L'épuration extrarénale appliquée au patient hospitalisé aux soins intensifs

in Néphrologie & Thérapeutique (2007), 3(4), 126-32

Mortality remains high in intensive care patients with renal failure requiring extra corporeal blood purification. This article reviews the recent data that have led to the improvement of the care for ... [more ▼]

Mortality remains high in intensive care patients with renal failure requiring extra corporeal blood purification. This article reviews the recent data that have led to the improvement of the care for such patients. We will discuss the criteria to determine the choice of the technique (intermittent or continuous), of the membrane, of the prescribing dose, and the type of anticoagulation and when to initiate such a treatment. [less ▲]

Nouveautés dans la prise en charge des anomalies du bilan phosphocalcique chez le patient dialysé

in Revue Médicale de Liège (2007), 62(5-6, May-Jun), 360-5

Disorders of the phosphocalcic metabolism are frequent in dialysis patients. Such disorders are difficult to treat and have negative impact on bone health, but also on cardiovascular mortality ... [more ▼]

Disorders of the phosphocalcic metabolism are frequent in dialysis patients. Such disorders are difficult to treat and have negative impact on bone health, but also on cardiovascular mortality. Hyperphosphoremia is a strong predictor of cardiovascular mortality. New phosphate binders are now available in Belgium. A new molecule acting on the calcium receptor of the parathyroid glands is able to control secondary and tertiary hyperparathyroidism in dialysis patients. These new therapies, specific for dialysis patients, will be reviewed in this article. [less ▲]

Evolution en un an de l’index de pression artérielle systolique cheville-bras chez des patients dialysés

Poster (2006, October 03)

Large-pore membrane hemofiltration increases cytokine clearance and improves right ventricular-vascular coupling during endotoxic shock in pigs

in Artificial Organs (2006), 30(7), 560-564

Hemodynamic improvement in patients suffering from both septic shock and renal failure who received hemofiltration suggested that an extrarenal epuration technique could be of interest in patients with ... [more ▼]

Hemodynamic improvement in patients suffering from both septic shock and renal failure who received hemofiltration suggested that an extrarenal epuration technique could be of interest in patients with septic shock alone. However, most of the studies using continuous venovenous hemofiltration (CVVH) in this setting evidenced neither cytokine clearance nor significant reduction in their plasma level. Lack of significant clearance was explained in part by the small size of the membrane pores. Therefore, we investigated the effects of large-pore membrane hemofiltration (LPHF) during endotoxic shock in pigs on interleukin 6 (IL-6) and interleukin 10 (IL-10) clearances, and on right ventricular (RV)-vascular coupling. Thirteen anesthetized healthy pigs weighing 20-30 kg were divided into two groups. In the Endo group (n = 6), the pigs received a 0.5-mg/kg endotoxin infusion over a period of 30 mins from T0 to T30. In the EndoHF group (n = 7), LPHF (cutoff = 80 kDa) and an ultrafiltration rate of 45 mL/kg/h were started 30 mins after the end of the endotoxin infusion, from T60 to T240. In this model of porcine endotoxic shock, LPHF was responsible for a significant clearance of IL-6 (20 mL/min) and Il-10 (14 mL/min), and for an improvement in RV-vascular coupling. [less ▲]

Clairance plasmatique des cytokines IL6 et IL10 par hémofiltration avec un filtre à larges pores dans un modèle porcin de choc septique.

in Réanimation (2006), 15(S1), 7

Ankle-Brachial blood pressure index in hemodialyzed patients.

Conference (2005, October 22)

Amputation des membres inférieurs, diabète et survie chez le patient dialysé chronique

Poster (2005, September 27)

Chez les patients HD, la mortalité après amputation est importante (83%). La période critique post opératoire est de 2 mois avec une médiane de survie d'environ 1 an. Le diabète et les troubles ... [more ▼]

Chez les patients HD, la mortalité après amputation est importante (83%). La période critique post opératoire est de 2 mois avec une médiane de survie d'environ 1 an. Le diabète et les troubles phosphocalciques sont en relation avec la nécessité d'amputation et la survie médiocre chez des patients ayant de lourds antécédents cv. Une optimalisation de la prise en charge thérapeutique de ces patients à risque est nécessaire. [less ▲]

Amputation des membres inférieurs, diabète et survie chez le patient dialysé chronique

in Néphrologie & Thérapeutique (2005, September), 1(S2), 110

Objectif. – La mortalité cardiovasculaire (cv) est très élevée chez les patients hémodialysés chroniques (HD). Les atteintes vasculaires responsables d'amputations ne font qu'accroître cette mortalité. Le ... [more ▼]

Objectif. – La mortalité cardiovasculaire (cv) est très élevée chez les patients hémodialysés chroniques (HD). Les atteintes vasculaires responsables d'amputations ne font qu'accroître cette mortalité. Le but de cette étude est de décrire les causes de décès et la courbe de survie post-amputation ainsi que d'analyser les facteurs pouvant influencer cette survie. [less ▲]

Which peridialysis blood pressure best predicts interdialytic level?

in Journal of Hypertension (Supplement) (2005), 23(suppl 2), 34

Antihypertensive therapy and blood pressure control in renal transplant recipients.

in American Journal of Hypertension : Journal of the American Society of Hypertension (2004), 17(5), 122-123

Renal transplant recipients are at high risk of cardiovascular diseases which represent,with infections, their major cause of excessive deaths. Immunosuppressive treatments are partly responsible leading ... [more ▼]

Renal transplant recipients are at high risk of cardiovascular diseases which represent,with infections, their major cause of excessive deaths. Immunosuppressive treatments are partly responsible leading to hypertension (HT), diabetes and hyperlipidemia. Aim: This study analyses the blood pressure (BP) control in renal transplant recipients with functioning graft according to their current antihypertensive and immunosuppressive therapies. Data were collected for 211 patients (M:58%; F:42%) transplanted on average since 7.7 years (2-360 months). Mean age was 50 years (16–72), 84% had hypercholesterolemia (>1.9 g/l), 18% were diabetics and 24% were smokers. Seventy-eight % were under antihypertensive treatment. Results: HT (mean OBP of 3 visits: >140 and/or >90 mmHg or treated) was observed in half of the untreated patients and uncontrolled in 80% of the treated ones. Ninety % of the treated hypertensive diabetic patients didn't reach target BP <130/80 mmHg. HT was significantly more frequent in patients whose glomerular filtration(GFR) was lower than the median value of GFR (55 ml/min/1.73 m2) of the population. Among treated patients, 48% had 1 drug, 29% had 2 drugs and 23% had 3 drugs or more. Beta-Blockers were the most prescribed even in association, while diuretics were less used since, even in 3 drugs therapy, only 60% received such class. Calcium inhibitors were not prescribed readily in first line but accounted for 47% in 2 drugs combinations. These observations were not related to the GFR level. Only 26% received an ACE inhibitor, their prescription decreases roughly in patients with impaired GFR. AII-RB concerned only 10% of therapies. Body weight, creatinine, graft survival and recipient's age were significantly related to SBP and DBP. In patients treated with cyclosporin, a highly significant relation (p=0.02) was found between BP and blood level of CsA, this was not observed in patients treated with tacrolimus . Conclusion: HT was highly prevalent in renal transplant recipients( 88% of patients) even when treated. This study leads to reconsider habits of prescrition in view to improve the BP control by increasing the use of diuretics and to improve cardioprotection by using more often ACE inhibitors (when not contra-indicated) in that high cardiovascular risk population. As mentioned in literature, the effect of tacrolimus on BP appears lesser than the cyclosporine one. [less ▲]