References of "Krzesinski, Jean-Marie"
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See detailComment je mesure la pression artérielle au cabinet
Krzesinski, Jean-Marie ULg; Saint-Remy, Annie ULg

in Revue Médicale de Liège (2012), 67(9), 492-498

Routinely measuring blood pressure is still performed according to the auscultatory method using recognition of Korotkoff sounds. This usual technique is, however, often mishandled and is thus a source of ... [more ▼]

Routinely measuring blood pressure is still performed according to the auscultatory method using recognition of Korotkoff sounds. This usual technique is, however, often mishandled and is thus a source of error in the estimation of the true blood pressure level. Accuracy of such measure is, however, of paramount importance to be useful in daily medical practice. This methodology paper more specifically written for medical students recalls the essential principles of blood pressure measurement at the medical office, but also at home. [less ▲]

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See detailIntérêt de la chronothérapie dans le traitement de l'hypertension artérielle
VANDERWECKENE, Pauline ULg; ERPICUM, Pauline ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale Suisse (2012), 8(351), 1604-1610

The interest of chronotherapy in the field of arterial hypertension is progressively rising, especially in treated hypertensive patients characterized by a small decrease of their blood pressure during ... [more ▼]

The interest of chronotherapy in the field of arterial hypertension is progressively rising, especially in treated hypertensive patients characterized by a small decrease of their blood pressure during the night, and therefore often presenting a high cardiovascular risk. There are more and more data showing that administration of one antihypertensive drug in the evening (and even aspirin) can improve the blood pressure control during the night and the day/night blood pressure pattern, and so can diminish the level of risk. The role of chronotherapy also emphasizes the interest of 24 h ambulatory blood pressure monitoring in the management of high risk hypertensive patients. [less ▲]

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See detailNormal reference values for glomerular filtration rate: what do we really know?
DELANAYE, Pierre ULg; Schaeffner, E; Ebert, N et al

in Nephrology Dialysis Transplantation (2012), 27(7), 2664-72

In nephrology, chronic kidney disease is defined by both proteinuria and measurement of glomerular filtration rate (GFR). This article focuses on GFR and different ways to define its normal reference ... [more ▼]

In nephrology, chronic kidney disease is defined by both proteinuria and measurement of glomerular filtration rate (GFR). This article focuses on GFR and different ways to define its normal reference values. In this context, we compare two perspectives: first the reference values defined by measuring GFR in normal individuals (the 'classical way') and secondly a fixed cut-off value at 60 mL/min/1.73 m(2) according to the associated mortality risk (the 'prognostic way'). Following the classical way, we can assert that normal GFR values are largely over 60 mL/min/1.73 m(2) in healthy subjects, at least before the age of 70 years. However, we know that GFR physiologically decreases with age, and in adults older than 70 years, values below 60 mL/min/1.73 m(2) could be considered normal. Following the 'prognostic way', the fixed cut-off of 60 mL/min/1.73 m(2) has been retained in the K-DIGO guidelines. However, we challenge this concept and the fact that the variable 'age' is poorly taken into account in these data. There is an obvious discrepancy between the reference values defined either by the 'classical way' or by the 'prognostic way' which we think could be largely reduced, if age was better taken into consideration in these definitions. [less ▲]

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See detailResults of kidney transplantation from controlled donors after cardio-circulatory death: a single center experience
Le Dinh, Hieu ULg; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 667

Objectives: The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival ... [more ▼]

Objectives: The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival, and post-transplant complications. The influence of delayed graft function (DGF) on graft survival and DGF risk factors were analyzed as secondary end-points. Methods: This is a retrospective mono-center review of a consecutive series of 80 DCD-KT performed at the University Hospital of Sart Tilman, University of Liège, between Jan 2005 and Dec 2011. Mean patient follow-up was 28.5 months. Results: Overall graft survival was 93.7%, 89.5%, 85% and 81.3% at 3 months, 1 year, 3 and 5 years, respectively. Death-censored graft survival at the corresponding time points was 93.7%, 93.7%, 90.8% and 90.8%. Main cause of graft loss was patient’s death with a functioning graft. No primary non-function grafts were encountered. Renal graft function was suboptimal at hospital discharge, but nearly normalized at 3 months. DGF was observed in 36% of all DCD-KT. DGF significantly increased post-operative length of hospitalization, but had no deleterious impact on graft function or survival. Donor body mass index (BMI) ≥30 kg/m2, recipient BMI ≥30 kg/m2 and pre-transplant dialysis duration significantly increased the risk of DGF in a multivariate logistic regression analysis (p < 0.05). Conclusions: Despite a higher rate of DGF, controlled DCD-KT offers a valuable contribution to the pool of deceased donor kidney grafts, with comparable mid-term results to those procured after brain death. [less ▲]

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See detailDietary and urinary excretion of sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant patients
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; BONVOISIN, Catherine ULg et al

Conference (2012, April 26)

Abstract Background. In kidney transplant (kt) recipients , hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory ... [more ▼]

Abstract Background. In kidney transplant (kt) recipients , hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP (OBP) remains the most frequently used for clinical decisions, however home BP (HBP) have brought a significant improvement in the BP control. Sodium is a modifiable risk factor, many studies accounted for a decrease of BP with a sodium restricted diet. Increased potassium intake has been also recommended in hypertension management. Using an agreement between office and home BP, the present study investigated the relations between the BP control in kt recipients and their urinary excretion and dietary consumption of sodium and potassium. Methods. The BP control defined by OBP <140/90 mmHg and HBP <135/85 mmHg was measured in 70 kt recipients (mean age 56 ± 11.5 years; mean graft survival 7 ± 6.6 years) treated with antihypertensive medications. OBP and HBP were measured with a validated oscillometric device (Omron M6â). 24-hour urinary sodium (Na+) and potassium (K+) excretion as well as dietary intakes (food recall) were compared between controlled and uncontrolled (in office and at home) recipients. Non parametric Wilcoxon Mann-Whitney Test was used for between groups comparisons and Fisher’s exact test for frequencies comparisons. Results. Using an agreement between OBP and HBP, we identified controlled (21%) and uncontrolled recipients (49%). Major confounding effects susceptible to interfere with the BP regulation did not differ between groups, the amounts of sodium excretion were similar (154 ± 93 vs 162 ± 88 mmol/24h) but uncontrolled patients excreted less potassium (68 ± 14 vs 54 ± 20 mmol/24h; P=0.029) and had significantly lower intakes (3279 ± 753 vs 2208 ± 720 mg/24h; P=0.009), resulting in a higher Na+/K+ ratio. Systolic HBP was inversely and significantly correlated to urinary potassium when age, BMI and urinary sodium were controlled (r= -0.46; P=0.002). When age, BMI and urinary potassium were controlled, a positive relation was observed with urinary sodium (P=0.042). Conclusions. Half of the treated hypertensive kt recipients remained uncontrolled in office and at home. Restoring a well-balanced sodium/potassium ratio intakes could be a non pharmacological opportunity to improve blood pressure control. [less ▲]

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See detailQuelques mesures de prévention de l’IRC et de traitement
Krzesinski, Jean-Marie ULg

Conference (2012, April 24)

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See detailWhat is new in anemia treatment in CKD since 2010?
Krzesinski, Jean-Marie ULg

Conference (2012, April 18)

•Partial correction (Hb in the range of 10-11.5 g/dL) of CKD-related anemia appears a safer strategy during the last 5y. So recommendation is to start ESA only when Hb <10 and to avoid too high ESA dose ... [more ▼]

•Partial correction (Hb in the range of 10-11.5 g/dL) of CKD-related anemia appears a safer strategy during the last 5y. So recommendation is to start ESA only when Hb <10 and to avoid too high ESA dose (CE DOSE study ongoing in HD)! •Identify resistant patients and try to improve it. •Importance of adequate iron management and of hepcidin role in the all-mortality risk in CKD. Newer strategies for correcting anemia are currently explored [less ▲]

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See detailAnémies et insuffisance rénale : quoi de neuf?
Krzesinski, Jean-Marie ULg

Conference (2012, April 17)

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See detailDelayed graft function does not harm the future of donation-after- cardiac-death kidney transplants
LeDinh, H; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

Conference (2012, March 29)

Introduction: Delayed graft function (DGF) occurs more frequently in kidney transplants from donation after cardiac death (DCD) than from donation after brain death (DBD). We investigated the effect of ... [more ▼]

Introduction: Delayed graft function (DGF) occurs more frequently in kidney transplants from donation after cardiac death (DCD) than from donation after brain death (DBD). We investigated the effect of DGF on post-transplant outcomes in controlled DCD kidney grafts. Patients and Methods: This single-center retrospective study recruited 80 controlled DCD kidney allo- grafts which have been performed at the University Hospital of Sart Tilman, University of Liège, from Jan 2005 to Dec 2011. Results: Mean patient follow-up was 28.5 months. No primary non-function grafts were encountered. DGF rate was 36%. Overall graft survivals between groups with and without DGF were 92.4% and 95.1% at 1 year, 92.4% and 91.7% at 3 years, and 84.7% and 91.7% at 5 years (p=ns), respectively. Patients with and without DGF had the same survival rates at the corresponding time points (92.4% and 97.1%, 92.4% and 93.7%, and 84.7% and 93.7%, p=ns, respectively). Estimated glomerular filtration rate (eGFR) was significantly lower in DGF group compared to non-DGF group at hospital discharge (29 vs 42 ml/min, p=0.001) and up to 1 year post-transplant (46 vs 53 ml/min, p=0.045), but the differ- ence disappeared afterwards (50 vs 48 ml/min at 3 years, and 54 vs 53 ml/min at 5 years, p=ns). DGF did not increase the risk of acute rejection or surgical complications. 29.6% of recipients with DGF de- veloped acute rejection (biopsy-proven rejection and clinically suspected rejection) compared with 29.2% of recipients without DGF (p=ns). The rate of all surgical complications was 33.3% and 25% in recipients with and without DGF (p=ns). However, DGF prolonged significantly the length of hospitaliza- tion in DGF than non-DGF group (18.9 vs 13 days, p=0.000). Donor BMI 􏰤 30 kg/m2􏰁􏰀􏰚􏰌􏰈􏰏􏰥􏰏􏰌􏰝􏰣􏰀􏰕􏰉􏰂􏰀􏰤 30 kg/m2 and pre-transplant dialysis duration increased the risk of DGF in a multivariate logistic regression analysis. Conclusions: Apart from longer hospital stay, DGF had no deleterious impact on the future of DCD kidney allografts. Comparable graft and patient survival, renal function, rejection rate and surgical com- plications were observed between groups with and without DGF. [less ▲]

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See detailInsuffisance rénale de la personne âgée
Krzesinski, Jean-Marie ULg

Conference (2012, March 17)

•L’insuffisance rénale avec l’âge n’est pas une fatalité. •Une prévention des FRCV est indispensable. •Une identification précoce d’une réduction de GFR (mesure précise GFR?) et de la présence d’une ... [more ▼]

•L’insuffisance rénale avec l’âge n’est pas une fatalité. •Une prévention des FRCV est indispensable. •Une identification précoce d’une réduction de GFR (mesure précise GFR?) et de la présence d’une protéinurie est capitale. •Approche multidisciplinaire et précoce surtout chez le sujet âgé! Tester autonomie et dénutrition. •Référence précoce pour décider ensemble si évolutivité et SN traitement de suppléance. •Décider de lancer un traitement de suppléance nécessite une réflexion à plusieurs: le patient, sa famille, le médecin de famille, l’équipe de néphrologie en abordant la QOL •On peut tenter si doute, avec arrêt dès que la situation s’aggrave! [less ▲]

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See detailInsuffisance rénale de la personne âgée
Krzesinski, Jean-Marie ULg

Conference (2012, March 17)

L’insuffisance rénale avec l’âge n’est pas une fatalité. Il faut prévenir très tôt les facteurs de risque cardio-vasculaire et les corriger au mieux pour éviter que ces facteurs n’agissent plus tard dans ... [more ▼]

L’insuffisance rénale avec l’âge n’est pas une fatalité. Il faut prévenir très tôt les facteurs de risque cardio-vasculaire et les corriger au mieux pour éviter que ces facteurs n’agissent plus tard dans la vie et soient des facteurs de comorbidité très importants favorisant la dégradation fonctionnelle rénale et l’évolution vers une insuffisance rénale très sévère exposant le patient à un risque cardio-vasculaire, à des techniques de suppléance de la fonction rénale et à un décès plus rapide avec perte préalable de la qualité de vie. Il faut donc identifier précocement la réduction de la GFR et l’apparition d’une protéinurie, agir de concert ensemble sur de nombreux facteurs pour ralentir la progression. Ces facteurs sont souvent des facteurs de risque cardio-vasculaire, donc on fait un double coup en les corriger. La référence précoce lorsque vous remarquez une évolutivité de la GFR vers la baisse pour décider ensemble si un traitement de suppléance doit être lancé. Celui-ci ne sera décidé qu’en concertation commune si nous avons le temps de l’établir après avoir évaluer des niveaux d’autonomie de nutrition, de risque cardio-vasculaire, et tout cela intégré dans le côté social et environnemental du patient. Il faut rappeler ici l’importance des trajets de soins à proposer à tout patient insuffisant rénal en dessous de 45 ml/min, moment stratégique pour que le néphrologue puisse en partenariat avec le médecin généraliste contrer les perturbations de l’insuffisance rénale terminale. [less ▲]

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See detailHypertension réfractaire : diagnostic et prise en charge
Krzesinski, Jean-Marie ULg

Conference (2012, February 11)

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See detailResults of kidney transplantation from controlled donors after cardio-circulatory death: a single center experience.
Ledinh, H.; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

in Transplant International (2012), 25

The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival, and post ... [more ▼]

The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival, and post-transplant complications. The influence of delayed graft function (DGF) on graft survival and DGF risk factors were analyzed as secondary end-points. This is a retrospective mono-center review of a consecutive series of 59 DCD-KT performed between 2005 and 2010. Overall graft survival was 96.6%, 94.6%, and 90.7% at 3 months, 1 and 3 years, respectively. Main cause of graft loss was patient's death with a functioning graft. No primary nonfunction grafts. Renal graft function was suboptimal at hospital discharge, but nearly normalized at 3 months. DGF was observed in 45.6% of all DCD-KT. DGF significantly increased postoperative length of hospitalization, but had no deleterious impact on graft function or survival. Donor body mass index >/=30 was the only donor factor that was found to significantly increase the risk of DGF (P < 0.05). Despite a higher rate of DGF, controlled DCD-KT offers a valuable contribution to the pool of deceased donor kidney grafts, with comparable mid-term results to those procured after brain death. [less ▲]

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See detailHypertriglycéridémie et rein
Krzesinski, Jean-Marie ULg

Conference (2012, January 24)

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See detailVignette thérapeutique de l'étudiant. Quelles cibles tensionnelles viser chez un patient diabétique de type 2?
Krzesinski, Jean-Marie ULg; Scheen, André ULg

in Revue Médicale de Liège (2012), 67

L'hypertension artérielle est fréquemment observée chez le patient diabétique de type 2 et aggrave le pronostic cardio-vasculaire et rénal. Abaisser la pression artérielle représente donc un objectif ... [more ▼]

L'hypertension artérielle est fréquemment observée chez le patient diabétique de type 2 et aggrave le pronostic cardio-vasculaire et rénal. Abaisser la pression artérielle représente donc un objectif essentiel dans cette population. Cependant, les valeurs de pression systolique et diastolique à atteindre restent controversées et la cible doit sans doute être ajustée en fonction des caractéristiques individuelles du patient ("médecine personnalisée"). Cette vignette clinique résume les principaux arguments à propos du choix des cibles tensionnelles, en termes de rapport bénéfices/risques, selon que le patient diabétique présente un syndrome métabolique sans complications, une néphropathie ou une insuffisance coronaire. [less ▲]

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See detailOutcome of the living kidney donor
DELANAYE, Pierre ULg; WEEKERS, Laurent ULg; DUBOIS, Bernard ULg et al

in Nephrology Dialysis Transplantation (2012), 27(1), 41-50

Renal transplantation from living kidney donors is still relatively marginal in most of the European countries. However, this source of kidney grafts may help to overcome in part the organ donor shortage ... [more ▼]

Renal transplantation from living kidney donors is still relatively marginal in most of the European countries. However, this source of kidney grafts may help to overcome in part the organ donor shortage of cadaveric donors. The living donor strategy implies correct and objective information about donation risks and completely free acceptance of the living candidate of the donation. In this paper, we reviewed the consequences of kidney donation on the living donor health, considering very short term (linked to the surgery), short term (effect of nephrectomy on glomerular filtration rate) and long term (risk of mortality, chronic kidney disease, proteinuria and hypertension) consequences of kidney donation. [less ▲]

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See detailLes maladies complexes : l'hypertension artérielle
Krzesinski, Jean-Marie ULg; Saint-Remy, Annie ULg

in Revue Médicale de Liège (2012), 67(5-6), 279-285

Essential hypertension, defined as a blood pressure equal to or above 140/90 mmHg, is a common (25% of the population), but complex disease the phenotype of which results from interactions between ... [more ▼]

Essential hypertension, defined as a blood pressure equal to or above 140/90 mmHg, is a common (25% of the population), but complex disease the phenotype of which results from interactions between numerous genes and environmental factors. The role attributable to genetic factors amounts to some 25% among hypertensive families, but can reach 65% when monozygotic twins are compared. In the present state of our knowledge, there is no hope to obtain a genetic test of value for the diagnosis and prognosis of hypertension. An individualized environmental approach, applied early in life, is the only worhtwhile attitude. Nonetheless, in the presence of a subject with still normal blood pressure values, but with a family history of hypertension, the physician should firmly recommend an appropriate hygieno-dietetic lifestyle with a view to lower blood pressure, or retard the development of arterial hypertension [less ▲]

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See detailLe débit de filtration glomérulaire est-il un déterminant de la concentration plasmatique du NGAL aux soins intensifs ?
DELANAYE, Pierre ULg; Claisse, Guillaume; Mehdi, Manoli et al

Poster (2012)

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