Cholecaciferol in haemodialysis patients: a randomized, double-blind, proof-of-concept and safety study

in Nephrology Dialysis Transplantation (in press)

Background. The role of cholecalciferol supplementation in end-stage renal disease (ESRD) patients has been questioned. The objective of this randomized double-blinded study is to assess whether ... [more ▼]

Background. The role of cholecalciferol supplementation in end-stage renal disease (ESRD) patients has been questioned. The objective of this randomized double-blinded study is to assess whether cholecalciferol therapy can increase serum 25-hydroxyvitamin D [25(OH)D] levels in haemodialysed patients and the safety implications of this therapy on certain biological parameters and vascular calcifications score. Methods. Forty-three haemodialysis patients were randomized to receive placebo or cholecalciferol (25 000 IU) therapy every 2 weeks. The biological parameters, serum calcium, phosphorus, 25(OH)D and parathormone (PTH) levels, were monitored monthly for 12 consecutive months. Vascular calcifications were assessed by lateral X-ray radiography. Results. At baseline, the mean serum 25(OH)D levels were low and similar in both groups. Thirty patients (16 treated and 14 placebo) completed the study: 11 patients died (5 placebo and 6 treated), 1 patient dropped out and 1 patient was transplanted (both from the placebo group). After 1 year, the percentage of 25(OH)D deficient patients was significantly lower in the treated group. None of the patients developed hypercalcaemia. The PTH levels tended to increase over the study period under placebo and to decrease in the cholecalciferol group. The median changes in PTH levels from baseline to 1 year were statistically different between the two groups [+80 (−58 to 153) and −115 (−192 to 81) under placebo and cholecalciferol treatment, respectively, P = 0.02].The calcification scores increased equivalently in both groups (+2.3 per year). Conclusions. Cholecalciferol is effective and safe, and does not negatively affect calcium, phosphorus, PTH levels and vascular calcifications. Additional studies are needed to compare the impacts of nutritional and active vitamin D agents on vascular calcification and mortality. [less ▲]

Prise en charge de l'hyperuricémie

Conference (2013, May 30)

Plan du diaporama : •Métabolisme de l’acide urique •Risques de l’hyperuricémie•Goutte •Autres •Traitements •De la crise aiguë •De fond •Hyperuricémie asymptomatique •Cas cliniques

Stratification du risque cardiovasculaire selon la fonction rénale

in Journal de Cardiologie [= JDC] = Tijdschrift voor Cardiologie [= TVC] (2013), 3

Le risque cardiovasculaire est particulièrement important chez le patient qui a une insuffisance rénale (GFR abaissée et/ou albuminurie présente). Il est souvent sous-estimé en utilisant la table SCORE ... [more ▼]

Le risque cardiovasculaire est particulièrement important chez le patient qui a une insuffisance rénale (GFR abaissée et/ou albuminurie présente). Il est souvent sous-estimé en utilisant la table SCORE par l'agrégation de facteurs de risque traditionnels et non traditionnels quand i y a une IR, à identifier correctement et précocement. La prise en charge de ces facteurs agit sur la prévention à la fois rénale et cardiovasculaire. [less ▲]

KDIGO – prise en charge de l’hypertension artérielle en dialyse

Conference (2013, March 28)

1. A lower target may be chosen in CKD patients with proteinuria but after individualized risk-benefit assessment. The price to pay is a need for a higher number of antiHTA drugs and a risk of more ... [more ▼]

1. A lower target may be chosen in CKD patients with proteinuria but after individualized risk-benefit assessment. The price to pay is a need for a higher number of antiHTA drugs and a risk of more frequent side-effects. 2. Confirmation of a high BP level is necessary through out-of-the clinic BP measurement In CKD, ABPM offers night-time BP information useful for CV and renal risk evaluation. BP variability is a new point to be considered in the future. Proteinuria but also other specific risk factors (Phosphate, anemia, inflammation,..) should be integrated in the management of hypertension in CKD [less ▲]

Stratification du risque cardiovasculaire selon la fonction

Conference (2013, March 09)

Delayed graft function (DGF) does not harm the results of controlled donation-after-cardiovascular death (DCD) in kidney transplantation.

Poster (2013, February 08)

L'Hypotension orthostatique: 1ere partie: definition, symptomatologie, evaluation et physiopathologie.

in Revue Médicale de Liège (2013), 68(2), 65-73

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but ... [more ▼]

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but may also be rather vague. Diagnosis may be easily made by the physician in his/ her office, and confirmed, if necessary, by more sophisticated measurements. Pathophysiology is generally rather complex, but mostly involves a defect in the autonomic nervous system, in its sympathetic component. Failure of peripheral vasoconstriction seems to play a more important role than the defect in reflex tachycardia. Causes of OH are multiples. OH may occur in healthy subjects, when exposed to exceptional circumstances, but is more generally associated with various diseases, either neurological disorders or pathologies characterized by hypovolemia. Medications can also aggravate the risk of OH, among which some antihypertensive or psychotropic agents. Elderly people, especially frailty subjects, are exposed to a high risk of OH, whose origin is often multifactorial, and this complication may have serious medical consequences. [less ▲]

Parathormone and bone-specific alkaline phosphatase for the follow-up of bone turnover in hemodialysis patients : Is it so simple?

in Clinica Chimica Acta (2013), 417

Background: Chronic Kidney Disease (CKD) is associated with mineral and bone disorders (MBD). International guidelines suggest that levels of serum parathormone (PTH) or bone-specific alkaline phosphatase ... [more ▼]

Background: Chronic Kidney Disease (CKD) is associated with mineral and bone disorders (MBD). International guidelines suggest that levels of serum parathormone (PTH) or bone-specific alkaline phosphatase (b-ALP) can be used to evaluate MBD in dialysis patients. The evidence remains moderate and based on transversal studies. <br />Methods: We retrospectively investigated the variations of PTH (ΔPTH) and b-ALP (Δb-ALP) serum concentrations over a short (6-weeks) and a long (one-year) period in a monocentric hemodialysis population. The proportion of patients reaching the critical difference (CD) (50% for PTH and 25% for b-ALP) was calculated. <br />Results: Seventy-seven patientswere included. A significant correlation between PTHand b-ALP levelswas found at baseline (r=0.51). By contrast, no correlation was observed between ΔPTH and Δb-ALP over a 6-week interval (r=0.07). The CD for PTH and b-ALP was reached by 19 and 11 patients, respectively, with 2 patients showing consistent variations of both biomarkers. One year later, measurements were repeated in 48 survivors. <br />No correlation was found between ΔPTH and Δb-ALP (r=0.27). The CD for PTH or b-ALP was reached by 24 patients and 28 patients, respectively, with 6 patients (12.5%) showing opposite results for both biomarkers. <br />Conclusion: This study shows the lack of correlation between ΔPTH and Δb-ALP over time in patients under chronic hemodialysis. [less ▲]

Hyperuricémie et risque cardiovasculaire dans la maladie rénale chronique

Scientific conference (2012, December 20)

Plusieurs études de populations ont noté qu’une hyperuricémie peut favoriser l’apparition d’une insuffisance rénale. Par ce biais, l’hyperuricémie participerait au risque CV de l’IRC! Acide urique accru ... [more ▼]

Plusieurs études de populations ont noté qu’une hyperuricémie peut favoriser l’apparition d’une insuffisance rénale. Par ce biais, l’hyperuricémie participerait au risque CV de l’IRC! Acide urique accru: bon, mauvais ou indifférent? Rôle antioxydant à concentration normale A concentration élevée, épidémiologie en faveur d’un rôle délétère sur le plan CV et rénal (marqueur ou acteur?). Participe à la dysfonction endothéliale, à la stimulation du SRA, au stress oxydant et à l’inflammation, tous facteurs de risque CV. Rôle dans l’initiation et la progression de l’IRénale Cependant, EBM non prouvé de l’intérêt du traitement IXO Manque cruel d’études multicentriques, randomisées, contrôlées sur l’intérêt d’une baisse de l’acide urique par un IXO pour la protection CV et rénale ! [less ▲]

Peritoneal equilibration test with conventional ‘low pH/high glucose degradation product’ or with biocompatible ‘normal pH/low glucose degradation product’ dialysates: does it matter?

in Nephrology Dialysis Transplantation (2012)

Abstract Background. The evaluation of the peritoneal transport characteristics is mandatory in peritoneal dialysis (PD) patients. This is usually performed in routine clinical practice with a peritoneal ... [more ▼]

Abstract Background. The evaluation of the peritoneal transport characteristics is mandatory in peritoneal dialysis (PD) patients. This is usually performed in routine clinical practice with a peritoneal equilibration test (PET) using conventional dialysates, with low pH and high glucose degradation product (GDP) concentrations. An increasing proportion of patients are now treated with biocompatible dialysates, i.e. with physiological pH and lower GDP concentrations. This questions the appropriateness to perform a PET with conventional solutions in those patients. The aim of our study is to compare the results of the PET using biocompatible and conventional dialysates, respectively. Methods. Nineteen stable PD patients (13 males, 6 females; mean age: 67.95 ± 2.36 years, mean body surface area: 1.83 ± 0.04 m2, dialysis vintage: 2.95 ± 0.19 years) were included, among which 10 were usually treated with biocompatible and 9 with conventional solutions. Two PETs were performed, within a 2-week interval, in each patient. PET sequence (conventional solution first or biocompatible solution first) was randomized in order to avoid ‘time bias’. Small (urea, creatinine and glucose), middle (beta-2-microglobulin) and large molecules’ (albumin and alpha-2-macroglobulin) dialysate/plasma (D/P) concentration ratios and clearances were measured during each PET. Ultrafiltration (UF) and sodium filtration were also recorded. Results of both tests were compared by the Wilcoxon paired test. Results. No statistical difference was found between both dialysates for small molecule transport rates or for sodium filtration and UF. However, a few patients were not similarly classified for small-solute transport characteristics within the PET categories. Beta-2-microglobulin and albumin D/P ratios at different time points of the PET were significantly higher with the biocompatible, when compared with the conventional, solutions: 0.10 ± 0.03 versus 0.08 ± 0.02 (P < 0.01) and 0.008 ± 0.003 versus 0.007 ± 0.003 (P = 0.01), respectively. A similar difference was also observed for beta-2-microglobulin that was higher with biocompatible dialysates (1.04 ± 0.32 versus 0.93 ± 0.32 mL/min, respectively). Conclusion. Peritoneal transport of water and small solutes is independent of the type of dialysate which is used. This is not the case for the transport of beta-2-microglobulin and albumin that is higher under biocompatible dialysates. Vascular tonus modification could potentially explain such differences. The PET should therefore always be carried out with the same dialysate to make longitudinal comparisons possible. [less ▲]