References of "VANDERWECKENE, Pauline"
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See detailComment mesurer correctement la PA chez les patients hémodialysés?
VANDERWECKENE, Pauline ULg; SAINT-REMY, Annie ULg; KRZESINSKI, Jean-Marie ULg

Poster (2016, December)

Objectifs : Le contrôle de la pression artérielle (PA) chez le patient hémodialysé (HD) est un enjeu majeur en raison des résultats controversés sur les risques cardiovasculaires qui y sont associés ... [more ▼]

Objectifs : Le contrôle de la pression artérielle (PA) chez le patient hémodialysé (HD) est un enjeu majeur en raison des résultats controversés sur les risques cardiovasculaires qui y sont associés. Cependant, la mesure de la PA dans cette population est difficile à appréhender au vu de sa grande variabilité. L’exactitude des mesures péridialytiques (enregistrées dans l’unité d’HD pendant la séance) est souvent remise en question. L’objectif de notre étude est d’établir la contribution et la concordance entre deux techniques de mesure ambulatoire pour détecter la PA non contrôlée chez ces patients HD. Il s’agit du monitoring ambulatoire interdialytique de 44h (MAPA) et de l’automesure au domicile (HBPM) pendant une durée variable de 3, 5 et 7 jours. Méthodologie : 43 patients hémodialysés chroniques (H=28, F = 15), avec une moyenne de 68,3±13 ans ont réalisé une MAPA de 44h (Spacelabs 90207), de la fin d’une séance d’HD au début de la suivante, immédiatement suivie par une automesure de 7 jours (Omron M6). Les mesures péridialytiques étaient la moyenne des PA pré-dialyse ou post-dialyse enregistrées sur 2 semaines (6 séances d’HD). L’hypertension était définie par une PA égale ou supérieure à 140/90 mmHg pour la PA pré-HD, 130/80 mmHg pour la PA post-HD, 130/80 mmHg pour la MAPA de 44 h et 135/85 mmHg pour l’HBPM. Résultats : Nous avons constaté de bonnes corrélations entre la MAPA et l’HBPM pour le diagnostic de l’hypertension chez le patient HD. Comparées aux PA péridialytiques, les 2 techniques ambulatoires ont permis d’identifier la même proportion d’hypertension masquée et d’hypertension de la blouse blanche (25%). La plus grande précision de diagnostic sur le status tensionnel est retrouvée pour les plus longues périodes d’enregistrement (44h pour la MAPA et 7 jours pour l’HBPM). Les plus courtes périodes étaient mieux tolérées par les patients mais moins précises pour détecter l’hypertension. L’automesure était plus appréciée que la MAPA de 44h. Conclusion : La MAPA et l’automesure ont permis d’identifier un quart de patients avec un phénotype particulier d’hypertension, qui n’aurait pas été classé correctement en se fiant uniquement aux mesures péridialytiques. L’automesure devrait être recommandée en première ligne chez le patient HD (au moins une semaine/mois). Cependant, la MAPA fournit des informations uniques comme la PA nocturne et pourrait être proposée, idéalement une fois par an, chez tous les patients. [less ▲]

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See detailThe closure of arteriovenous fistula is associated with a significant acceleration of eGFR decline in kidney transplant recipients
Jouret, François ULg; DELANAYE, Pierre ULg; VANDERWECKENE, Pauline ULg et al

Poster (2016, November)

Background The creation of arteriovenous fistula (AVF) may retard chronic kidney disease progression in the general population. Conversely, there is limited literature regarding the impact of AVF closure ... [more ▼]

Background The creation of arteriovenous fistula (AVF) may retard chronic kidney disease progression in the general population. Conversely, there is limited literature regarding the impact of AVF closure on renal function in kidney transplant recipients (KTR). Methods All KTR were retrospectively identified from 01/01/2007 to 31/12/2013, and grouped into: (0) no AVF; (1) closed AVF; and (2) left open AVF. Glomerular filtration rate was estimated (eGFR) upon MDRD and FAS equations. Linear mixed models calculated the slope and intercept of eGFR decline versus time, starting at 3 months post transplantation (Tx). Comparative analyses of eGFR slopes were performed among groups, as well as before vs after AVF closure in group 1. For the latter, time was balanced before vs after AVF closure, with at least 10 observations per patient. Results The cohort included 285 KTR (Table 1), with a median follow-up of 1750 days [1665; 2028]. Focusing on group 1, AVF closure occurred after a mean time of 653 ± 441 days post Tx, with a thrombosis/ligation ratio of 19/95. Balanced study periods before vs after AVF closure lasted 15.7 and 14.9 months, respectively. No difference was found between corresponding intercepts (p, 0.11). By contrast, eGFR slopes were significantly different before (0.043 ml/min/year) versus after (-0.176 ml/min/year) AVF closure (p, 0.0115). Similar observations were obtained using FAS equation Conclusion A significant acceleration of eGFR decline is observed over the 15 months following the closure of functioning AVF in KTR. [less ▲]

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See detailHow to measure accurately blood pressure in hemodialysis patients?
VANDERWECKENE, Pauline ULg; SAINT-REMY, Annie ULg; KRZESINSKI, Jean-Marie ULg

Conference (2016, October 29)

Objective : Blood pressure (BP) control in chronic hemodialysis (HD) patients is a major challenge and could explain the controversial results about its cardiovascular risk. Our study aimed to assess the ... [more ▼]

Objective : Blood pressure (BP) control in chronic hemodialysis (HD) patients is a major challenge and could explain the controversial results about its cardiovascular risk. Our study aimed to assess the contribution of two ambulatory techniques of measurements compared with office BP (OBP): ambulatory monitoring during a maximum of 44h interdialytic period (ABPM) and home blood pressure (HBPM) during a variable period of days in prevalent HD patients. Methodology : 43 prevalent chronically HD patients (M=28; F=15), mean age 68.3±13 years were submitted to a 44h monitoring of BP (Spacelabs 90207) from the end of an HD session to 10 minutes before the next session, immediately followed by a 7days HBPM (Omron M6). Office BP was the mean of pre-dialysis BP or post-dialysis-BP recorded over 2 weeks (6 HD sessions). Hypertension was defined as BP equal or higher than 140/90 mmHg for pre-HD, 130/80 mmHg for post-HD, 130/80 mmHg for 44 h ABPM and 135/85 mmHg for HBPM. Results : Good correlations were noted between ABPM and HBPM for the diagnosis of hypertension in HD patients. Both ambulatory techniques give the same proportion of masked hypertension and white coat hypertension compared with OBP (25%). The best diagnostic precision was noted for the longest periods of recordings (44h for ABPM and 7days for HBPM). Shorter periods were more practical for the patients but less precise for high BP identification. HBPM was more appreciated than ABPM by the patients Conclusion : ABPM and HBPM identified a quarter of patients with a particular phenotype of hypertension not correctly classified by OBP. HBPM should be first recommended in HD (at least 1 week/month). As ABPM provides unique information for nocturnal BP, it could be proposed 1 time/year in all patients. [less ▲]

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See detailThe closure of arteriovenous fistula in kidney transplant recipients is associated with an acceleration of kidney function decline
WEEKERS, Laurent ULg; VANDERWECKENE, Pauline ULg; pottel, hans et al

in Nephrology Dialysis Transplantation (2016)

ABSTRACT Background. The creation of arteriovenous fistula (AVF) may retard chronic kidney disease progression in the general population. Conversely, the impact of AVF closure on renal function in kidney ... [more ▼]

ABSTRACT Background. The creation of arteriovenous fistula (AVF) may retard chronic kidney disease progression in the general population. Conversely, the impact of AVF closure on renal function in kidney transplant recipients (KTRs) remains unknown. Methods. From 2007 to 2013, we retrospectively categorized 285 KTRs into three groups: no AVF (Group 0, n = 90), closed AVF (Group 1, n = 114) and left-open AVF (Group 2, n = 81). AVF closure occurred at 653 ± 441 days after kidney transplantation (KTx), with a thrombosis:ligation ratio of 19:95. Estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Disease equation. Linear mixed models calculated the slope and intercept of eGFR decline versus time, starting at 3 months post-KTx, with a median follow-up of 1807 days (95% confidence interval 1665–2028). Results. The eGFR slope was less in Group 1 (−0.081 mL/min/ month) compared with Group 0 (−0.183 mL/min/month; P = 0.03) or Group 2 (−0.164 mL/min/month; P = 0.09). Still, the eGFR slope significantly deteriorated after (−0.159 mL/min/month) versus before (0.038 mL/min/month) AVF closure (P= 0.03). Study periods before versus after AVF closure were balanced to a mean of 13.5 and 12.5 months, respectively, with at least 10 observations per patient (n = 99). Conclusions. In conclusion, a significant acceleration of eGFR decline is observed over the 12 months following the closure of a functioning AVF in KTRs. [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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