References of "Krzesinski, Jean-Marie"
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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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See detailY a-t-il encore une place pour la double inhibition du système rénine-angiotensine en 2012?
Krzesinski, Jean-Marie ULg; Scheen, André ULg

in Revue Médicale Suisse (2012), 8(351), 1598-1603

The blockade of the renin-angiotensin system (RAS) improves the prognosis of patients with complications related to diabetes, hypertension or, in general, atherosclerosis. Several observational studies ... [more ▼]

The blockade of the renin-angiotensin system (RAS) improves the prognosis of patients with complications related to diabetes, hypertension or, in general, atherosclerosis. Several observational studies have suggested the use of a dual blockade of the RAS to benefit from a better cardiorenal protection. However, recent randomized controlled studies failed to demonstrate that a dual blockade exert a better protection than single blockade, but showed a higher risk for renal complications and hyperkalemia. To decrease the residual risk, other opportunities may be recommended such as reinforcement of low salt diet, use of supraphysiological dose of a monotherapy inhibiting the RAS (perhaps prescribed at the evening) or addition of an aldosterone antagonist. However, all these approaches, as dual therapy, may also increase the risk of hypotension and renal insufficiency and thus require to be used under strict medical supervision. [less ▲]

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See detailDelayed graft function does not harm the future of donation-after-cardiac death in kidney transplantation.
Le Dinh, Hieu; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

in Transplantation Proceedings (2012), 44(9), 2795-802

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 posttransplantation outcomes among grafts from controlled DCD kidneys. PATIENTS AND METHODS: This single-center retrospective study recruited 80 controlled DCD kidneys transplanted from January 2005 to December 2011. Mean patient follow-up was 28.5 months. RESULTS: There were no primary nonfunction grafts; the DGF rate was 35.5%. Overall graft survival rates between groups with versus without DGF were 92.4% and 95.2% at 1 year, 92.4% and 87.1% at 3 years, and 84.7% and 87.1% at 5 years, respectively (P = not significant (NS)). Patients with versus without DGF showed the same survival rates at the corresponding time 92.4% vs 97.2%, 92.4% vs 93.9%, and 84.7% vs 93.9% (P = NS). Estimated glomerular filtration rate was significantly lower in the DGF compared with the non-DGF group at hospital discharge (29 vs 42 mL/min; P = .00) and at 6 months posttransplantation (46 vs 52 mL/min; P = .04), but the difference disappeared thereafter: 47 vs 52 mL/min at 1 year, 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 an acute rejection episode (29.6% vs 30.6%; P = NS) or rate of surgical complications (33.3% vs 26.5%; P = NS). However, DGF prolonged significantly the length of hospitalization in the DGF versus the non- DGF group (18.9 vs 13 days; P = .00). Donor body mass index (BMI) >/= 30 kg/m(2), recipient BMI >/=30 kg/m(2), and pretransplantation dialysis duration increased the risk of DGF upon multivariate logistic regression analysis. CONCLUSIONS: Apart from the longer hospital stay, DGF had no deleterious impact on the future of kidney allografts from controlled DCD, which showed comparable graft and patient survivals, renal function, rejection rates, and surgical complications as a group without DGF. Therefore, DGF should no longer be considered to be a medical barrier to the use of kidney grafts from controlled DCD. [less ▲]

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