References of "Krzesinski, Jean-Marie"
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See detailPeritoneal equilibration test with conventional ‘low pH/high glucose degradation product’ or with biocompatible ‘normal pH/low glucose degradation product’ dialysates: does it matter?
VAN OVERMEIRE, Lionel ULg; Goffin, Eric; Krzesinski, Jean-Marie ULg et al

in Nephrology Dialysis Transplantation (2013)

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 ▲]

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See detailPlace de l'AMP-activated protein kinase dans le preconditionnement ischemique renal.
Erpicum, Pauline; Krzesinski, Jean-Marie ULg; Jouret, François ULg

in Nephrologie & therapeutique (2013)

Kidney transplantation represents the best treatment of end-stage renal disease. In addition to the degree of human leukocyte antigen matching, long-term graft survival is influenced by the quality of the ... [more ▼]

Kidney transplantation represents the best treatment of end-stage renal disease. In addition to the degree of human leukocyte antigen matching, long-term graft survival is influenced by the quality of the graft before its transplantation. Quality criteria include the level of ischemic damage caused by the transplantation per se. Renal ischemic preconditioning (IP) consists of different approaches to prevent ischemia/reperfusion (I/R) damage induced by the interruption and recovery of renal circulation, as observed during transplantation. Distinct animal models show promising results regarding the efficiency of PCI to preserve kidney structure and function in I/R conditions. Characterizing the cellular cascades involved in I/R led to the identification of putative targets of renal IP, including the adenosine monophosphate-activated protein kinase (AMPK). AMPK is a ubiquitous energy sensor, which has been implicated in the maintenance of epithelial cell polarization under energy deprivation. Among others, the anti-diabetic drug, metformin, is a potent activator of AMPK. Here, we summarize the in vitro and in vivo data about the role of AMPK in renal IP. Defining the pharmacological conditions of IP would help to improve the quality of the renal graft before its transplantation, thereby increasing its long-term survival. [less ▲]

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See detailL'hypotension orthostatique: 2eme partie. Epidemiologie, complications et traitements.
Tyberghein, M.; Philips, J.-C.; Krzesinski, Jean-Marie ULg et al

in Revue Médicale de Liège (2013), 68(4), 163-70

Orthostatic hypotension (OH) is a rather common phenomenon in clinical practice. It may occur in 5-10 % of normal individuals, but its prevalence increases with age and various pathologies, so that it may ... [more ▼]

Orthostatic hypotension (OH) is a rather common phenomenon in clinical practice. It may occur in 5-10 % of normal individuals, but its prevalence increases with age and various pathologies, so that it may rise above 35 % in certain subgroups of patients. OH is associated with various comorbidities, in particular cardio-cerebro-vascular accidents and falls (especially in the elderly), and may even increase mortality. It is, however, difficult to determine whether OH is simply a marker of frailty or whether it is really a risk factor. OH treatment involves physical manoeuvres or medications, which aim at inducing a peripheral vasoconstriction (midodrine, etilefrine) or an increase of circulating blood volume (9-alpha-fluohydrocortisone). However, their use should be cautious, because of a risk of arterial hypertension in supine position. [less ▲]

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See detailL'Hypotension orthostatique: 1ere partie: definition, symptomatologie, evaluation et physiopathologie.
Tyberghein, Maelle; PHILIPS, Jean-Christophe ULg; Krzesinski, Jean-Marie ULg et al

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 ▲]

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See detailTolvaptan in autosomal dominant polycystic kidney disease.
JOURET, François ULg; Krzesinski, Jean-Marie ULg

in New England Journal of Medicine [=NEJM] (2013), 368(13), 1258-9

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See detailLes syndromes cardio-rénaux
Krzesinski, Jean-Marie ULg

Learning material (2013)

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See detailHyperuricémie et risque cardiovasculaire dans la maladie rénale chronique
Krzesinski, Jean-Marie ULg

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 ▲]

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See detailCoronary heart disease: the MONICA-BELLUX Register
JeanJean, Michel; Krzesinski, Jean-Marie ULg; Wunsch, Guillaume

Conference (2012, December 05)

Background : Cardiovascular diseases contribute to 42% of overall mortality in the European Union. Over a third of deaths from CVD are from coronary heart disease and just over a quarter are from ... [more ▼]

Background : Cardiovascular diseases contribute to 42% of overall mortality in the European Union. Over a third of deaths from CVD are from coronary heart disease and just over a quarter are from cerebrovascular disease (stroke). Standardized death rates for heart disease have fallen dramatically in the last 25 years in Western Europe, both for men and for women. Multinational MONItoring of trends and determinants in CArdiovascular disease The MONICA Project : A major source of information on cardiovascular diseases established in the early 1980s under the auspices of WHO, to monitor trends in cardiovascular diseases and to relate these to risk factor changes over a ten year period. There were a total of 37 MONICA Collaborating Centres in 21 countries (including 29 populations in 16 European countries). The ten year data collection was completed in the late 1990s, though several Centres are still active today. Conclusions : CVD registers remain nevertheless an invaluable source for monitoring levels and trends in incidence and case fatality. Trends in incidence rates and in case fatality rates can significantly differ from one another. This situation requires better detection of individuals at risk. The intervention component of the BELLUX register is well-suited for this task. [less ▲]

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See detailL'insuffisance rénale aiguë dans le décours d'une chirurgie cardiaque adulte: incidence au Centre Hospitalier Universitaire de Liège
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Scientific conference (2012, November 20)

Cadre théorique En chirurgie cardiaque, l’insuffisance rénale aiguë (IRA) est une complication postopératoire sévère et est associée à une augmentation du taux de mortalité, de morbidité et des durées de ... [more ▼]

Cadre théorique En chirurgie cardiaque, l’insuffisance rénale aiguë (IRA) est une complication postopératoire sévère et est associée à une augmentation du taux de mortalité, de morbidité et des durées de séjour aux soins intensifs (SI). Elle survient dans 5 à 30 % des cas selon le type de définition utilisée (1,2). Objectifs L’objectif de cette étude est de présenter un état des lieux de l’IRA survenant dans le décours d’une chirurgie cardiaque, dans notre Centre. Matériel et Méthodes Cette étude rétrospective inclut des patients pris en charge pour une chirurgie cardiaque entre le 1er avril 2008 et le 31 mars 2009. Les patients sélectionnés sont des opérés de : pontages aorto-coronaires avec CEC (PAC CEC), pontages aorto-coronaires à cœur battant (PAC battant), remplacement valvulaire aortique (RVA), remplacement ou réparation valvulaire mitral (RVM), ou remplacement valvulaire aortique associé à des pontages aorto-coronaires (RVA+PAC). Les insuffisants rénaux chroniques dialysés, en période préopératoire, sont exclus. La classification RIFLE (Risk, Injury, Failure, Loss and End stage kidney disease) permet de stratifier les patients en trois grades de sévérité d’IRA. Cette stratification est basée sur l’élément le plus péjoratif observé durant les 7 premiers jours postopératoires : augmentation du niveau de créatinine sérique ou diminution de la diurèse, ou diminution de la filtration glomérulaire selon les critères définis par Bellomo (3). La fréquence d’IRA est étudiée par type de chirurgie ainsi que son impact sur les durées de séjour aux SI et hospitalier. Les proportions sont comparées par un test du Chi2 et les valeurs médianes par un test U de Mann Whitney. Les résultats sont considérés comme étant significatifs au niveau d’incertitude de 5% (p<0.05). Résultats Quatre cent trente-quatre patients sont inclus : âge médian (interquartiles) 69.0 (60.0-76.0) ans, 30.2% de femmes, 2.76 de cas urgents. Cinquante-huit patients (13.4%) sont opérés par la technique PAC battant, 182 (41.9%) PAC CEC, 104 (24.0%) RVA, 44 (10.1%) RVM et 46 (10.6%) RVA+PAC. Une IRA est diagnostiquée chez 213 (49.1%) patients : 79 (37.1%) « Risk », 108 (50.7%) « Injury » et 26 (12.2%) « Failure ». La distribution d’IRA par type de chirurgie est respectivement égale à 36.2% pour le groupe PAC battant, 44.0% PAC CEC, 49.0% RVA, 52.3 RVM et 82.6% RVA+PAC. La fréquence d’IRA diffère significativement selon le type d’intervention chirurgicale (p<0.0001). Les durées de séjour aux SI sont statistiquement plus longues (p<0.0001) pour le groupe de patients ayant développé une IRA, respectivement : 3(2-4) jours versus 2(2-3) jours. Cependant, il n’y a pas de différence (p=0.65) observée entre les deux groupes (IRA et non IRA) en termes de durées de séjour hospitalier : 13 (10-18) jours versus 12 (10-16) jours. Discussion L’incidence d’IRA est très élevée dans cette population de patients, comparée aux données disponibles dans la littérature. Cela est probablement dû au fait que les trois éléments de la classification RIFLE ont été utilisés sur toute la population de l’étude. Conclusions L’IRA après chirurgie cardiaque associée à la CEC devrait être étudiée, à l’avenir pour développer des mesures préventives pour réduire les IRA. [less ▲]

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See detailCardiac surgery and acute kidney injury: retrospective study
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Conference (2012, October 27)

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units ... [more ▼]

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units (ICU). It occurs in 5% to 30% of patients depending on the definition used [1] [2] [3]. The aim of this study is to present an overview of AKI following cardiac surgery associated or not with cardiopulmonary bypass, in our center. Methods: This retrospective study includes patients treated by cardiac surgery from April 1st, 2008 to March 31th, 2009 in a single center. We selected patients who underwent on-pump coronary artery bypass surgery (CABG), off-pump CABG (OPCAB), aortic valve replacement, mitral valve repair or replacement and aortic valve replacement combined with CABG. Patients undergoing renal replacement therapy preoperatively were excluded. The RIFLE classification (Risk, Injury, Failure, Loss and End stage kidney disease) allowed stratifying the patients into the 3 grades of AKI severity. The stratification was based on the most pejorative element observed within 7 days after surgery: increased serum creatinine level or decreased urine output, or decreased glomerular filtration rate according to criteria of Bellomo [4]. Occurrence of AKI was studied by type of cardiac surgery as its impact on the length of stay in ICU and in the hospital. Proportions were compared by the Chi-square test and median values by the Mann-Whitney U test. Results were considered significant at p < 0.05. Results: Four hundred and thirty-four patients were included: median (IQR) age 69.0(60.0-76.0) year, 30.2% females, 2.76% urgent/emergent cases. Fifty-eight patients (13.4%) underwent OPCAB, 182(41.9%) on-pump CABG, 104(24.0%) aortic valve replacement, 44(10.1%) mitral valve repair or replacement and 46(10.6%) aortic valve replacement combined with CABG. AKI occurred in 213(49.1%) patients: 79(37.1%) “Risk”, 108(50.7%) “Injury” and 26(12,2%) “Failure”. Distribution of AKI by type of surgery was equal to 36.2% among OPCABG, 44.0% on-pump CABG, 49.0% aortic valve replacement, 52.3% mitral valve surgery and 82.6% aortic valve replacement combined with CABG, respectively. AKI occurrences differed significantly according to the type of surgery (p<0.0001). Lengths of stay in ICU were significantly longer (p<0.0001) in AKI group compared with non AKI group: 3(2-4) days versus 2(2-3) days. However, no difference (p = 0.65) was observed between the two (AKI and NON-AKI) groups in hospital length of stay: 13(10-18) days versus 12(10-16) days. Conclusions: The incidence of AKI is very high in this population as compared to the literature. This may be due to the fact that the three elements of the RIFLE classification for all the population studied have been used. This study emphasizes the need for clear definition of AKI in order to compare different studies adequately. AKI after cardiac surgery with cardiopulmonary bypass would be further studied in order to develop more appropriate preventive measures. [less ▲]

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See detailCardiac surgery and acute kidney injury: retrospective study
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Conference (2012, September 29)

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units ... [more ▼]

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units (ICU). It occurs in 5% to 30% of patients depending on the definition used [1] [2] [3]. The aim of this study is to present an overview of AKI following cardiac surgery associated or not with cardiopulmonary bypass. Methods: This retrospective study includes patients treated by cardiac surgery from April 1st, 2008 to March 31th, 2009 in a single center. We selected patients who underwent on-pump coronary artery bypass surgery (CABG), off-pump CABG (OPCAB), aortic valve replacement, mitral valve repair or replacement and aortic valve replacement combined with CABG. Patients undergoing renal replacement therapy preoperatively were excluded. The RIFLE classification (Risk, Injury, Failure, Loss and End stage kidney disease) allowed to stratify the patients into the 3 grades of AKI severity. The stratification was based on the most pejorative element observed within 7 days after surgery: increased serum creatinine level or decreased urine output, or decreased glomerular filtration rate according to criteria of Bellomo [4]. Occurrence of AKI was studied by type of cardiac surgery as its impact on the length of stay in ICU and in the hospital. Proportions were compared by the Chi-square test and median values by the Kruskal-Wallis. Results were considered significant at p < 0.05. Results: Four hundred and thirty four patients were included: median (IQR) age 69.0(60.0-76.0) year, 30.2% females, 2.76% urgent/emergent cases. Fifty-eight patients (13.4%) underwent OPCAB, 182(41.9%) on-pump CABG, 104(24.0%) aortic valve replacement, 44(10.1%) mitral valve repair or replacement and 46(10.6%) aortic valve replacement combined with CABG. AKI occurred in 213(49.1%) patients: 79(37.1%) “Risk”, 108(50.7%) “Injury” and 26(12,2%) “Failure”. Occurrence of AKI after OPCAB was 21(9.86%), CABG 80(37.6%), aortic valve replacement 51(23.9%), mitral valve surgery 23(10.8%) and aortic valve replacement combined with CABG 38(17.8%). AKI occurrences differed significantly between the different groups of surgery (p<0.0001). Lengths of stay in ICU were significantly longer (p<0.0001) in AKI group compared with non AKI group: 3(2-4) days versus 2(2-3) days. No difference (p = 0.65) was observed between the two (AKI and NON-AKI) groups in hospital length of stay: 13(10-18) days versus 12(10-16) days. Conclusions: The incidence of AKI is very high in this population as compared to the literature. This may be due to the fact that the three elements of the RIFLE classification for all the population studied have been used: serum creatinine level, urine output and glomerular filtration rate. This study emphasizes the need for clear definition of AKI in order to compare adequately different studies. AKI after cardiac surgery with cardiopulmonary bypass would be further studied in order to develop more appropriate preventive measures. [less ▲]

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See detailUrinary and dietary sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant recipients: an observational study
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; Gellner, Karen et al

in BMC Nephrology (2012), 13

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 ... [more ▼]

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 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 tested 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 M6(R)). The 24-hour urinary sodium (Na+) and potassium (K+) excretions as well as dietary intakes 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. Pearson correlation coefficients and paired t-test were used when sample size was >30. 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/24 h) but uncontrolled patients excreted less potassium (68 +/- 14 vs 54 +/- 20 mmol/24 h; P = 0.029) and had significantly lower potassium intakes (3279 +/- 753 vs 2208 +/- 720 mg/24 h; P = 0.009), associated with a higher urinary Na+/K + ratio. Systolic HBP was inversely and significantly correlated to urinary potassium (r = -0.48; P = 0.002), a positive but non significant relation was observed with urinary sodium (r = 0,30;P = 0.074). 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 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)

Detailed reference viewed: 7 (0 ULg)
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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 ▲]

Detailed reference viewed: 60 (2 ULg)