incidence of a first CVRD manifestation was 15.3% after 5 years of follow-up with a constant linear increase over time for all CVRD manifestations: The most frequent was CKD representing 40.6% of first occurred CVRD manifestation, followed by HF (23.0%), then PAD (13.5%), stroke (13.2%) and MI (9.7%). HF and CKD together reached about one patient out of ten after 5 years and represented 63.6% of first CVRD manifestations. The 5-year global cost of all CVRD hospitalizations was 3.9 billion euros (B€), i.e. 2,450€ per patient of the whole cohort, with an exponential increase over time for each specific CVRD manifestation. The costliest was CKD (2.0 B€), followed by HF (1.2 B€), then PAD (0.7 B€), stroke (0.6 B€) and MI (0.3 B€). CONCLUSIONS/INTERPRETATION While MI, stroke and PAD remain classic major risks of complications for CVRD-free type 2 diabetes, HF and CKD nowadays represent individually a higher risk and cost than each of these classic manifestations, and jointly represents a risk and a cost twice as high as these three classic manifestations all together. This should encourage the development of specific HF and CKD preventive strategies.
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Affiliation(s)
- Patrick Blin
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France.
| | - Michael Joubert
- Diabetes Care Unit, Caen University Hospital, UNICAEN, Caen, 14033, France
| | | | | | - Estelle Guiard
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Dunia Sakr
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Caroline Dureau-Pournin
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Marie-Agnès Bernard
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Régis Lassalle
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | | | | | - Nicholas Moore
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Cécile Droz-Perroteau
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
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Jourdain P, Blin P, Zaoui P, Guiard E, Sakr D, Bernard MA, Dureau-Pournin C, Lassalle R, Thomas-Delecourt F, Bineau S, Moore N, Droz-Perroteau C, Joubert M. Cardiovascular or renal disease (CVRD) complication and mortality incidence for type 2 diabetics with a single or without CVRD comorbidity: A 5-year SNDS nationwide claims database cohort study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.212] [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: 12/31/2022]
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Zaoui P, Courivaud C, Rostoker G, Choukroun G, Dubel L, Lorenzo M, Harmand S, Menoyo Calonge V. Management of anaemia in French dialysis patients: results from a large epidemiological retrospective study. Clin Kidney J 2022; 16:501-511. [PMID: 36865005 PMCID: PMC9972811 DOI: 10.1093/ckj/sfac245] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Indexed: 12/29/2022] Open
Abstract
Background Limited real-world data are available in Europe, especially France, regarding the therapeutic management of anaemia in patients with dialysis-dependent chronic kidney disease (DD CKD). Methods This retrospective, longitudinal, observational study was based on medical records from the MEDIAL database of not-for-profit dialysis units in France. From January to December 2016, we included eligible patients (≥18 years), with a diagnosis of CKD and receiving maintenance dialysis. Patients with anaemia were followed up for 2 years after inclusion. Patient demographic data, anaemia status, CKD-related anaemia treatments, and treatment outcomes including laboratory test results were evaluated. Results Of 1632 DD CKD patients identified from the MEDIAL database, 1286 had anaemia; 98.2% of patients with anaemia were receiving haemodialysis at index date (ID). Of patients with anaemia, 29.9% had haemoglobin (Hb) levels of 10-11 g/dL and 36.2% had levels of 11-12 g/dL at ID. Furthermore, 21.3% had functional iron deficiency and 11.7% had absolute iron deficiency. The most commonly prescribed treatments at ID for patients with DD CKD-related anaemia were intravenous (IV) iron with erythropoietin-stimulating agents (ESAs) (65.1%). Among patients initiating ESA treatment at ID or during follow-up, 347 (95.3%) reached the Hb target of 10-13 g/dL and maintained response within the target Hb range for a median duration of 113 days. Conclusions Despite combined use of ESAs and IV iron, duration within the Hb target range was short, suggesting that anaemia management can be further improved.
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Affiliation(s)
| | | | - Guy Rostoker
- Hôpital Privé Claude Galien, Ramsay-Générale de Santé, Quincy sous Sénart, Essonne, France
| | - Gabriel Choukroun
- Nephrology Dialysis Transplantation Department, CHU Amiens and MP3CV Research Unit, Université de Picardie Jules Verne, Amiens, France
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Jourdain P, Blin P, Zaoui P, Guiard E, Sakr D, Dureau-Pournin C, Bernard MA, Lassalle R, Thomas-Delecourt F, Bineau S, Moore N, Droz-Perroteau C, Joubert MA. Cardiovascular or renal disease (CVRD) complication and mortality incidence for type 2 diabetics with a single or without CVRD comorbidity: a 5-year SNDS nationwide claims database cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1306] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial infarction (MI), stroke, peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD) are common cardiovascular renal disease (CVRD) complications for type 2 diabetes (T2D). However, for those with a single CVRD comorbidity, the incidence of a new CVRD complication and death is not well known.
Purpose
To assess the 5-year CVRD complication and mortality incidence for T2D patients with a single CVRD comorbidity or without CVRD at baseline.
Methods
A cohort study of all T2D patients with a single CVRD or without CVRD (disease-free) at baseline (January 1st, 2014) identified and followed-up for 5 years within the French SNDS nationwide claims database. Incidence rates were estimated for 5 years and the risk of all-cause death was compared to the disease-free population using Cox proportional hazards risk model: hazard ratio (HR) with [95% confidence interval].
Results
From about 2 million T2D patients without cancer or transplantation at baseline, 76.5% were disease-free, 7.9% with a single CVRD and the others having several CVRD comorbidities history. Five-year CVRD complication and mortality incidence rates for 1,000 patient-years are presented in the table. CKD and HF were the most frequent CVRD complications for the disease-free and all CVRD comorbid populations, far ahead of MI, stroke and PAD, except PAD complication for PAD population and to a lesser degree stroke complication for stroke population. The incidence rate of all-cause death was the highest for HF+CKD patients, followed by HF patients, then PAD, stroke and CKD patients. Compared to disease-free patients with same sex and age, the HR of death was 4.3 [4.2–4.5] higher for HF+CKD patients, 2.7 [2.7–2.8], 2.1 [2.0–2.1], 2.1 [2.0–2.1], 1.9 [1.9–1.9] and 1.4 [1.3–1.4] for HF, CKD, PAD, stroke and MI patients, respectively.
Conclusions
While MI, stroke and PAD comorbidities remain major risks of complications for T2D patients, HF and CKD nowadays represent a clearly higher risk of CVRD complications and death, that needs improved preventive strategies.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Study performed with unconditional funding from AstraZeneca
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Affiliation(s)
- P Jourdain
- Hospital Kremlin Bicetre, APHP , Paris , France
| | - P Blin
- University of Bordeaux, Bordeaux PharmacoEpi, INSERM CIC-P 1401 , Bordeaux , France
| | - P Zaoui
- CHU Grenoble , Grenoble , France
| | - E Guiard
- University of Bordeaux, Bordeaux PharmacoEpi, INSERM CIC-P 1401 , Bordeaux , France
| | - D Sakr
- University of Bordeaux, Bordeaux PharmacoEpi, INSERM CIC-P 1401 , Bordeaux , France
| | - C Dureau-Pournin
- University of Bordeaux, Bordeaux PharmacoEpi, INSERM CIC-P 1401 , Bordeaux , France
| | - M A Bernard
- University of Bordeaux, Bordeaux PharmacoEpi, INSERM CIC-P 1401 , Bordeaux , France
| | - R Lassalle
- University of Bordeaux, Bordeaux PharmacoEpi, INSERM CIC-P 1401 , Bordeaux , France
| | | | - S Bineau
- AstraZeneca , Courbevoie , France
| | - N Moore
- University of Bordeaux, Bordeaux PharmacoEpi, INSERM CIC-P 1401 , Bordeaux , France
| | - C Droz-Perroteau
- University of Bordeaux, Bordeaux PharmacoEpi, INSERM CIC-P 1401 , Bordeaux , France
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Gellen B, Thorin‐Trescases N, Thorin E, Gand E, Ragot S, Montaigne D, Pucheu Y, Mohammedi K, Gatault P, Potier L, Liuu E, Hadjadj S, Saulnier P, Marechaud R, Ragot S, Piguel X, Saulnier P, Javaugue V, Gand E, Hulin‐Delmotte C, Llatty P, Ducrocq G, Roussel R, Rigalleau V, Pucheu Y, Zaoui P, Montaigne D, Halimi J, Gatault P, Sosner P, Gellen B. Increased serum S100A12 levels are associated with higher risk of acute heart failure in patients with type 2 diabetes. ESC Heart Fail 2022; 9:3909-3919. [PMID: 36637406 PMCID: PMC9773733 DOI: 10.1002/ehf2.14036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/09/2022] [Accepted: 06/08/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS The hyperglycaemic stress induces the release of inflammatory proteins such as S100A12, one of the endogenous ligands of the receptors for advanced glycation end products (RAGE). Chronic activation of RAGE has multiple deleterious effects in target tissues such as the heart and the vessels by promoting oxidative stress, inflammation by the release of cytokines, macrophages infiltration, and vascular cell migration and proliferation, causing ultimately endothelial cell and cardiomyocyte dysfunction. The aim of our study was to investigate the prognostic value of circulating S100A12 beyond established cardiovascular risk factors (CVRF) for heart failure (HF) and major adverse cardiovascular events (MACE) in a cohort of patients with type 2 diabetes. METHODS AND RESULTS Serum S100A12 concentrations were measured at baseline in 1345 type 2 diabetes patients (58% men, 64 ± 11 years) recruited in the SURDIAGENE prospective cohort. Endpoints were the occurrence of acute HF requiring hospitalization (HHF) and MACE. We used a proportional hazard model adjusted for established CVRF (age, sex, duration of diabetes, estimated glomerular filtration rate, albumin/creatinine ratio, history of coronary artery disease) and serum S100A12. During the median follow-up of 84 months, 210 (16%) and 505 (38%) patients developed HHF and MACE, respectively. Baseline serum S100A12 concentrations were associated with an increased risk of HHF [hazard ratio (HR) (95% confidence interval) 1.28 (1.01-1.62)], but not MACE [1.04 (0.90-1.20)]. After adjustment for CVRF, S100A12 concentrations remained significantly associated with an increased risk of HHF [1.29 (1.01-1.65)]. In a sub-analysis, patients with high probability of pre-existing HF [N terminal pro brain natriuretic peptide (NT-proBNP) >1000 pg/mL, n = 87] were excluded. In the remaining 1258 patients, the association of serum S100A12 with the risk of HHF tended to be more pronounced [1.39 (1.06-1.83)]. When including the gold standard HF marker NT-proBNP in the model, the prognostic value of S100A12 for HHF did not reach significance. Youden method performed at 7 years for HHF prediction yielded an optimal cut-off for S100A12 concentration of 49 ng/mL (sensitivity 53.3, specificity 52.2). Compared with those with S100A12 ≤ 49 ng/mL, patients with S100A12 > 49 ng/mL had a significantly increased risk of HHF in the univariate model [HR = 1.58 (1.19-2.09), P = 0.0015] but also in the multivariate model [HR = 1.63 (1.23-2.16), P = 0.0008]. After addition of NT-proBNP to the multivariate model, S100A12 > 49 ng/mL remained associated with an increased risk of HHF [HR = 1.42 (1.07-1.90), P = 0.0160]. However, the addition of S100A12 categories on top of multivariate model enriched by NT-pro BNP did not improve the ability of the model to predict HHF (relative integrated discrimination improvement = 1.9%, P = 0.1500). CONCLUSIONS In patients with type 2 diabetes, increased serum S100A12 concentration is independently associated with risk of HHF, but not with risk of MACE. Compared with NT-proBNP, the potential clinical interest of S100A12 for the prediction of HF events remains limited. However, S100A12 could be a candidate for a multimarker approach for HF risk assessment in diabetic patients.
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Affiliation(s)
- Barnabas Gellen
- ELSAN—Polyclinique de Poitiers1 Rue de la ProvidenceF‐86000PoitiersFrance
| | | | - Eric Thorin
- Montreal Heart Institute, Research CenterMontrealQuebecCanada,Department of Surgery, Faculty of MedicineUniversity of Montréal, Montreal Heart InstituteMontrealQuebecCanada
| | - Elise Gand
- Centre d'Investigation Clinique CIC1402Université de Poitiers, CHU de Poitiers, INSERMPoitiersFrance
| | - Stephanie Ragot
- Centre d'Investigation Clinique CIC1402Université de Poitiers, CHU de Poitiers, INSERMPoitiersFrance
| | - David Montaigne
- Department of Clinical Physiology—EchocardiographyCHU LilleLilleFrance,INSERMU1011, EGID, Institut Pasteur de LilleUniversity of LilleLilleFrance
| | - Yann Pucheu
- Department of CardiologyCHU de BordeauxPessacFrance
| | - Kamel Mohammedi
- Hôpital Haut‐Lévêque, Department of Endocrinology, Diabetes and Nutrition; University of Bordeaux, Faculty of Medicine; INSERM unit 1034, Biology of Cardiovascular DiseasesBordeaux University HospitalBordeauxFrance
| | | | - Louis Potier
- Department of DiabetologyHôpital Bichat—Claude‐Bernard, APHP, Université de ParisParisFrance,Cordeliers Research Centre, ImMeDiab team, INSERMParisFrance
| | - Evelyne Liuu
- Centre d'Investigation Clinique CIC1402Université de Poitiers, CHU de Poitiers, INSERMPoitiersFrance,Department of GeriatricsCHU de PoitiersPoitiersFrance
| | - Samy Hadjadj
- L'institut du ThoraxINSERM, CNRS, UNIV Nantes, CHU NantesNantesFrance
| | - Pierre‐Jean Saulnier
- Centre d'Investigation Clinique CIC1402Université de Poitiers, CHU de Poitiers, INSERMPoitiersFrance
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NOZU K, Appel G, Chin M, Fischbach B, Knebelmann B, Lieberman K, Meyer C, Pergola P, Rizk V. D, Silva L. A, Spinowitz B, Sprague M. S, Torra Balcells R, Zaoui P. POS-540 INTERIM ANALYSIS OF THE EAGLE TRIAL: AN OPEN-LABEL STUDY TO ASSESS THE LONG-TERM SAFETY AND TOLERABILITY OF BARDOXOLONE METHYL IN PATIENTS WITH ALPORT SYNDROME. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.571] [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: 10/19/2022] Open
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Truche AS, Bailly S, Fabre O, Legrand R, Zaoui P. A Specific High-Protein Weight Loss Program Does Not Impair Renal Function in Patients Who Are Overweight/Obese. Nutrients 2022; 14:384. [PMID: 35057566 PMCID: PMC8780753 DOI: 10.3390/nu14020384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
Although high-protein diets appear to be the most efficient way to lose weight, concerns may arise about their innocuity on renal function. The objective of this study is to assess the impact of a weight loss program on renal function. A multicentric cohort-based study was performed using the RNPC© French national weight loss program. Patients with at least two creatinine measurements at the beginning of the program and at the end of the weight loss phase between 1 January 2016 and 1 July 2021 were included. Renal function was assessed by Modification of Diet in Renal Disease (MDRD) equation-based estimated glomerular filtration rate (eGFR). From 4394 patients with two creatinine measurements included, 1579 (35.9%) had normal eGFR (MDRD 90-120 mL/min/1.73 m2), 210 (4.8%) had hyperfiltration (MDRD > 120 mL/min/1.73 m2), 2383 (54.2%) had chronic kidney disease (CKD) grade 2 (MDRD 60-90 mL/min/1.73 m2), and 221 (5.0%) had CKD grade 3 (MDRD 30-60 mL/min/1.73 m2). Multivariable analyses showed no eGFR change for patients in initial CKD grade 2, normal eGFR and hyperfiltration, and a significant increase in CKD grade 3. The RNPC© program avoids renal function impairment during the two first phases, regardless of the initial eGFR.
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Affiliation(s)
| | - Sébastien Bailly
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300 and Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - Odile Fabre
- Groupe Éthique et Santé, Actiburo 1, Bâtiment A—100 Chemin de l’Aumône Vieille, 13400 Aubagne, France; (O.F.); (R.L.)
| | - Rémy Legrand
- Groupe Éthique et Santé, Actiburo 1, Bâtiment A—100 Chemin de l’Aumône Vieille, 13400 Aubagne, France; (O.F.); (R.L.)
| | - Philippe Zaoui
- Service de Néphrologie, Dialyse, Transplantation Rénale, Grenoble Alpes University Hospital, 38700 La Tronche, France;
- AGDUC, Meylan Dialysis Center, 38240 Meylan, France
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Waijer SW, de Vries ST, Busch R, Xie D, Gansevoort RT, Hou FF, Górriz JL, Laverman GD, De Nicola L, Pascual J, Provenzano M, Pergola PE, Tang SC, Wanner C, Zaoui P, Parving HH, de Zeeuw D, Heerspink HJ. Large Between-Patient Variability in eGFR Decline before Clinical Trial Enrollment and Impact on Atrasentan's Efficacy: A Post Hoc Analysis from the SONAR Trial. J Am Soc Nephrol 2021; 32:2731-2734. [PMID: 34417318 PMCID: PMC8806091 DOI: 10.1681/asn.2021040498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Simke W. Waijer
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sieta T. de Vries
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert Busch
- Division of Community Endocrinology, Albany Medical Center, Albany, New York
| | - Di Xie
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Ron T. Gansevoort
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Jose L. Górriz
- Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, GEENDIAB, Valencia, Spain
| | - Gozewijn D. Laverman
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo, The Netherlands,Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Luca De Nicola
- Department of Advanced Medical and Surgical Sciences, Nephrology and Dialysis Unit, University L. Vanvitelli, Naples, Italy
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Michele Provenzano
- Department of Advanced Medical and Surgical Sciences, Nephrology and Dialysis Unit, University L. Vanvitelli, Naples, Italy
| | | | - Sydney C.W. Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Christoph Wanner
- Division of Nephrology, University Medical Center I, University of Wurzburg, Wurzburg, Germany
| | - Philippe Zaoui
- Service de Néphrologie Hemodialyse Apherese Transplantation Grenoble, Hospital Universite Grenoble, Alpes, France
| | | | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hiddo J.L. Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Briche N, Seinturier C, Cracowski JL, Zaoui P, Blaise S. Digital pressure with laser Doppler flowmetry is better than photoplethysmography to characterize peripheral arterial disease of the upper limbs in end-stage renal disease patients. Microvasc Res 2021; 139:104264. [PMID: 34653520 DOI: 10.1016/j.mvr.2021.104264] [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: 07/16/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is no consensual definition of significant peripheral arterial disease of the upper limbs. Patients with end-stage renal disease are usually explored with Doppler ultrasound, which seems insufficient to characterize and quantify the arterial disease in this anatomic site. Candidates for haemodialysis access tend to be increasingly older and have polyvascular disease, and a better assessment of the vascular status of their upper limbs with finger systolic blood pressure is necessary. Photoplethysmography is simple and currently used in practice, but laser Doppler flowmetry may be more sensitive for low values. Our objective is to investigate additional information in the digit assessment over the ultrasound assessment of the upper limbs of patients awaiting haemodialysis and compare digital pressure values taken by photoplethysmography and laser Doppler. METHODS All included patients with end-stage renal disease scheduled for haemodialysis access received a prospective evaluation of their upper limbs with a clinical examination of the hands, an arterial upper limb Doppler ultrasound, and finger systolic blood pressure using photoplethysmography and laser Doppler flowmetry. Significant upper limb arterial disease was defined by a finger systolic blood pressure below 60 mm Hg or a finger brachial pressure index below 0.7. RESULTS Twenty-four patients were included in the study. In all, 41.7% of patients (n = 10) had parietal calcifications to the antebrachial arteries on Doppler ultrasound, 8.3% of patients (n = 2) had bilateral finger systolic blood pressure values below 60 mm Hg with laser Doppler flowmetry (but not confirmed with photoplethysmography), and 16.6% of patients (n = 4) had a finger brachial pressure index below 0.7 on both laser Doppler flowmetry and photoplethysmography. While there was an agreement between these two methods, higher values were recorded with photoplethysmography. The Pearson coefficient was 0.493 for the median of basal digital pressures in absolute values and 0.489 for finger brachial pressure index (p < 0.001). CONCLUSION Our study confirms the need to evaluate significant upper limb arterial disease in patients with end-stage renal disease not only with Doppler ultrasound but also with an evaluation of the finger systolic blood pressure. The correlation of the finger systolic blood pressure values using laser Doppler flowmetry and photoplethysmography was poor, which was probably due to an overestimation of the pressures with photoplethysmography. Despite the absence of a gold standard, we suggest that Laser Doppler flowmetry should be used rather than photoplethysmography to better characterize significant peripheral arterial disease of the upper limbs in patients with end-stage renal disease, particularly before creation of a new haemodialysis access. Protocol Record on clinical trial 38RC19.285.
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Affiliation(s)
- Nicolas Briche
- Department of Vascular Medicine, Dijon University Hospital, 21000 Dijon, France
| | - Christophe Seinturier
- Department of Vascular Medicine, Grenoble Alpes University Hospital, F-38000 Grenoble, France
| | - Jean Luc Cracowski
- INSERM CIC1406, Grenoble Alpes University Hospital, F-38000 Grenoble, France; Univ. Grenoble Alpes, INSERM, HP2, F-38000 Grenoble, France
| | - Philippe Zaoui
- Department of Nephrology, Grenoble Alpes University Hospital, F-38000 Grenoble, France
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital, F-38000 Grenoble, France; Univ. Grenoble Alpes, INSERM, HP2, F-38000 Grenoble, France.
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Wanner C, Nangaku M, Kraus B, Zinman B, Mattheus M, Ohneberg K, Ben Hajmessaoud N, Zaoui P, Schmoor C, Inzucchi S. Médiateurs de l’effet du traitement par empagliflozine sur les résultats rénaux dans l’essai EMPA-REG OUTCOME. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.233] [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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11
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Meuleman MS, Guilmin-Crépon S, Hummel A, Daugas E, Dumas A, Leye F, Dantal J, Rigothier C, Provot F, Chauveau D, Burtey S, Hertig A, Dahan K, Durrbach A, Dossier C, Karras A, Guerrot D, Esnault V, Rémy P, Massy ZA, Tostivint I, Morin MP, Zaoui P, Fritz O, Le Quintrec M, Wynckel A, Bourmaud A, Boyer O, Sahali D, Alberti C, Audard V, Mellerio H. Long-term health-related quality of life outcomes of adults with pediatric onset of frequently relapsing or steroid-dependent nephrotic syndrome. J Nephrol 2021; 35:1123-1134. [PMID: 34224090 DOI: 10.1007/s40620-021-01111-0] [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: 04/23/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Long-term psychosocial outcomes and health-related quality of life (HRQOL) in adults with pediatric onset of frequently relapsing or steroid-dependent idiopathic nephrotic syndrome (FRNS or SDNS) remain to be determined. METHODS In this prospective cohort study, 59 adults with pediatric onset of FRNS/SDNS and persistent active glomerular disease in adulthood completed the GEDEPAC-2 questionnaire exploring 11 well-being domains. Data were compared to the French general population (FGP) with standardized incidence ratio ([SIR]; adjusted for period, age, gender). Regression models were performed to identify predictive factors of psychosocial well-being. RESULTS In 82% of cases, the questionnaire was completed while the participants (n = 59; 47 men; median age = 32 years; median number of relapses = 13) were in complete remission (under specific therapy in 76% of cases). Participants had higher educational degree than in the FGP (SIR = 6.3; p < 0.01) and more frequently a managerial occupation (SIR = 3.1; p < 0.01). Social integration was acceptable with regard to marital status and experience of sexual intercourse, but experiences of discrimination were far more frequent (SIR = 12.5; p < 0.01). The SF-12 mental component summary (MCS) score was altered (Z-score = - 0.6; p < 0.01) and mean multidimensional fatigue inventory (MFI-20) global fatigue score appeared high (12). Transfer from pediatric to adult healthcare was followed by a period of discontinued care for 33% of participants. Multivariate analysis revealed a close relationship between MFI-20, physical health, and MCS. CONCLUSIONS This study shows that pediatric onset FRNS and SDNS may have a long-term negative impact on mental HRQOL and highlights the impact of fatigue, which is often not adequately considered in routine care.
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Affiliation(s)
- Marie-Sophie Meuleman
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare "Syndrome Néphrotique Idiopathique", Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", 51 Avenue du Marechal-de-Lattre-de-Tassigny, Créteil Cedex, 94010, Creteil, France. .,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, Equipe 21, Creteil, France.
| | - Sophie Guilmin-Crépon
- Université de Paris, ECEVE UMR 1123, INSERM, 75010, Paris, France.,Unité d'Épidémiologie Clinique, CIC 1426, AP-HP.Nord, Hôpital Universitaire Robert Debré, Inserm, 75019, Paris, France
| | - Aurélie Hummel
- Service de Néphrologie, AP-HP, Hôpital Necker, Paris, France
| | - Eric Daugas
- Service de Néphrologie, AP-HP, Hôpital Bichat, Université de Paris, INSERM U1149, Paris, France
| | - Agnès Dumas
- Université de Paris, ECEVE UMR 1123, INSERM, 75010, Paris, France
| | - Fallou Leye
- Unité d'Épidémiologie Clinique, CIC 1426, AP-HP.Nord, Hôpital Universitaire Robert Debré, Inserm, 75019, Paris, France
| | - Jacques Dantal
- Service de Néphrologie Immunologie Clinique Transplantation, Centre de Recherche en Transplantation et Immunologie (CRTI), Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | - Claire Rigothier
- Service de Néphrologie Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - François Provot
- Service de Néphrologie, Hôpital Huriez, CHU de Lille, Lille, France
| | - Dominique Chauveau
- Service de Néphrologie et Transplantation d'Organes, Hôpital de Rangueil et Centre de Référence Maladies Rénales Rares, CHU de Toulouse, Toulouse, France
| | - Stéphane Burtey
- APHM, INSERM, INRAe, C2VN, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Aix Marseille University, Marseille, France
| | - Alexandre Hertig
- Service de Néphrologie et Transplantation Rénale, AP-HP, Hôpital Tenon, Paris, France
| | - Karine Dahan
- Service de Néphrologie et Dialyse, AP-HP, Hôpital Tenon, Paris, France
| | - Antoine Durrbach
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare "Syndrome Néphrotique Idiopathique", Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", 51 Avenue du Marechal-de-Lattre-de-Tassigny, Créteil Cedex, 94010, Creteil, France
| | - Claire Dossier
- Service de Néphrologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
| | - Alexandre Karras
- Service de Néphrologie, AP-HP, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | | | - Vincent Esnault
- Service de Néphrologie, Hôpital Pasteur, CHU de Nice, Nice, France
| | - Philippe Rémy
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare "Syndrome Néphrotique Idiopathique", Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", 51 Avenue du Marechal-de-Lattre-de-Tassigny, Créteil Cedex, 94010, Creteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, Equipe 21, Creteil, France
| | - Ziad A Massy
- Service de Néphrologie, AP-HP, Hôpital Ambroise Paré, Boulogne-Billancourt, France.,INSERM U1018 CESP, UVSQ, UPS Villejuif, Villejuif, France
| | - Isabelle Tostivint
- Service de Néphrologie et Transplantation, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Marie-Pascale Morin
- Service de Néphrologie, Hôpital de Pontchaillou, CHU de Rennes, Rennes, France
| | - Philippe Zaoui
- Service de Néphrologie, Hémodialyse, Aphérèse et Transplantation Rénale, CHU de Grenoble Alpes, Université Grenoble-Alpes, Grenoble, France
| | - Olivier Fritz
- Service de Néphrologie, Centre Hospitalier (CH) La Rochelle, La Rochelle, France
| | - Moglie Le Quintrec
- Service de Néphrologie Dialyse et Transplantation Rénale, Hôpital Lapeyronie, CHU de Montpellier, Montpellier, France
| | | | - Aurélie Bourmaud
- Université de Paris, ECEVE UMR 1123, INSERM, 75010, Paris, France.,Unité d'Épidémiologie Clinique, CIC 1426, AP-HP.Nord, Hôpital Universitaire Robert Debré, Inserm, 75019, Paris, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, Centre de Référence Maladie Rare "Syndrome Néphrotique Idiopathique", Institut Imagine, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Dil Sahali
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare "Syndrome Néphrotique Idiopathique", Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", 51 Avenue du Marechal-de-Lattre-de-Tassigny, Créteil Cedex, 94010, Creteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, Equipe 21, Creteil, France
| | - Corinne Alberti
- Université de Paris, ECEVE UMR 1123, INSERM, 75010, Paris, France.,Unité d'Épidémiologie Clinique, CIC 1426, AP-HP.Nord, Hôpital Universitaire Robert Debré, Inserm, 75019, Paris, France
| | - Vincent Audard
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare "Syndrome Néphrotique Idiopathique", Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", 51 Avenue du Marechal-de-Lattre-de-Tassigny, Créteil Cedex, 94010, Creteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, Equipe 21, Creteil, France
| | - Hélène Mellerio
- Université de Paris, ECEVE UMR 1123, INSERM, 75010, Paris, France.,Service de médecine d'adolescent, Plateforme de Transition AD'venir, AP-HP, Hôpital Robert Debré, Paris, France.,Groupe Français de Recherche en Médecine et Santé de l'Adolescent, Paris, France
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Torra Balcells R, Appel B G, Fischbach B, Kandai N, Knebelmann B, Lieberman K, Meyer J C, Packham M D, Rastogi A, Rizk V D, Silva L A, Spinowitz B, Sprague M S, Zaoui P, Pergola E P. POS-496 INTERIM ANALYSIS OF THE EAGLE TRIAL: AN OPEN-LABEL STUDY TO ASSESS THE LONG-TERM SAFETY AND TOLERABILITY OF BARDOXOLONE METHYL IN PATIENTS WITH ALPORT SYNDROME. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.523] [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] Open
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13
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Zaoui P, Chin M, Delatycki M, Giunti P, Goldsberry A, Meyer C, O'Grady M, Perlman S, Subramony SH, Zesiewicz T, Lynch D. P0222KIDNEY EFFECTS IN THE MOXIE TRIAL: A STUDY OF OMAVELOXOLONE IN PATIENTS WITH FRIEDRICH'S ATAXIA. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0222] [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
Omaveloxolone, an Nrf2 activator, is an investigational drug that targets targets inflammation and mitochondrial dysfunction, metabolic, and bioenergetic pathways. Omaveloxolone is an analog of bardoxolone, methyl which has been shown to improve kidney function in multiple studies of chronic kidney diseases. The MOXIe Part 2 trial investigated omaveloxolone in patients with Friedreich’s ataxia (FA), a rare and serious hereditary disease caused by mitochondrial dysfunction that affects multiple organ systems resulting in ataxia, cardiomyopathy, and reduced lifespan. The study met its primary efficacy endpoint, and omaveloxolone improved neurological function, as assessed by the modified Friedreich’s ataxia rating scale (mFARS). We report the effect of omaveloxolone on kidney function in this patient population.
Method
The MOXIe trial (NCT02255435) was an international, multi-center, double-blind, placebo-controlled, randomized trial that enrolled 103 patients between 16 and 40 years of age with genetically confirmed FA. Patients were randomized 1:1 to receive either omaveloxolone 150 mg or placebo administered once daily for 48 weeks. The trial included 24 patients that were younger than 18 years of age. Baseline eGFR for the overall patient population receiving placebo or omaveloxolone was 109.2 ± 21.7 and 113.4 ± 14.7 mL/min/1.73 m2, respectively. Baseline eGFR for the pediatric population receiving placebo or omaveloxolone was 99.1 ± 33.7 and 106.3 ± 15.6 mL/min/1.73 m2, respectively. Serum creatinine was collected at baseline, Weeks 4, 12, 18, 24, 36 and 48 on-treatment and 4-weeks off-treatment at Week 52. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for patients ≥ 18 years of age. For patients <18 years of age, the Bedside Schwartz equation was used to calculate eGFR.
Results
In placebo patients, mean (SD) eGFR decreased by 4.4 ± 11.0 mL/min/1.73 m2 from baseline whereas patients receiving omaveloxolone had an average increase of +7.0 ± 10.7 mL/min/1.73 m2 from baseline after 48 weeks, resulting in a difference of 11.4 mL/min/1.73 m2 between treatment groups. At Week 52, mean eGFR was -4.2 ± 10.9 mL/min/1.73 m2 relative to baseline in placebo patients and remained +0.9 ± 10.8 mL/min/1.73 m2 above baseline in omaveloxolone patients after 4-weeks off-treatment. In pediatric patients randomized to placebo, at week 48 eGFR decreased by -11.3 ± 14.3 mL/min/1.73 m2 whereas patients receiving omaveloxolone had an average increase of +5.5 ± 14.5 mL/min/1.73 m2 from baseline, resulting in a difference of 16.8 mL/min/1.73 m2 between treatment groups.
Conclusion
Patients with FA randomized to placebo in the MOXIe trial had eGFR declines over 48 weeks that were similar to rates of decline observed in the most rapidly progressing forms of chronic kidney disease. The rapid kidney function decline in FA reflects the multi-system nature of the disease whereby mitochondrial dysfunction, and associated chronic inflammation, affects not only the central nervous system but also the heart and possibly the kidney. In contrast to placebo, treatment with omaveloxolone improved eGFR in patients with FA and the effects were sustained through one year of treatment. The durability of eGFR improvements are consistent with those observed with its analog, bardoxolone methyl, in clinical trials for various forms of CKD.
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Affiliation(s)
- Philippe Zaoui
- Université Grenoble Alpes, Clinique de Néphrologie CHU Grenoble, La Tronche, France
| | - Melanie Chin
- Reata Pharmaceuticals, Inc., Product Development, Plano, United States of America
| | | | - Paola Giunti
- UCL Queen Square Institute of Neurology, Clinical and Movement Neurosciences, London, United Kingdom
| | - Angie Goldsberry
- Reata Pharmaceuticals, Inc., Product Development, Plano, United States of America
| | - Colin Meyer
- Reata Pharmaceuticals, Inc., Product Development, Plano, United States of America
| | - Megan O'Grady
- Reata Pharmaceuticals, Inc., Product Development, Plano, United States of America
| | - Susan Perlman
- Ronald Reagan UCLA Medical Center, Department Neurology, Los Angeles, United States of America
| | - S H Subramony
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, Gainesville, United States of America
| | - Theresa Zesiewicz
- University Of South Florida, Department of Neurology, Tampa, United States of America
| | - David Lynch
- Children's Hospital of Philadelphia, Department Neurology, Philadelphia, United States of America
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14
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Frimat L, Amirou M, Jaulin JP, Sinnasse-Raymond G, Pau D, Zaoui P, Rostoker G. [Impact of comorbidities on hemoglobin stability in patients with chronic kidney insufficiency on hemodialysis, treated with CERA in current practice: The MIRIADE study]. Nephrol Ther 2019; 15:162-168. [PMID: 30905547 DOI: 10.1016/j.nephro.2018.11.006] [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: 06/14/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
This national, prospective and multicenter study aimed to describe the real-life impact of comorbidities on hemoglobin stability in patients with chronic kidney disease on hemodialysis, treated with CERA in relay of an erythropoietin stimulating agent. Comorbidities were defined by the Charlson Index (adjusted on age) and hemoglobin stability as a variation of ±1g/dL after the 6-month treatment period. The 585 analyzed patients were distributed as follows according to the adjusted Charlson index: score≤3 (12% of patients), 4≤score≤5 (17%), 6≤score≤7 (31%) and score≥8 (40%). At CERA start, its median monthly dose was of 100μg for the overall population, with no changes during the treatment period and with little variation according to the comorbidity score. Patients with stable hemoglobin (56%, 67% if score≤3) were more numerous to reach the therapeutic target range between 10 and 12g/dL after 6 months (85% versus 43% if not stable hemoglobin). Patients with low C-reactive protein value (≤5mg/L ; P=0.04), no red blood cell transfusion (P=0.03), or no/low dose of intravenous iron (≤200mg ; P=0.03) were more likely to reach stable hemoglobin under CERA after 6 months. Among the 644 CERA-treated patients, 4 patients (<1%) had one serious adverse event related to treatment. A stable hemoglobin within the therapeutic target was reached in the majority of the patients after 6 months in current practice with a lower CERA dose, regardless of the comorbidities scores of patients on hemodialysis.
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Affiliation(s)
- Luc Frimat
- Service de néphrologie, CHU de Nancy, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - Mustapha Amirou
- Service de néphrologie-hémodialyse, hôpital Jacques-Puel, avenue de l'Hôpital, 12000 Rodez, France
| | - Jean-Paul Jaulin
- Service de médecine néphrologie-hémodialyse, centre hospitalier les Oudairies, 85000 La Roche-sur-Yon, France
| | | | - David Pau
- Département médical, Roche, 30, cours de l'Île-Seguin, 92100 Boulogne-Billancourt, France
| | - Philippe Zaoui
- Service de néphrologie, hôpital A.-Michallon, boulevard de la Chantourne, 38700 La Tronche, France
| | - Guy Rostoker
- Hôpital privé Claude-Galien, 20, route de Boussy-Saint-Antoine, 91480 Quincy-sous-Sénart, France
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15
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Combe C, Mann J, Goldsmith D, Dellanna F, Zaoui P, London G, Denhaerynck K, Krendyukov A, Abraham I, MacDonald K. Potential life-years gained over a 5-year period by correcting DOPPS-identified modifiable practices in haemodialysis: results from the European MONITOR-CKD5 study. BMC Nephrol 2019; 20:81. [PMID: 30836953 PMCID: PMC6402099 DOI: 10.1186/s12882-019-1251-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/08/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND DOPPS reported that thousands of life-years could be gained in the US and Europe over 5 years by correcting six modifiable haemodialysis practices. We estimated potential life-years gained across 10 European countries using MONITOR-CKD5 study data. METHODS The DOPPS-based target ranges were used, except for haemoglobin due to label changes, as well as DOPPS-derived relative mortality risks. Percentages of MONITOR-CKD5 patients outside targets were calculated. Consistent with the DOPPS-based analyses, we extrapolated life-years gained for the MONITOR-CKD5 population over 5 years if all patients were within targets. RESULTS Bringing the 10 MONITOR-CKD5 countries' dialysis populations into compliance on the six practices results in a 5-year gain of 97,428 patient-years. In descending order, survival impact was the highest for albumin levels, followed by phosphate levels, vascular access, haemoglobin, dialysis adequacy, and interdialytic weight gain. CONCLUSIONS Optimal management of the six modifiable haemodialysis practices may achieve 6.2% increase in 5-year survival. TRIAL REGISTRATION NCT01121237 . Clinicaltrials.gov registration May 12, 2010 (retrospectively registered).
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Affiliation(s)
- Christian Combe
- Centre Hospitalier Universitaire de Bordeaux and Unité INSERM 1026, University of Bordeaux, Bordeaux, France
| | - Johannes Mann
- Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | - Gérard London
- Centre Hospitalier F.H. Manhés, Fleury-Mérogis, France
| | - Kris Denhaerynck
- Matrix45, Tucson, AZ USA
- Department of Public Health, University of Basel, Basel, Switzerland
| | | | - Ivo Abraham
- Matrix45, Tucson, AZ USA
- University of Arizona College of Pharmacy and College of Medicine, Tucson, AZ USA
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16
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Romanet T, Bedouch P, Zaoui P. [Assessment of iron deficiency anemia management in the general hospital of Grenoble: A 12-month follow-up of an intravenous ferric carboxymaltose treatment program in a cohort of patients with non-dialysis-dependent chronic kidney disease]. Nephrol Ther 2019; 15:104-109. [PMID: 30803900 DOI: 10.1016/j.nephro.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The FIND-CKD study has validated the use of ferric carboxymaltose (FCM) injection with a target of ferritin level between 400 and 600ng/mL to treat iron deficiency anemia in non-dialysis-dependent chronic kidney disease (ND-CKD) patients. In order to assess this strategy in clinical practice, we constituted a cohort of patients within our nephrology department. PATIENTS AND METHODS Patients had CKD stages 3 to 5, hemoglobin level (Hb)<13g/dL (men) or<12g/dL (women), and ferritin level (F)<100ng/mL or transferrin saturation (TSAT)<20%. They were not treated by erythropoiesis-stimulating agent (ESA) for at least one month, and oral iron had been poorly tolerated or ineffective. FCM first dose was adjusted according to patient weight. A new infusion was possible, at least one month after the first, with a half-dose if TSAT<20% but F≥200ng/mL; no perfusion was performed if F≥400ng/mL. RESULTS In all, 53 patients were included with a mean Hb of 11.4g/dL and a mean TSAT of 16%. Over one year of follow-up, only 12 patients (22.6%) needed another treatment for anemia (blood transfusion or ESA). No patient showed a significant decrease in Hb. In all, 62% of patients received only one infusion of FCM. CONCLUSION The administration of FCM IV with ferritin levels in the recommended target has proven effective in correcting anemia of ND-CKD patients while limiting the use of another therapeutic strategy.
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Affiliation(s)
- Thierry Romanet
- Service de néphrologie, dialyses, aphérèses, transplantation rénale, CHU Grenoble-Alpes, CS 10 217, 38043 Grenoble cedex 9, France; Pôle pharmacie, pharmacie clinique, secteur soins pharmaceutiques, CHU Grenoble-Alpes, CS 10 217, 38043 Grenoble cedex 9, France
| | - Pierrick Bedouch
- Pôle pharmacie, pharmacie clinique, secteur soins pharmaceutiques, CHU Grenoble-Alpes, CS 10 217, 38043 Grenoble cedex 9, France
| | - Philippe Zaoui
- Service de néphrologie, dialyses, aphérèses, transplantation rénale, CHU Grenoble-Alpes, CS 10 217, 38043 Grenoble cedex 9, France.
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17
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Zaoui P, Hannedouche T, Combe C. [Cardiovascular protection of diabetic patient with chronic renal disease and particular case of end-stage renal disease in elderly patients]. Nephrol Ther 2018; 13:6S16-6S24. [PMID: 29463395 DOI: 10.1016/s1769-7255(18)30036-1] [Citation(s) in RCA: 4] [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] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes has an increasing prevalence. Life expectancy is dominated by cardiovascular risk, which is the leading cause of death in these patients. Up to one third of diabetic patients will develop diabetic nephropathy related to micro-angiopathy. Renal impairment further increases cardiovascular risk. Reducing cardiovascular morbidity and mortality is a major public health issue, as well as early preventing and managing chronic kidney disease (CKD). Good glycemic control prevents the micro-vascular complications of the disease (retinopathy, nephropathy, etc.) and, more recently recognized through prolonged monitoring of the VADT cohort, prevents cardiovascular complications. Control of blood pressure and dyslipidemia are essential in primary or secondary cardiovascular prevention. In addition, the blockers of the renin-angiotensin system slow down the progression of the MRC. Elderly patients with chronic kidney disease (CKD) form another growing group of the nephrologist daily patient pool. Especially for very elderly patients with comorbidities, the question of favoring conservative treatment rather than starting or pursuing dialysis may arise. Survival and quality of life are indeed not necessarily better in elderly patients undergoing dialysis, complications can occur eventually leading to discontinuation, and are occasionally associated with a feeling of stubbornness. Creation of prognostic score is a useful tool to help the decision-making process. However, dialogue with the patient and his/her family, as well as multidisciplinary collaboration remain fundamentals to determine the most suitable care.
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Affiliation(s)
- P Zaoui
- Pôle Digestif Uro-Néphro-Endocrinologie (DIGIDUNE), AGDUC, CHU Université Grenoble Alpes, Pole Santé, France.
| | - T Hannedouche
- Service de Néphrologie, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine, Strasbourg, France.
| | - C Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France Unité INSERM 1026 Biotis, Université de Bordeaux, Bordeaux, France.
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18
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Bertocchio JP, Baranger T, Isnard-Rouchon M, Zaoui P, Mousson C, Deray G. Divergences (et convergences) de perceptions entre patients et néphrologues de l’impact de l’insuffisance rénale chronique non terminale sur l’élan vital en France : résultats de l’enquête MAEVA. Nephrol Ther 2018; 14:222-230. [DOI: 10.1016/j.nephro.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 11/16/2022]
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Barbieux P, György B, Gand E, Saulnier PJ, Ducrocq G, Halimi JM, Feigerlova E, Hulin-Delmotte C, Llaty P, Montaigne D, Rigalleau V, Roussel R, Sosner P, Zaoui P, Ragot S, Marre M, Tregouët DA, Hadjadj S. No prognostic role of a GWAS-derived genetic risk score in renal outcomes for patients from French cohorts with type 1 and type 2 diabetes. Diabetes Metab 2018. [PMID: 29540294 DOI: 10.1016/j.diabet.2018.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- P Barbieux
- Service d'endocrinologie, CHU de Poitiers, 86000 Poitiers, France
| | - B György
- Inserm UMR-S1166, Sorbonne universités, UPMC université Paris 06, 75013, Paris, France; ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
| | - E Gand
- CHU de Poitiers, pôle Dune, 86000 Poitiers, France
| | - P-J Saulnier
- UFR médecine pharmacie, centre d'investigation clinique, université de Poitiers, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Inserm, CIC 1402 & U1082, 86000 Poitiers, France
| | - G Ducrocq
- Inserm U698, 75018 Paris, France; Département de cardiologie, groupe hospitalier Bichat Claude-Bernard, Assistance publique-Hôpitaux de Paris (AP-HP), 75018 Paris, France
| | - J-M Halimi
- Service néphrologie, dialyse et transplantation, CHU de Tours, 37000 Tours, France; Inserm, centre d'investigation clinique 0202, 37000 Tours, France
| | - E Feigerlova
- Service d'endocrinologie, CHU de Poitiers, 86000 Poitiers, France; UFR médecine pharmacie, centre d'investigation clinique, université de Poitiers, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Inserm, CIC 1402 & U1082, 86000 Poitiers, France
| | | | - P Llaty
- Service de cardiologie, CHU de Poitiers, 86000 Poitiers, France
| | - D Montaigne
- Service d'explorations fonctionnelles cardiovasculaires, CHU de Lille, 59000 Lille, France; Université de Lille, 59000 Lille, France; Inserm, U1011, 59000 Lille, France; EGID, 59000 Lille, France; Institut Pasteur de Lille, 59019 Lille, France
| | - V Rigalleau
- Service endocrinologie, diabétologie maladies métaboliques et nutrition, CHU de Bordeaux, 33604 Pessac cedex, France; Université Victor-Segalen, faculté de médecine, 33000 Bordeaux, France
| | - R Roussel
- UMR_S 1138, centre de recherche des Cordeliers, Sorbonne Paris-Cité, université Paris-Diderot, 75006 Paris, France; Diabetologie endocrinologie nutrition, DHU FIRE, AP-HP, hôpital Bichat, 75018 Paris, France; Inserm UMR-S 1138, centre de recherche des Cordeliers, 75006 Paris, France
| | - P Sosner
- Service de cardiologie, CHU de Poitiers, 86000 Poitiers, France; Complexe médico-sportif Mon Stade, 75013 Paris, France; Laboratoire MOVE (EA 6314), université de Poitiers, 86000 Poitiers, France
| | - P Zaoui
- Service néphrologie, dialyse et transplantation, CHU de Grenoble, 38000 Grenoble, France; Faculté de médecine, université Grenoble Alpes, 38000 Grenoble, France
| | - S Ragot
- UFR médecine pharmacie, centre d'investigation clinique, université de Poitiers, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Inserm, CIC 1402 & U1082, 86000 Poitiers, France
| | - M Marre
- UMR_S 1138, centre de recherche des Cordeliers, Sorbonne Paris-Cité, université Paris-Diderot, 75006 Paris, France; Diabetologie endocrinologie nutrition, DHU FIRE, AP-HP, hôpital Bichat, 75018 Paris, France; Inserm UMR-S 1138, centre de recherche des Cordeliers, 75006 Paris, France
| | - D-A Tregouët
- Inserm UMR-S1166, Sorbonne universités, UPMC université Paris 06, 75013, Paris, France; ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
| | - S Hadjadj
- Service d'endocrinologie, CHU de Poitiers, 86000 Poitiers, France; UFR médecine pharmacie, centre d'investigation clinique, université de Poitiers, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Inserm, CIC 1402 & U1082, 86000 Poitiers, France; UFR médecine pharmacie, université de Poitiers, 86000 Poitiers, France.
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Romanet T, Tartry D, Jouet C, Zaoui P. Anémie ferriprive au cours de l’insuffisance rénale chronique non dialysée : évaluation d’une prise en charge protocolisée. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.243] [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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Rigault G, Franko B, Chabre O, Quemerai MA, Nemoz B, Zaoui P. [Hyponatremic-hypertensive syndrome successfully treated by endovascular therapy: A case report]. Ann Cardiol Angeiol (Paris) 2017; 66:243-245. [PMID: 28506580 DOI: 10.1016/j.ancard.2017.03.001] [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: 02/17/2016] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hyponatremic-hypertensive syndrome (HHS) is characterized by hypertension and hyponatremia. CASE PRESENTATION We report a case of HHS in a 73-year-old woman, revealed by a hyponatremia leading to status epilepticus, without initial hypertension due to hypovolemia. She was successfully treated by endovascular therapy without any long-term supplementation or anti-hypertensive medication. CONCLUSION Physiopathology hypothesis of HHS implicate pressure natriuresis, in this case, hypertension is not initially found and we discuss other hyponatremia mechanisms.
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Affiliation(s)
- G Rigault
- Service de néphrologie, hospital A.-Michallon, boulevard de la Chantourne, 38700 La Tronche, France
| | - B Franko
- Service de néphrologie, hospital A.-Michallon, boulevard de la Chantourne, 38700 La Tronche, France; Service de néphrologie, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France.
| | - O Chabre
- Service d'endocrinologie, hospital A.-Michallon, boulevard de la Chantourne, 38700 La Tronche, France
| | - M-A Quemerai
- Service d'endocrinologie, hospital A.-Michallon, boulevard de la Chantourne, 38700 La Tronche, France
| | - B Nemoz
- Département de biologie, institut de biologie et de pathologie, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Zaoui
- Service de néphrologie, hospital A.-Michallon, boulevard de la Chantourne, 38700 La Tronche, France
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22
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Saulnier PJ, Gand E, Velho G, Mohammedi K, Zaoui P, Fraty M, Halimi JM, Roussel R, Ragot S, Hadjadj S. Association of Circulating Biomarkers (Adrenomedullin, TNFR1, and NT-proBNP) With Renal Function Decline in Patients With Type 2 Diabetes: A French Prospective Cohort. Diabetes Care 2017; 40:367-374. [PMID: 27998909 DOI: 10.2337/dc16-1571] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/24/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We explored the prognostic value of three circulating candidate biomarkers-midregional-proadrenomedullin (MR-proADM), soluble tumor necrosis factor receptor 1 (sTNFR1), and N-terminal prohormone brain natriuretic peptide (NT-proBNP)-for change in renal function in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Outcomes were defined as renal function loss (RFL), ≥40% decline of estimated glomerular filtration rate (eGFR) from baseline, and rapid renal function decline (RRFD), absolute annual eGFR slope <-5 mL/min/year. We used a proportional hazard model for RFL and a logistic model for RRFD. Adjustments were performed for established risk factors (age, sex, diabetes duration, HbA1c, blood pressure, baseline eGFR, and urinary albumin-to-creatinine ratio [uACR]). C-statistics were used to assess the incremental predictive value of the biomarkers to these risk factors. RESULTS Among 1,135 participants (mean eGFR 76 mL/min, median uACR 2.6 mg/mmol, and median GFR slope -1.6 mL/min/year), RFL occurred in 397, RRFD developed in 233, and 292 died during follow-up. Each biomarker predicted RFL and RRFD. When combined, MR-proADM, sTNFR1, and NT-proBNP predicted RFL independently from the established risk factors (adjusted hazard ratio 1.59 [95% CI 1.34-1.89], P < 0.0001; 1.33 [1.14-1.55], P = 0.0003; and 1.22 [1.07-1.40], P = 0.004, respectively) and RRFD (adjusted odds ratio 1.56 [95% CI 1.7-2.09], P = 0.003; 1.72 [1.33-2.22], P < 0.0001; and 1.28 [1.03-1.59], P = 0.02, respectively). The combination of the three biomarkers yielded the highest discrimination (difference in C-statistic = 0.054, P < 0.0001; 0.067, P < 0.0001 for RFL; and 0.027, P < 0.0001 for RRFD). CONCLUSIONS In addition to established risk factors, MR-proADM, sTNFR1, and NT-proBNP improve risk prediction of loss of renal function in patients with type 2 diabetes.
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Affiliation(s)
- Pierre-Jean Saulnier
- Centre Investigation Clinique 1402, University of Poitiers, Poitiers, France .,Centre Investigation Clinique, CHU Poitiers, Poitiers, France.,Centre Investigation Clinique CIC1402, INSERM, Poitiers, France
| | - Elise Gand
- Pole DUNE, CHU Poitiers, Poitiers, France
| | - Gilberto Velho
- INSERM, UMRS1138, Paris, France.,UMRS1138, University of Paris 7 Denis Diderot, Paris, France
| | - Kamel Mohammedi
- INSERM, UMRS1138, Paris, France.,Department of Endocrinology, Diabetology, Nutrition, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Philippe Zaoui
- Department of Nephrology, CHU Grenoble, Grenoble, France
| | | | | | - Ronan Roussel
- INSERM, UMRS1138, Paris, France.,UMRS1138, University of Paris 7 Denis Diderot, Paris, France.,Department of Endocrinology, Diabetology, Nutrition, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphanie Ragot
- Centre Investigation Clinique 1402, University of Poitiers, Poitiers, France.,Centre Investigation Clinique, CHU Poitiers, Poitiers, France.,Centre Investigation Clinique CIC1402, INSERM, Poitiers, France
| | - Samy Hadjadj
- Centre Investigation Clinique 1402, University of Poitiers, Poitiers, France.,Centre Investigation Clinique, CHU Poitiers, Poitiers, France.,Centre Investigation Clinique CIC1402, INSERM, Poitiers, France.,Pole DUNE, CHU Poitiers, Poitiers, France.,U1082, INSERM, Poitiers, France
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23
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Gellen B, Thorin-Trescases N, Sosner P, Gand E, Saulnier PJ, Ragot S, Fraty M, Laugier S, Ducrocq G, Montaigne D, Llaty P, Rigalleau V, Zaoui P, Halimi JM, Roussel R, Thorin E, Hadjadj S. ANGPTL2 is associated with an increased risk of cardiovascular events and death in diabetic patients. Diabetologia 2016; 59:2321-2330. [PMID: 27491833 DOI: 10.1007/s00125-016-4066-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/12/2016] [Indexed: 01/24/2023]
Abstract
AIMS/HYPOTHESIS A high serum angiopoietin-like 2 (ANGPTL2) concentration is an independent risk factor for developing diabetes and is associated with insulin resistance and atherosclerosis. In this work, we have examined the impact of serum ANGPTL2 on improving cardiovascular (CV) risk stratification in patients with type 2 diabetes. METHODS A prospective, monocentric cohort of consecutive type 2 diabetes patients (the SURDIAGENE cohort; total of 1353 type 2 diabetes patients; 58% men, mean ± SD age 64 ± 11 years) was followed for a median of 6.0 years for death as primary endpoint and major adverse CV events (MACE; i.e. CV death, myocardial infarction or stroke) as a secondary endpoint. Patients with end-stage renal disease, defined as a requirement for dialysis or a history of kidney transplantation, were excluded. Patients were grouped into quartiles according to ANGPTL2 concentrations at inclusion: <11.2 (Q1), 11.2-14.7 (Q2), 14.8-19.5 (Q3) or >19.5 (Q4) ng/ml. RESULTS During follow up, 367 patients (representing 4.5% of the total person-years) died and 290 patients (representing 3.7% of the total person-years) presented with MACE. Both the survival and MACE-free survival rates were significantly different between ANGPTL2 quartiles (logrank 82.12, p < 0.0001 for death; and logrank 65.14, p < 0.0001 for MACE). Patients with ANGPTL2 concentrations higher than 19.5 ng/ml (Q4) had a significantly higher risk of death and MACE than those with ANGPTL2 levels of 19.5 ng/ml or less (Q1-3) (HR for death 2.44 [95% CI 1.98, 3.00], p < 0.0001; HR for MACE 2.43 [95% CI 1.92, 3.06], p < 0.0001) after adjustment for sex, age and established CV risk factors. Using ANGPTL2 concentrations, prediction of the risk of mortality, as assessed by integrated discrimination improvement (IDI), was significantly improved (IDI 0.006 ± 0.002, p = 0.0002). CONCLUSIONS/INTERPRETATION In patients with type 2 diabetes, serum ANGPTL2 concentrations were independently associated with death and MACE. Therefore, ANGPTL2 is a promising candidate biomarker for improving risk stratification in type 2 diabetes patients, and may prove to be a valuable therapeutic target.
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Affiliation(s)
- Barnabas Gellen
- ELSAN, Polyclinique de Poitiers, 1 Rue de la Providence, F-8600, Poitiers, France.
- Department of Cardiology, CHU Henri Mondor, Créteil, France.
- Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France.
| | - Nathalie Thorin-Trescases
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, QC, Canada
| | - Philippe Sosner
- CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France
- Université de Poitiers, Laboratoire MOVE (EA 6314), Poitiers, France
- Centre Médico-Sportif Mon Stade, Paris, France
| | - Elise Gand
- CHU de Poitiers, Pôle Dune, Poitiers, France
| | - Pierre-Jean Saulnier
- CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France
- Inserm, CIC 1402, Poitiers, France
- UFR Médecine Pharmacie, Université de Poitiers, Poitiers, France
| | - Stéphanie Ragot
- CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France
| | | | - Stéphanie Laugier
- UFR Médecine Pharmacie, Université de Poitiers, Poitiers, France
- Endocrinologie-Diabétologie, CHU de Poitiers, Poitiers, France
| | - Grégory Ducrocq
- Département Hospitalo-Universitaire FIRE, APHP, Hôpital Bichat, Paris, France
- Faculté de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Inserm U-1148, Paris, France
| | - David Montaigne
- CHU Lille, Service d'Explorations Fonctionnelles Cardiovasculaires, Hôpital Cardiologique, Lille, France
- Faculté de Médecine, Université de Lille, Lille, France
- Inserm U1011, Lille, France
- EGID, Lille, France
- Institut Pasteur de Lille, Lille, France
| | - Pierre Llaty
- CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France
| | - Vincent Rigalleau
- CHU Bordeaux, Haut-Lévêque Hospital, Nutrition-Diabetology Department, Pessac, France
| | - Philippe Zaoui
- CHU de Grenoble, Service Néphrologie, Dialyse et Transplantation, Grenoble, France
- Faculté de Médecine, Université Joseph Fournier, Grenoble, France
| | - Jean-Michel Halimi
- CHU de Tours, Service Néphrologie, Dialyse et Transplantation, Tours, France
| | - Ronan Roussel
- Département Hospitalo-Universitaire FIRE, APHP, Hôpital Bichat, Paris, France
- Faculté de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Eric Thorin
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, QC, Canada
| | - Samy Hadjadj
- CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France
- Inserm, CIC 1402, Poitiers, France
- UFR Médecine Pharmacie, Université de Poitiers, Poitiers, France
- Endocrinologie-Diabétologie, CHU de Poitiers, Poitiers, France
- Inserm U1082, Poitiers, France
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Voelker J, Berg PH, Sheetz M, Duffin K, Shen T, Moser B, Greene T, Blumenthal SS, Rychlik I, Yagil Y, Zaoui P, Lewis JB. Anti-TGF- β1 Antibody Therapy in Patients with Diabetic Nephropathy. J Am Soc Nephrol 2016; 28:953-962. [PMID: 27647855 DOI: 10.1681/asn.2015111230] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 07/31/2016] [Indexed: 12/15/2022] Open
Abstract
TGF-β has been implicated as a major pathogenic factor in diabetic nephropathy. This randomized, double-blind, phase 2 study assessed whether modulating TGF-β1 activity with a TGF-β1-specific, humanized, neutralizing monoclonal antibody (TGF-β1 mAb) is safe and more effective than placebo in slowing renal function loss in patients with diabetic nephropathy on chronic stable renin-angiotensin system inhibitor treatment. We randomized 416 patients aged ≥25 years with type 1 or type 2 diabetes, a serum creatinine (SCr) level of 1.3-3.3 mg/dl for women and 1.5-3.5 mg/dl for men (or eGFR of 20-60 ml/min per 1.73 m2), and a 24-hour urine protein-to-creatinine ratio ≥800 mg/g to TGF-β1 mAb (2-, 10-, or 50-mg monthly subcutaneous dosing for 12 months) or placebo. We assessed a change in SCr from baseline to 12 months as the primary efficacy variable. Although the Data Monitoring Committee did not identify safety issues, we terminated the trial 4 months early for futility on the basis of their recommendation. The placebo group had a mean±SD change in SCr from baseline to end of treatment of 0.33±0.67 mg/dl. Least squares mean percentage change in SCr from baseline to end of treatment did not differ between placebo (14%; 95% confidence interval [95% CI], 9.7% to 18.2%) and TGF-β1 mAb treatments (20% [95% CI, 15.3% to 24.3%], 19% [95% CI, 14.2% to 23.0%], and 19% [95% CI, 14.0% to 23.3%] for 2-, 10-, and 50-mg doses, respectively). Thus, TGF-β1 mAb added to renin-angiotensin system inhibitors did not slow progression of diabetic nephropathy.
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Affiliation(s)
- James Voelker
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana;
| | - Paul H Berg
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Matthew Sheetz
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Kevin Duffin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Tong Shen
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Brian Moser
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Tom Greene
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Samuel S Blumenthal
- Department of Medicine, Zablocki Veterans Administration Medical Center, Milwaukee, Wisconsin
| | - Ivan Rychlik
- Second Department of Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Yoram Yagil
- Barzilai University Medical Center, Department of Nephrology and Hypertension, Ashkelon and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Philippe Zaoui
- Clinique Universitaire de Néphrologie, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France; and
| | - Julia B Lewis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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25
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Carron P, Heitz M, Gierczak V, Truche A, Mingat N, Sirajedine K, Guillon WQ, Gaultier J, Clavarino G, Maurizi J, Zaoui P. Utilisation du rituximab pour le traitement de la maladie des anticorps anti-membrane basale glomérulaire (anti-MBG). Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.199] [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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26
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Truche A, Darmon M, Bailly S, Clec’h C, Dupuis C, Misset B, Schwebel C, Adrie C, Marcotte G, Zaoui P, Souweine B, Timsit J. Impact sur la mortalité et le pronostic rénal de la modalité d’épuration extrarénale employée en réanimation. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.319] [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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27
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Baranger T, Bertocchio J, Isnard-Rouchon M, Mousson C, Zaoui P, Deray G. Élan vital des patients insuffisants rénaux chroniques (IRC) non dialysés : vision croisée des néphrologues et des patients d’après les premiers résultats de l’enquête MAEVA. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.182] [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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28
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Truche AS, Darmon M, Bailly S, Clec'h C, Dupuis C, Misset B, Azoulay E, Schwebel C, Bouadma L, Kallel H, Adrie C, Dumenil AS, Argaud L, Marcotte G, Jamali S, Zaoui P, Laurent V, Goldgran-Toledano D, Sonneville R, Souweine B, Timsit JF. Erratum to: Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery. Intensive Care Med 2016; 42:1523. [PMID: 27448247 DOI: 10.1007/s00134-016-4418-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anne-Sophie Truche
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France
- Nephrology, Grenoble University Hospital, La Tronche, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint Etienne University Hospital, Saint-Etienne, France
- Jacques Lisfranc Medicine University, Jean Monnet University, Saint-Etienne, France
| | - Sébastien Bailly
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France
- Grenoble Alpes University, U823, Rond-point de La Chantourne, 38700, La Tronche, France
| | - Christophe Clec'h
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France
- Intensive Care Unit, AP-HP, Avicenne Hospital, Paris, France
- Medicine University, Paris 13 University, Bobigny, France
| | - Claire Dupuis
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France
- AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University, 75018, Paris, France
| | - Benoit Misset
- Intensive Care Unit, Saint Joseph Hospital Network, Paris, France
- Sorbonne Cite, Medicine University, Paris Descartes University, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, AP-HP, Saint Louis Hospital, Paris, France
- Medicine University, Paris 5 University, Paris, France
| | - Carole Schwebel
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France
| | - Lila Bouadma
- AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University, 75018, Paris, France
| | - Hatem Kallel
- Medical Surgical ICU, Centre Hospitalier de Cayenne, Guyane, France
| | - Christophe Adrie
- Physiology Department, Cochin University Hospital, Assistance Publique Des Hôpitaux de Paris (AP-HP), Paris Descartes University, Sorbonne Cite, Paris, France
| | - Anne-Sylvie Dumenil
- AP-HP, Antoine Béclère University Hospital, Medical-surgical Intensive Care Unit, Clamart, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Lyon University Hospital, Lyon, France
| | | | - Samir Jamali
- Critical Care Medicine Unit Dourdan Hospital, Dourdan, France
| | - Philippe Zaoui
- Nephrology, Grenoble University Hospital, La Tronche, France
| | - Virginie Laurent
- Medical Intensive Care Unit, André Mignot Hospital, Versailles, France
| | | | - Romain Sonneville
- AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University, 75018, Paris, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-Francois Timsit
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France.
- AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University, 75018, Paris, France.
- Université Paris Diderot/Hôpital Bichat, Réanimation Medicale et des maladies infectieuses, 46 rue Henri Huchard, Paris, 75018, France.
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Ragot S, Saulnier PJ, Velho G, Gand E, de Hauteclocque A, Slaoui Y, Potier L, Sosner P, Halimi JM, Zaoui P, Rigalleau V, Fumeron F, Roussel R, Marre M, Hadjadj S. Dynamic Changes in Renal Function Are Associated With Major Cardiovascular Events in Patients With Type 2 Diabetes. Diabetes Care 2016; 39:1259-66. [PMID: 27222502 DOI: 10.2337/dc15-2607] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/18/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The pattern of renal function decline prior to cardiovascular (CV) events in type 2 diabetes is not well known. Our aim was to describe the association between renal function trajectories and the occurrence of a CV event. RESEARCH DESIGN AND METHODS We considered patients with type 2 diabetes from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study (discovery cohort) and the DIABHYCAR (Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril) study (replication cohort). Global patterns of estimated glomerular filtration rate (eGFR) (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and serum creatinine (SCr) prior to a major CV event (MACE) or last update were determined using a linear mixed-effects model and annual individual slopes computed by simple linear regression. RESULTS In the 1,040 participants of the discovery cohort, establishment of global patterns including 22,227 SCr over 6.3 years of follow-up showed an annual eGFR decline and an annual SCr increase that were significantly greater in patients with MACE compared with patients without (-3.0 and -1.7 mL/min/1.73 m(2)/year and +10.7 and +4.0 μmol/L/year, respectively; P < 0.0001 for both). Median annual individual slopes were also significantly steeper in patients with MACE, and adjusted risk of MACE was 4.11 times higher (3.09-5.45) in patients with rapid decline in eGFR (change less than -5 mL/min/1.73 m(2)/year). Consideration of renal function trajectories provided significant additive information helping to explain the occurrence of MACE for both SCr and eGFR (PIDI < 0.0001 and P = 0.0005, respectively). These results were confirmed in the replication cohort. CONCLUSIONS Renal function decline was associated with a higher risk of MACE. The pattern of renal function decline, beyond baseline kidney function, is an independent factor of CV risk.
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Affiliation(s)
- Stéphanie Ragot
- INSERM CIC 1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
| | - Pierre-Jean Saulnier
- INSERM CIC 1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
| | - Gilberto Velho
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Elise Gand
- Pôle DUNE, CHU de Poitiers, Poitiers, France
| | | | - Yousri Slaoui
- Laboratoire de Mathématiques et Applications, Université de Poitiers, Poitiers, France
| | - Louis Potier
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Philippe Sosner
- Complexe Médico-Sportif Mon Stade, Paris, France Laboratoire MOVE (EA 6314), Université de Poitiers, Poitiers, France
| | - Jean-Michel Halimi
- Service Néphrologie Immunologie Clinique, CHU de Tours, Tours, France Cellules Dendritiques, Immunomodulation, et Greffes (EA 4245), Université François Rabelais, Tours, France
| | - Philippe Zaoui
- Service Néphrologie, Dialyse, et Transplantation, CHU de Grenoble, Grenoble, France Faculté de Médecine, Université Joseph Fournier, Grenoble, France
| | - Vincent Rigalleau
- Service Nutrition-Diabétologie, CHU Haut-Lévêque, Pessac, France Faculté de Médecine, Université Victor Segalen, Bordeaux, France
| | - Frederic Fumeron
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Ronan Roussel
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Michel Marre
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Samy Hadjadj
- INSERM CIC 1402, Poitiers, France UFR Médecine Pharmacie, Université de Poitiers, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM U1082 IRTOMIT, Poitiers, France
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Truche AS, Darmon M, Bailly S, Clec'h C, Dupuis C, Misset B, Azoulay E, Schwebel C, Bouadma L, Kallel H, Adrie C, Dumenil AS, Argaud L, Marcotte G, Jamali S, Zaoui P, Laurent V, Goldgran-Toledano D, Sonneville R, Souweine B, Timsit JF. Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery. Intensive Care Med 2016; 42:1408-17. [PMID: 27260258 DOI: 10.1007/s00134-016-4404-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/23/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE The best renal replacement therapy (RRT) modality remains controversial. We compared mortality and short- and long-term renal recovery between patients treated with continuous RRT and intermittent hemodialysis. METHODS Patients of the prospective observational multicenter cohort database OUTCOMEREA™ were included if they underwent at least one RRT session between 2004 and 2014. Differences in patients' baseline and daily characteristics between treatment groups were taken into account by using a marginal structural Cox model, allowing one to substantially reduce the bias resulting from confounding factors in observational longitudinal data analysis. The composite primary endpoint was 30-day mortality and dialysis dependency. RESULTS Among 1360 included patients with RRT, 544 (40.0 %) and 816 (60.0 %) were initially treated by continuous RRT and intermittent hemodialysis, respectively. At day 30, 39.6 % patients were dead. Among survivors, 23.8 % still required RRT. There was no difference between groups for the primary endpoint in global population (HR 1.00, 95 % CI 0.77-1.29; p = 0.97). In patients with higher weight gain at RRT initiation, mortality and dialysis dependency were significantly lower with continuous RRT (HR 0.54, 95 % CI 0.29-0.99; p = 0.05). Conversely, this technique appeared to be deleterious in patients without shock (HR 2.24, 95 % CI 1.24-4.04; p = 0.01). Six-month mortality and persistent renal dysfunction were not influenced by the RRT modality in patients with dialysis dependence at ICU discharge. CONCLUSION Continuous RRT did not appear to improve 30-day and 6-month patient outcomes. It seems beneficial for patients with fluid overload, but might be deleterious in the absence of hemodynamic failure.
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Affiliation(s)
- Anne-Sophie Truche
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France.,Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France.,Nephrology, Grenoble University Hospital, La Tronche, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint Etienne University Hospital, Saint-Etienne, France.,Jacques Lisfranc Medicine University, Jean Monnet University, Saint-Etienne, France
| | - Sébastien Bailly
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France.,Grenoble Alpes University, U823, Rond-point de La Chantourne, 38700, La Tronche, France
| | - Christophe Clec'h
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France.,Intensive Care Unit, AP-HP, Avicenne Hospital, Paris, France.,Medicine University, Paris 13 University, Bobigny, France
| | - Claire Dupuis
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France.,AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University, 75018, Paris, France
| | - Benoit Misset
- Intensive Care Unit, Saint Joseph Hospital Network, Paris, France.,Sorbonne Cite, Medicine University, Paris Descartes University, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, AP-HP, Saint Louis Hospital, Paris, France.,Medicine University, Paris 5 University, Paris, France
| | - Carole Schwebel
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France
| | - Lila Bouadma
- AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University, 75018, Paris, France
| | - Hatem Kallel
- Medical Surgical ICU, Centre Hospitalier de Cayenne, Guyane, France
| | - Christophe Adrie
- Physiology Department, Cochin University Hospital, Assistance Publique Des Hôpitaux de Paris (AP-HP), Paris Descartes University, Sorbonne Cite, Paris, France
| | - Anne-Sylvie Dumenil
- AP-HP, Antoine Béclère University Hospital, Medical-surgical Intensive Care Unit, Clamart, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Lyon University Hospital, Lyon, France
| | | | - Samir Jamali
- Critical Care Medicine Unit Dourdan Hospital, Dourdan, France
| | - Philippe Zaoui
- Nephrology, Grenoble University Hospital, La Tronche, France
| | - Virginie Laurent
- Medical Intensive Care Unit, André Mignot Hospital, Versailles, France
| | | | - Romain Sonneville
- AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University, 75018, Paris, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-Francois Timsit
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, 75018, Paris, France. .,AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University, 75018, Paris, France. .,Université Paris Diderot/Hôpital Bichat, Réanimation Medicale et des maladies infectieuses, 46 rue Henri Huchard, Paris, 75018, France.
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Franko B, Benhamou PY, Genty C, Jouve T, Nasse L, Rzeoecki V, Semeraro P, Stasia MJ, Zaoui P. RAGE and CYBA polymorphisms are associated with microalbuminuria and end-stage renal disease onset in a cohort of type 1 diabetes mellitus patients over a 20-year follow-up. Acta Diabetol 2016; 53:469-75. [PMID: 26607824 DOI: 10.1007/s00592-015-0820-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/09/2015] [Indexed: 11/30/2022]
Abstract
AIMS We investigated the association of polymorphisms of three genes implicated in oxidative stress: CYBA C242T, RAGE -374T/A and -429T/C, and ALOX12 Arg261Gln, with the delay of microalbuminuria onset in patients with type 1 diabetes mellitus (DT1). METHODS A total of 162 T1D patients presenting with diabetes for 32.9 ± 9 years were included in the study; 53 had persistent microalbuminuria (>30 mg/l) and 109 did not. Onset of diabetes, microalbuminuria and end-stage renal disease (ESRD) were recorded as bio-clinical data. We determined polymorphism association of microalbuminuria with a Cox regression model. RESULTS All polymorphisms respected the Hardy-Weinberg equilibrium. The Cox regression model validated four significant variables associated with microalbuminuria: RAGE 374AA (HR 4.19 [1.84-9.58] (p = 0.001)), CYBA TT+TC (HR 2.1 [1.16-3.80], p = 0.015), male sex (HR 1.92 [1.07-3.43], p = 0.028) and diabetes diagnosis at the pediatric stage (HR 1.85 [1.03-3.32], p = 0.039). The same association was found with ESRD (p = 0.028 and p = 0.033 for CYBA TC+TT and RAGE 374AA, respectively). CYBA C242T and RAGE 374T/A were not significantly associated with diabetic retinopathy. CONCLUSIONS CYBA C242T and RAGE -374T/A correlate with microalbuminuria onset in the French DT1 cohort. The same correlation with ESRD onset supports the argument for the involvement of a genetic predisposition involving kidney-specific oxidative stress for diabetic nephropathy.
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Affiliation(s)
- Benoit Franko
- Department of Nephrology, Nephrology Clinic, Grenoble University Hospital, Grenoble, 38043, France.
- Chronic Granulomatous Disease Diagnosis and Research Centre, Therex-TIMC/Imag, UMR CNRS 5525, UJF-Grenoble 1, Université Grenoble Alpes, Grenoble, 38041, France.
| | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble, 38043, France
| | - Céline Genty
- UJF-Grenoble 1/CNRS/Clinical Research Centre-Inserm CIC03/TIMC-IMAG UMR 5525/Themas, Grenoble University Hospital, Grenoble, France
| | - Thomas Jouve
- Department of Nephrology, Nephrology Clinic, Grenoble University Hospital, Grenoble, 38043, France
| | - Laure Nasse
- Department of Endocrinology, Grenoble University Hospital, Grenoble, 38043, France
| | - Vincent Rzeoecki
- Chronic Granulomatous Disease Diagnosis and Research Centre, Therex-TIMC/Imag, UMR CNRS 5525, UJF-Grenoble 1, Université Grenoble Alpes, Grenoble, 38041, France
| | - Paul Semeraro
- Chronic Granulomatous Disease Diagnosis and Research Centre, Therex-TIMC/Imag, UMR CNRS 5525, UJF-Grenoble 1, Université Grenoble Alpes, Grenoble, 38041, France
| | - Marie José Stasia
- Chronic Granulomatous Disease Diagnosis and Research Centre, Therex-TIMC/Imag, UMR CNRS 5525, UJF-Grenoble 1, Université Grenoble Alpes, Grenoble, 38041, France
- CGD Centre, BEP/DBTP/Pôle Biologie, CHU de Grenoble, Grenoble, 38043, France
| | - Philippe Zaoui
- Department of Nephrology, Nephrology Clinic, Grenoble University Hospital, Grenoble, 38043, France
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Monseu M, Gand E, Saulnier PJ, Ragot S, Piguel X, Zaoui P, Rigalleau V, Marechaud R, Roussel R, Hadjadj S, Halimi JM. Acute Kidney Injury Predicts Major Adverse Outcomes in Diabetes: Synergic Impact With Low Glomerular Filtration Rate and Albuminuria. Diabetes Care 2015; 38:2333-40. [PMID: 26512039 DOI: 10.2337/dc15-1222] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 09/24/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Subjects with diabetes are prone to the development of cardiovascular and noncardiovascular complications. In separate studies, acute kidney injury (AKI), albuminuria, and low estimated glomerular filtration rate (eGFR) were shown to predict adverse outcomes, but, when considered together, their respective prognostic value is unknown. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes consecutively recruited in the SURDIAGENE cohort were prospectively followed up for major diabetes-related events, as adjudicated by an independent committee: death (with cause), major cardiovascular events (myocardial infarction, stroke, congestive heart failure, amputation, and arterial revascularization), and renal failure (i.e., sustained doubling of serum creatinine level or end-stage renal disease). RESULTS Intrahospital AKI occurred in 411 of 1,371 patients during the median follow-up period of 69 months. In multivariate analyses, AKI was significantly associated with cardiovascular and noncardiovascular death, including cancer-related death. In multivariate analyses, AKI was a powerful predictor of major adverse cardiovascular events, heart failure requiring hospitalization, myocardial infarction, stroke, lower-limb amputation or revascularization, and carotid artery revascularization. AKI, eGFR, and albuminuria, even when simultaneously considered in multivariate models, predicted all-cause and cardiovascular deaths. All three renal biomarkers were also prognostic of most adverse outcomes and of the risk of renal failure. CONCLUSIONS AKI, low eGFR, and elevated albuminuria, separately or together, are compelling biomarkers of major adverse outcomes and death in diabetes.
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Affiliation(s)
- Mathilde Monseu
- Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France
| | - Elise Gand
- Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France
| | - Pierre-Jean Saulnier
- Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France
| | - Stéphanie Ragot
- Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France
| | - Xavier Piguel
- Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France
| | - Philippe Zaoui
- Service Néphrologie, Dialyse et Transplantation, CHU de Grenoble, La Tronche, France Faculté de Médecine, Domaine de la Merci, Université Joseph Fourrier, Grenoble, France
| | - Vincent Rigalleau
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques et Nutrition, CHU de Bordeaux, Pessac, France
| | - Richard Marechaud
- Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
| | - Ronan Roussel
- Université Paris 7 Denis Diderot, U695, Paris, France Service d'Endocrinologie, Diabétologie, Nutrition, Groupe Hospitalier Bichat Claude Bernard, Assistance Public-Hôpitaux de Paris, Paris, France
| | - Samy Hadjadj
- Université de Poitiers, CIC1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM, CIC1402, Poitiers, France Service d'Endocrinologie, CHU de Poitiers, Pôle DUNE, Poitiers, France Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France INSERM, U1082, Poitiers, France
| | - Jean-Michel Halimi
- Service de Néphrologie, CHU de Tours, Tours, France Université François-Rabelais, EA4245, Faculté de Médecine, Tours, France
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Rigault G, Franko B, Pinel N, Ponard D, Zaoui P. Efficacité des échanges plasmatiques et du mabthera dans la glomérulonéphrite membrano-proliférative par anticorps anti-facteur H. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.250] [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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Roucher A, Zaoui P, Tartry D, Choukroun G, Mathis C, Moulin B, Fauvel J. Surveillance de la kaliémie et de la créatininémie au cours des essais cliniques par le laboratoire centralisé ou local ? Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.393] [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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Maurizi Balzan J, Fourneret E, Cimar L, Calvino Gunther S, Carron PL, Palacin P, Zaoui P. SP744MAINTENANCE DIALYSIS WITHDRAWAL: ACTIONS TO IMPROVE A SHARED-DECISION-MAKING MODEL. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv200.63] [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: 11/14/2022] Open
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Gesualdo L, Combe C, Covic A, Dellanna F, Goldsmith D, London G, Mann JF, Zaoui P, Turner M, Muenzberg M, MacDonald K, Abraham I. Risk-based individualisation of target haemoglobin in haemodialysis patients with renal anaemia in the post-TREAT era: theoretical attitudes versus actual practice patterns (MONITOR-CKD5 study). Int Urol Nephrol 2015; 47:837-45. [PMID: 25894959 PMCID: PMC4555197 DOI: 10.1007/s11255-015-0970-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 03/26/2015] [Accepted: 03/29/2015] [Indexed: 01/04/2023]
Abstract
Purpose Data from an ongoing European pharmacoepidemiological study (MONITOR-CKD5) were used to examine congruence between physician-reported risk-based individualisation of target haemoglobin (Hb) and the actual Hb targets set by these physicians for their patients, as well as actual Hb levels in their patients.
Methods Physician investigators participating in the study completed a questionnaire about their anaemia practice patterns and attitudes post-TREAT at the start of the study (T1) and in summer 2013 (T2). These data were compared with the Hb targets identified at baseline for actual patients (n = 1197) enrolled in the study. Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).
Results At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis. At T1, there was a clear difference in physician-reported (theoretical) target Hb levels for patients across the different risk groups, but there was no difference in patients’ actual Hb levels across the risk groups. A similar disparity was noted at T2. Conclusions Physicians’ theoretical attitudes to anaemia management in patients on haemodialysis appear to have been influenced by the results of the TREAT study, which involved patients not on dialysis. Physicians claim to use risk-based target Hb levels to guide renal anaemia care. However, there is discrepancy between these declared risk-based target Hb levels and actual target Hb levels for patients with variable risk factors.
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de Hauteclocque A, Ragot S, Slaoui Y, Gand E, Miot A, Sosner P, Halimi JM, Zaoui P, Rigalleau V, Roussel R, Saulnier PJ, Hadjadj Samy S. The influence of sex on renal function decline in people with Type 2 diabetes. Diabet Med 2014; 31:1121-8. [PMID: 24773061 DOI: 10.1111/dme.12478] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/03/2014] [Accepted: 04/23/2014] [Indexed: 12/20/2022]
Abstract
AIMS Several reports have suggested a relationship between male sex and albuminuria in Type 2 diabetes, but impact on renal function decline has not been established. Our aim was to describe the influence of sex on renal function decline in Type 2 diabetes. METHODS SURDIAGENE, an inception cohort, consisted in 1470 people with Type 2 diabetes. Patients without renal replacement therapy and with ≥ 3 serum creatinine determinations during follow-up prior to end-stage renal disease were included in the study. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Primary outcome was steep estimated glomerular filtration rate (eGFR) decline, defined as a yearly slope value lower than -3.5 ml min(-1) 1.73 m(-2). Secondary outcomes were estimated glomerular filtration rate trajectories according to sex and occurrence of end-stage renal disease. RESULTS A total of 22 914 serum creatinine determinations were considered in 1146 participants (60% men), aged 65 ± 11 years, with a median follow-up duration of 5.7 years (range 0.1-10.2). Median yearly estimated glomerular filtration rate slope was -1.31 ml min(-1) 1.73 m(-2) in women and -1.77 ml min(-1) 1.73 m(-2) in men (P < 0.001). Men were more likely than women to develop end-stage renal disease (22 men vs. 7 women; P(log-rank) = 0.03). Male sex was an independent risk factor of steep estimated glomerular filtration rate decline [adjusted odds ratio = 1.33 (1.02-1.76), P = 0.04] after adjustment for age, time from diagnosis of Type 2 diabetes, glycated haemoglobin, systolic blood pressure and urinary albumin:creatinine ratio. A multivariable linear mixed-effects model showed a significant difference of estimated glomerular filtration rate trajectories between men and women (P < 0.001). CONCLUSION Male sex is an important independent factor associated with renal function decline in Type 2 diabetes.
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Truche A, Guergour M, André M, Brocard S, Ducreux C, Kovacic I, Lopez L, Rognin E, Varano F, Granjean J, Carron PL, Zaoui P. Dialyse péritonéale et angiœdème héréditaire par déficit en C1 inhibiteur font-ils bon ménage ? Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.035] [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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Franko B, Brault J, Jouve T, Beaumel S, Benhamou PY, Zaoui P, Stasia MJ. Differential impact of glucose levels and advanced glycation end-products on tubular cell viability and pro-inflammatory/profibrotic functions. Biochem Biophys Res Commun 2014; 451:627-31. [PMID: 25130465 DOI: 10.1016/j.bbrc.2014.08.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/08/2014] [Indexed: 11/16/2022]
Abstract
High glucose (HG) or synthetic advanced glycation end-products (AGE) conditions are generally used to mimic diabetes in cellular models. Both models have shown an increase of apoptosis, oxidative stress and pro-inflammatory cytokine production in tubular cells. However, the impact of the two conditions combined has rarely been studied. In addition, the impact of glucose level variation due to cellular consumption is not clearly characterized in such experiments. Therefore, the aim of this study was to compare the effect of HG and AGE separately and of both on tubular cell phenotype changes in the HK2 cell line. Moreover, glucose consumption was monitored every hour to maintain the glucose level by supplementation throughout the experiments. We thus observed a significant decrease of apoptosis and H2O2 production in the HK2 cell. HG or AGE treatment induced an increase of total and mitochondrial apoptosis as well as TGF-β release compared to control conditions; however, AGE or HG led to apoptosis preferentially involving the mitochondria pathway. No cumulative effect of HG and AGE treatment was observed on apoptosis. However, a pretreatment with RAGE antibodies partially abolished the apoptotic effect of HG and completely abolished the apoptotic effect of AGE. In conclusion, tubular cells are sensitive to the lack of glucose as well as to the HG and AGE treatments, the AGE effect being more deleterious than the HG effect. Absence of a potential synergistic effect of HG and AGE could indicate that they act through a common pathway, possibly via the activation of the RAGE receptors.
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Affiliation(s)
- Benoit Franko
- Nephrology Clinic, Grenoble University Hospital, Grenoble F-38043, France; TIMC/Therex Laboratory, UMR 5525 (CNRS-UJF) Faculty of Medicine, Univ. Grenoble Alpes, Grenoble F-38041, France
| | - Julie Brault
- TIMC/Therex Laboratory, UMR 5525 (CNRS-UJF) Faculty of Medicine, Univ. Grenoble Alpes, Grenoble F-38041, France; Chronic Granulomatous Disease Diagnosis and Research Centre (CDiReC), Pôle Biologie, CHU de Grenoble, Grenoble F-38043, France
| | - Thomas Jouve
- Nephrology Clinic, Grenoble University Hospital, Grenoble F-38043, France
| | - Sylvain Beaumel
- TIMC/Therex Laboratory, UMR 5525 (CNRS-UJF) Faculty of Medicine, Univ. Grenoble Alpes, Grenoble F-38041, France; Chronic Granulomatous Disease Diagnosis and Research Centre (CDiReC), Pôle Biologie, CHU de Grenoble, Grenoble F-38043, France
| | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble F-38043, France
| | - Philippe Zaoui
- Nephrology Clinic, Grenoble University Hospital, Grenoble F-38043, France
| | - Marie José Stasia
- TIMC/Therex Laboratory, UMR 5525 (CNRS-UJF) Faculty of Medicine, Univ. Grenoble Alpes, Grenoble F-38041, France; Chronic Granulomatous Disease Diagnosis and Research Centre (CDiReC), Pôle Biologie, CHU de Grenoble, Grenoble F-38043, France.
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Croze LE, Tetaz R, Roustit M, Malvezzi P, Janbon B, Jouve T, Pinel N, Masson D, Quesada JL, Bayle F, Zaoui P. Conversion to mammalian target of rapamycin inhibitors increases risk ofde novodonor-specific antibodies. Transpl Int 2014; 27:775-83. [DOI: 10.1111/tri.12330] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 11/24/2013] [Accepted: 03/26/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | - Rachel Tetaz
- Clinique Universitaire de Néphrologie; CHU Grenoble; Grenoble France
| | - Matthieu Roustit
- Centre d'Investigation Clinique; INSERM CIC03; CHU Grenoble; Grenoble France
- INSERM U1042 - HP2; Université Joseph Fourier; Grenoble France
| | - Paolo Malvezzi
- Clinique Universitaire de Néphrologie; CHU Grenoble; Grenoble France
| | - Bénédicte Janbon
- Clinique Universitaire de Néphrologie; CHU Grenoble; Grenoble France
| | - Thomas Jouve
- Clinique Universitaire de Néphrologie; CHU Grenoble; Grenoble France
| | - Nicole Pinel
- Départment d'Anatomo-Pathologie; CHU Grenoble; Grenoble France
| | - Dominique Masson
- Laboratoire d'Immunologie et Histocompatibilité; Etablissement Français du Sang; Grenoble France
| | - Jean-Louis Quesada
- Centre d'Investigation Clinique; INSERM CIC03; CHU Grenoble; Grenoble France
| | - François Bayle
- Clinique Universitaire de Néphrologie; CHU Grenoble; Grenoble France
| | - Philippe Zaoui
- Clinique Universitaire de Néphrologie; CHU Grenoble; Grenoble France
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Saulnier PJ, Gand E, Ragot S, Ducrocq G, Halimi JM, Hulin-Delmotte C, Llaty P, Montaigne D, Rigalleau V, Roussel R, Velho G, Sosner P, Zaoui P, Hadjadj S. Association of serum concentration of TNFR1 with all-cause mortality in patients with type 2 diabetes and chronic kidney disease: follow-up of the SURDIAGENE Cohort. Diabetes Care 2014; 37:1425-31. [PMID: 24623026 DOI: 10.2337/dc13-2580] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Renal dysfunction is a key risk factor for all-cause mortality in patients with type 2 diabetes (T2D). Circulating tumor necrosis factor receptor 1 (TNFR1) was recently suggested as a strong biomarker for end-stage renal failure in T2D. However, its relevance regarding all-cause death has yet to be conclusively established. We aimed to assess the prognostic value of serum TNFR1 concentration for all-cause death in T2D and diabetic kidney disease (DKD) from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study. RESEARCH DESIGN AND METHODS A total of 522 T2D patients with DKD (estimated glomerular filtration rate [eGFR] <60 and/or urinary albumin-to-creatinine ratio [uACR] >30 mg/mmol) were followed for a median duration of 48 months, and 196 deaths occurred. RESULTS Incidence rate (95% CI) for death increased as quartiles of TNFR1 concentration increased (first quartile: 4.7% patient-years [3.0-6.3%]; second quartile: 7.7% [5.4-10.0%]; third quartile: 9.3% [6.7-11.9%]; fourth quartile: 15.9% [12.2-19.5%]). In multivariate analysis taking age, diabetes duration, HbA1c, uACR, and eGFR into account, compared with the first quartile, patients from the fourth quartile had an adjusted hazard ratio for death of 2.98 (95% CI 1.70-5.23). The integrated discrimination improvement index was statistically significant when adding TNFR1 concentration to the UK Prospective Diabetes Study outcome equation (P = 0.031). CONCLUSIONS TNFR1 is a strong prognostic factor for all-cause mortality in T2D with renal dysfunction, and its clinical utility is suggested in addition to established risk factors for all-cause mortality.
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Reynard M, Villemaire M, Cartier J, Croze L, Rodière M, Thony F, Maurizi J, Carron P, Zaoui P. OAP flash révélant une obstruction partielle des ostia des artères rénales liée à la migration rétrograde d’une endoprothèse aortique. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.069] [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: 10/26/2022]
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Gesualdo L, London G, Turner M, Lee C, Macdonald K, Goldsmith D, Covic A, Zaoui P, Combe C, Mann J, Dellanna F, Muenzberg M, Abraham I. A pharmacoepidemiological study of the multi-level determinants, predictors, and clinical outcomes of biosimilar epoetin alfa for renal anaemia in haemodialysis patients: background and methodology of the MONITOR-CKD5 study. Intern Emerg Med 2013; 8:389-99. [PMID: 21590439 DOI: 10.1007/s11739-011-0622-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 04/29/2011] [Indexed: 11/24/2022]
Abstract
Prior longitudinal observational studies have examined the practice patterns and outcomes of anaemia management, including the use of erythropoiesis-stimulating agents (ESAs). Several dimensions of effectiveness remain unaddressed; especially considering the revised ESA label (target Hb levels between 10 and 12 g/dL), the recently published TREAT study, and the European approval of the first ESA biosimilar (HX575). Anecdotal evidence suggests that patient outcomes are influenced by physician-related variables and whether anaemia management is congruent with practice guidelines, but this has not been studied systematically. MONITOR-CKD5 is an international, prospective, observational, pharmacoepidemiological study evaluating the multi-level factors and outcomes of treatment with HX575 for renal anaemia in haemodialysis patients. Driven by a novel, integrated, multi-focal framework for post-approval observational studies, it examines determinants of response at both the patient and the physician level; integrates an advocated statistical methodology here to fore used mainly in the social and behavioural sciences; assesses factors potentially predictive of a poor treatment response; and evaluates the extent to which treatment is congruent with evidence-based guidelines, good practice evidence, and the revised ESA label. This pan-European study will recruit at least 1,000 patients from a minimum of 75 centres, and follow them for up to 24 months following initiation of anaemia management with biosimilar epoetin alfa. MONITOR-CKD5 will not only study the core issues addressed by prior observational studies but also aims to take knowledge discovery a step further by assessing outcomes across varying cohorts of patients, and examining the impact of evidence-based practice on clinical outcomes, differentiating, in the process, between physician-level and patient-level determinants.
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Affiliation(s)
- Loreto Gesualdo
- Department of Nephrology, Università degli Studi di Bari, Bari, Italy.
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Maurizi Balzan J, Moreaud O, Palacin P, Truche AS, Zaoui P. Unité de concertation éthique en néphrologie (UCEN) : bilan de fonctionnement à dix ans sur le bassin grenoblois. Nephrol Ther 2013; 9:222-7. [DOI: 10.1016/j.nephro.2012.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 10/01/2012] [Accepted: 10/21/2012] [Indexed: 11/24/2022]
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Mikhail A, Kaplan M, Macdougall I, Schmidt RJ, Rastogi A, Wang W, Tong S, Mayo M, Oestreicher N, Schiller B, Green JM, Verma R, Leu K, Mortensen RB, Young PR, Schatz P, Wojchowski DM, Shimonaka Y, Sasaki Y, Yorozu K, Sasaki MN, Ikuta K, Kohgo Y, Shimonaka Y, Sasaki Y, Omori YM, Yorozu K, Hiramatsu M, Momoki N, Kakio Y, Shibuto N, Takeuchi H, Fukumoto M, Maruyama K, Matsuo Y, Sasaki Y, Omori Y, Yorozu K, Shimonaka Y, Robinson BM, Larkina M, Goodkin DA, Li Y, Locatelli F, Nolen J, Kleophas W, Pisoni RL, Sibbel S, Brunelli S, Krishnan M, Horie M, Hasegawa E, Minoshima KI, Shimonaka Y, Ambrus C, Kerkovits L, Szegedi J, Benke A, Toth E, Nagy L, Borbas B, Rozinka A, Nemeth J, Varga G, Kulcsar I, Gergely L, Szakony S, Kiss I, Danielson K, Qureshi AR, Heimburger O, Stenvinkel P, Lindholm B, Hylander-Rossner B, Germanis G, Hansson M, Beshara S, Barany P, Dueymes JM, Kolko A, Couchoud C, Combe C, Covic A, Goldsmith D, Zaoui P, Gesualdo L, London G, Dellanna F, Mann J, Turner M, Muenzberg M, MacDonald K, Denhaerynck K, Abraham I, Sanchez MB, Casero RC, Ortiz RV, Carmelo IG, Munoz SC, Gomez ER, Rodriguez CS, Kuji T, Fujikawa T, Kakimoto-Shino M, Shibata K, Toya Y, Umemura S, Topuzovic N, Mihaljevic I, Rupcic V, Sterner G, Clyne N, Mann J, Dellanna F, London G, Combe C, Covic A, Gesualdo L, Goldsmith D, Zaoui P, Turner M, Muenzberg M, MacDonald K, Denhaerynck K, Abraham I, Toblli J, Di Gennaro F, Chmielewski M, Jagodzinski P, Lichodziejewska-Niemierko M, Rutkowski B, Takasawa K, Takaeda C, Ueda H, Higuchi M, Maeda T, Tomosugi N, Moghazy TF, Jakic M, Zibar L, Romei Longhena G, Beck W, Liebchen A, Teatini U, Rottembourg JB, Guerin A, Diaconita M, Dansaert A, Koike K, Fukami K, Shimamatsu K, Kawaguchi A, Okuda S. Anaemia in CKD 5D. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft119] [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: 11/14/2022] Open
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Elewa U, Fernandez B, Egido J, Ortiz A, Kaifu K, Tahara N, Ueda S, Yamagishi SI, Takeuchi M, Okuda S, Buraczynska M, Zukowski P, Wacinski P, Ksiazek A, Wu HY, Peng YS, Hung KY, Wu KD, Tu YK, Chien KL, Papale M, Vocino G, Di Paolo S, Pontrelli P, Conserva F, Rocchetti MT, Grandaliano G, De Cosmo S, Gesualdo L, Prkacin I, Duvnjak L, Bulum T, Prkacin I, Duvnjak L, Bulum T, Dumann K, Horrmann B, Lammert A, Gorski M, Kramer B, Heid I, Boger C, Aggarwal HK, Jain D, Talapatra P, Lenghel AR, Moldovan D, Rusu CC, Rusu A, Rahaian R, Bondor CI, Kacso IM, Unal A, Kocyigit I, Yilmaz S, Eser B, Elmali F, Sipahioglu M, Tokgoz B, Oymak O, Velioglu A, Guler D, Arikan H, Koc M, Tuglular S, Ozener C, Pallayova M, Rayner HC, Taheri S, Dasgupta I, Fernandes FB, Fernandes AB, Febba ACDS, Vitalle MSDS, Jung F, Casarini DE, Liu F, Huang M, Fu P, Bulatovic A, Popovic J, Ille K, Jelic S, Beljic Zivkovic T, Dimkovic N, Kohli HS, Ramachandran R, Kumar S, Jha V, Sakhuja V, Hamamoto K, Inaba M, Yamada S, Yoda K, Imanishi Y, Emoto M, Okuno S, Shoji S, Silva A, Fragoso A, Pinho A, Silva C, Santos N, Faisca M, Neves PL, Capolongo G, Restivo A, Pluvio M, Capasso G, Bello BT, Mabayoje OM, Amira OC, Theodoridis M, Panagoutsos S, Roumeliotis A, Kantartzi K, Tsigalou C, Passadakis P, Vargemezis V, Deeb A, Zaoui P, Le Penven S, Tartry D, Ducher M, Fauvel JP, Angioi A, Asunis AM, Cao R, Atzeni A, Conti M, Floris M, Melis P, Pili G, Piras D, Piredda G, Pani A, Murata M, Ishikawa SE, Aoki A, Unal A, Kocyigit I, Cerci I, Dogan E, Arikan T, Sipahioglu M, Tokgoz B, Oymak O, Madziarska K, Letachowicz K, Golebiowski T, Zmonarski SC, Krajewska M, Letachowicz W, Penar J, Kusztal M, Augustyniak-Bartosik H, Klak R, Weyde W, Klinger M. Diabetes - clinical studies. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Deeb A, Zaoui P, Le Penven S, Tartry D, Lantelme P, Ducher M, Fauvel JP. Are triplicate urine samples necessary to assess albuminuria? Nephron Clin Pract 2013; 122:80-5. [PMID: 23594792 DOI: 10.1159/000350429] [Citation(s) in RCA: 3] [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: 08/20/2012] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Urinary albumin excretion is subject to intra-individual variability. Thus, for research purposes, it is recommended to test three urine samples collected over a short period of time. The objective of our analysis was to check the usefulness of triplicate samples to determine the albuminuric status of diabetic patients. METHODS We present the results of the non-planned retrospective analysis of 246 triplicate morning urine samples obtained from 95 type 2 diabetics included in three multinational, randomized, double-blind studies. Albuminuria was determined by immunoturbidimetry on fresh samples in the same central laboratory. Microalbuminuria was defined by a urine albumin to creatinine ratio (UACR) between 2.5 and 25 mg/mmol in males and between 3.5 and 35 mg/mmol in females. Concordance was obtained when the second and/or third sample (UACR2 and UACR3) confirmed the albuminuric status obtained from the first sample (UACR1). RESULTS Considering the first samples, 9% were within the normal range, 35% showed microalbuminuria and 56% showed macroalbuminuria. The overall concordance rate was 95%. The log of UACR was highly correlated between samples. Bland-Altman plots expressed in percent variations between two samples confirmed that the mean variation was low (around 8%) but revealed the scattering of values, 95% being between -60 and +77% of variation between samples. CONCLUSIONS There is no benefit in repeating morning UACR determination in diabetic patients to accurately categorize a subject as having normo-, micro- or macroalbuminuria. However, in order to accurately quantify albuminuria, repeated determinations are required.
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Affiliation(s)
- Abbas Deeb
- Department of Nephrology and Hypertension, Hospices Civils de Lyon and EA4173: Génomique fonctionnelle de l'HTA Université Claude Bernard Lyon 1, Lyon, France
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Deroux A, Larrat S, Hilleret MN, Baccard M, Qin W, Billet G, Zaoui P, Morand P. Case report: detection of a hepatitis B surface antigen variant emerging in an elderly patient after an ischemic cerebral vascular accident. J Med Virol 2013; 84:1897-900. [PMID: 23080493 DOI: 10.1002/jmv.23420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
HBV reactivations are observed frequently in patients with past hepatitis B infection receiving cytotoxic and/or immunosuppressive chemotherapy for hemato-oncological malignancies or autoimmune diseases. Recent ischemic stroke was shown to induce immunodepression by misunderstood mechanisms. To our knowledge, the association between HBV reactivation and ischemic stroke has not been reported before. This study reports the case of an anti-HBs- and anti-HBc-positive patient who presented HBV reactivation in a context of recent ischemic stroke, with no other intercurrent iatrogenic phenomenon or usual immunosuppressive pathology.
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Affiliation(s)
- Alban Deroux
- Virology Laboratory / UMI 3265 UJF-EMBL-CNRS, CHU Grenoble, Michallon Hospital, BP 217, 38043 Grenoble Cedex 9, France
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Truche AS, Cartier JC, Imbert B, Maurizi J, Zaoui P, Carron PL. Renal artery embolization after intravenous mercury injection. Kidney Int 2012; 82:939. [DOI: 10.1038/ki.2012.177] [Citation(s) in RCA: 3] [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: 11/09/2022]
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50
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Elouazzani H, Janbon B, Malvezzi P, Zaoui P. Corrélation entre la recherche des Decoys cells urinaires et la PCR BK virus dans le sang à trois mois d’une greffe rénale. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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