David Attaf | Université Claude Bernard Lyon 1 (original) (raw)
Papers by David Attaf
Kidney International, 2009
Néphrologie & Thérapeutique, 2019
Nephrology Dialysis Transplantation, May 1, 2022
CHF patients had more episodes of hospitalization due to heart failure (HR 2.93, 95% CI 1. 49-5.7... more CHF patients had more episodes of hospitalization due to heart failure (HR 2.93, 95% CI 1. 49-5.76; P <0.01). However, compared with patients without CHF, the all-cause hospitalization risk was not much higher in CHF patients (HR 1.09, 95% CI 0.90-1.33; P = 0.39). CONCLUSION: In this prospective cohort study, the prevalence of CHF was identified to be around one quarter, and all-cause mortality in patients with combined CHF and HD was found to be higher. CHF was associated with an increased risk of all-cause mortality and a cause-specific hospitalization risk in HD patients. The associations were not affected by adjustment for several potential confounding factors. Thus, CHF is found to be an outcome predictor for HD patients, and measures should be adopted to improve care for these patients to improve their survival.
Néphrologie & Thérapeutique, 2020
Introduction La correction de l’anemie (Hb, coefficient de saturation de la transferrine, ferriti... more Introduction La correction de l’anemie (Hb, coefficient de saturation de la transferrine, ferritinemie) par des agents stimulants l’erythropoiese (ASE) et du fer injectable (F.IV) necessite une anticipation de la reponse attendue au 3e mois (delta Hb). Un modele predictif (Reseau de Neurones Artificiels [RNA]) facilite cette gestion. Il est nomme « Anemia Control Module » (ACM). Nous evaluons dans cette etude pilote son effet sur la prise en charge de l’anemie en hemodialyse. Description Etude prospective en HD (110 patients/9 mois) evaluant la capacite a predire le « delta Hb » au troisieme mois apres administration d’ASE/F.IV. Donnees biologiques recueillies a l’aide du logiciel Euclid : patients non selectionnes, presentant des evenements intercurrents (saignement, transfusion, inflammation, hospitalisation). Les pratiques medicales sont homogenes (Hb 10–12 g/dL, ferritinemie 400–600 μg/L, coef. saturation de la transferrine 25–30 %). Les propositions de l’ACM sont validees par le prescripteur. Methodes Nous avons utilise le module ACM de juin 2019 a avril 2020 et analyse prospectivement son impact sur la prise en charge de l’anemie (Hb, dose d’ASE) dans les centres NephroCare de Villejuif et Bievres. Resultats Les donnees Euclid (âge, comorbidites, modalite de dialyse, poids, CRP, Hb, ferritinemie, coefficient de saturation de la transferrine, doses d’ASE/F.IV) permettent de verifier la capacite du modele a predire le « delta Hb » au 3e mois. Entre juin 2019 et avril 2020, le pourcentage de patients dans la cible d’Hb augmente de 66 a 88 % (+21 %) et de 57 a 78 % (+22 %). Simultanement, les doses d’epoietine β ont diminue de 30 %. Conclusion Cette etude pilote a permis de valider la place du RNA dans notre pratique. Nos resultats indiquent une augmentation du pourcentage de patients dans la cible therapeutique avec une reduction du besoin en epoietine β. Le RNA a ete generalise en pratique courante sur nos unites NephroCare.
Néphrologie & Thérapeutique, 2020
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Néphrologie & Thérapeutique, 2018
Néphrologie & Thérapeutique, 2019
Néphrologie & Thérapeutique, 2019
Nephrology Dialysis Transplantation, 2019
Background Fluid overload is frequent among hemodialysis (HD) patients. Dialysis therapy itself m... more Background Fluid overload is frequent among hemodialysis (HD) patients. Dialysis therapy itself may favor sodium imbalance from sodium dialysate prescription. As on-line hemodiafiltration (OL-HDF) requires large amounts of dialysate infusion, this technique can expose to fluid accumulation in case of a positive sodium gradient between dialysate and plasma. To evaluate this risk, we have analyzed and compared the fluid status of patients treated with HD or OL-HDF in French NephroCare centers. Method This is a cross-sectional and retrospective analysis of prevalent dialysis patients. Data were extracted from the EUCLID5 data base. Patients were split in 2 groups (HD and OL-HDF) and compared as whole group or matched patients for fluid status criteria including predialysis relative fluid overload (RelFO%) status from the BCM®. Results 2242 patients (age 71 years; female: 39%; vintage: 38 months; Charlson index: 6) were studied. 58% of the cohort were prescribed post-dilution OL-HDF. Co...
Néphrologie & Thérapeutique, 2016
Introduction Les chelateurs des phosphates (CP) en hemodialyse (HD) constituent une part signific... more Introduction Les chelateurs des phosphates (CP) en hemodialyse (HD) constituent une part significative de la prise medicamenteuse journaliere. Celle-ci peut influencer l’adherence et par consequent le controle de l’hyperphosphatemie (HP). L’HP est associee a une surmortalite, aussi l’adherence aux CP doit etre evaluee et les facteurs de « non adherence » corriges. L’adherence peut etre estimee a l’aide d’une enquete patient utilisant un questionnaire valide. L’objectif de cette etude est d’evaluer en HD, au sein des centres de dialyse Nephrocare, l’adherence des patients aux CP et ses facteurs limitants. Patients et methodes Un questionnaire derive de l’echelle de Morisky est applique aux patients (IDE ou auto-evaluation perdialytique) ; ont ete collectes les donnees demographiques, le nombre de cp/j, la connaissance du patient sur l’HP et ses complications, l’adherence au CP et les facteurs susceptibles de l’influencer. Resultats Au total, 1290 patients repondeurs (âge moyen 69 ans), 47 % sont en dialyse depuis + de 3 ans, 48 % ont une prescription medicamenteuse de 8 a + de 12 cp/j, 63 % declarent « connaitre le phosphore », 67 % n’en connaissent pas les complications, 46 % des patients declarent une posologie de CP de 3 a 8+ cp/j, 71 % des patients declarent une « adherence totale » au CP. Parmi les non-adherents, 50 % « oublient » et 16 % « ne tolerent pas » leur CP. L’augmentation de la posologie du CP est associee a une augmentation non significative de l’adherence. L’âge, l’anciennete en HD, le centre de dialyse n’influencent pas l’adherence au CP. Discussion Les posologies et les « motifs de non-adherence » declares sont conformes a ceux de DOPPS. La correlation positive entre « posologie du CP » et « adherence » infirme DOPPS mais confirme l’etude de Neri et al. [1] . Dans cette etude, la relation entre « posologie du CP » et « adherence » est appreciee par un facteur global dit « charge de l’ensemble du traitement oral ». Ce facteur n’a pas ete evalue dans notre questionnaire et pourrait expliquer cette relation inattendue entre posologie et adherence [2] . Conclusion Les notions admises que « l’adherence est liee au nombre de comprimes prescrits » et qu’une « posologie reduite ameliorerait l’adherence » doivent etre nuancees. Cette etude confirme ainsi l’importance de l’education therapeutique en nephrologie/dialyse.
Néphrologie & Thérapeutique, 2015
Introduction L’acetate de calcium (AC) est disponible en IRC-5D en France depuis 2010 dans la che... more Introduction L’acetate de calcium (AC) est disponible en IRC-5D en France depuis 2010 dans la chelation des phosphates. En 2012, une etude monocentrique comparant AC et carbonate de calcium (CC) indique un controle de la phosphatemie equivalent tout en reduisant l’apport de calcium element (CaE) de 60 % pour l’AC. Cette etude vise a comparer AC et CC dans une etude multicentrique. Patients et methodes Etude menee aupres de 28 centres d’hemodialyse suivant des patients sous CC. L’AC a ete introduit en remplacement du CC (M0). Nous avons compare le dernier bilan realise a MO sous CC a celui realise au 6e mois sous AC (M6). Notre objectif etait de comparer l’apport de CaE et le controle de la phosphatemie et du calcium total sous AC versus CC. Resultats Deux cent quatre-vingt-treize patients (70,3 ans ± 14) suivis sous AC dans 28 centres. A M6, la posologie moyenne d’AC = 3,8 cp ± 2. Les caracteristiques demographiques sont conformes aux donnees REIN. Les donnees biologiques entre les M0 et M6 sont presentees dans le Tableau 1 . Discussion A M6, la dose de CaE est reduite de 57 %, le controle de la phosphatemie est similaire versus M0. La calcemie moyenne n’est pas modifiee. Les frequences des calcemies > 2,60 mmol/L et Phophatemies > 1,5 mmol/L ne sont pas modifiees. A M6, PTH et 25 OH vit D sont stables. Conclusion Cette etude multicentrique (i.e., strategies therapeutiques differentes) confirme que l’AC controle la phosphatemie de facon similaire au CC pour une dose reduite en CaE.
Néphrologie & Thérapeutique, 2014
![Research paper thumbnail of Erratum à « Effet du cinacalcet sur l’homéostasie calcique et le remodelage osseux chez 13 transplantés rénaux présentant une hyperparathyroïdie avec hypercalcémie » [Nephrol Ther 2012;8:47–53]](https://attachments.academia-assets.com/89344946/thumbnails/1.jpg)
](Néphrologie & Thérapeutique, 2012
Trois erreurs se sont glissé es dans le volume 8, numé ro1/2012 de Ne´phrologie & The´rapeutique.... more Trois erreurs se sont glissé es dans le volume 8, numé ro1/2012 de Ne´phrologie & The´rapeutique. À la fin du paragraphe de la section 3.8. Marqueurs biochimiques du remodelage osseux, page 50, il fallait lire : Ce rapport n'est modifié ni par le traitement par cinacalcet ni par son interruption avec des valeurs mé dianes respectivement à 6,6 et 7,1 nmol/mmol de cré atinine (Tableau 2). Dans le Tableau 1, la ré partition quotidienne des prises du 6 e patient est de 30-00-00 et non pas 60-00-00. Dans le Tableau 2, le test de Wilcoxon M0-M4, p des paramè tres biochimiques TmPi/DFG est de 0,01 et non pas de < 0,001. Nous prions les auteurs et nos lecteurs de nous excuser de cette erreur. Né phrologie & Thé rapeutique 8 (2012) 126-127 Tableau 1 Caracté ristiques initiales des patients.
Pathologie Biologie, 2010
Glycation and oxidative stress are two important processes known to play a key role in complicati... more Glycation and oxidative stress are two important processes known to play a key role in complications of many disease processes. Oxidative stress, either via increasing reactive oxygen species (ROS), or by depleting the antioxidants may modulate the genesis of early glycated proteins in vivo. Maillard Reactions, occur in vivo as well as in vitro and are associated with the chronic complications of diabetes, aging and age-related diseases. Hyperglycaemia causes the autoxidation of glucose, glycation of proteins, and the activation of polyol metabolism. These changes facilitate the generation of reactive oxygen species and decrease the activity of antioxidant enzymes such as Cu,Zn-superoxide dismutase, resulting in a remarkable increase of oxidative stress. A large body of evidence indicates that mitochondria alteration is involved and plays a central role in various oxidative stress-related diseases. The damaged mitochondria produce more ROS (increase oxidative stress) and less ATP (cellular energy) than normal mitochondria. As they are damaged, they cannot burn or use glucose or lipid and cannot provide cell with ATP. Further, glucose, amino acids and lipid will not be correctly used and will accumulate outside the mitochondria; they will undergo more glycation (as observed in diabetes, obesity, HIV infection and lipodystrophia). The objective of this paper is to discuss how to stop the vicious circle established between oxidative stress, Maillard Reaction and mitochondria. The potential application of some antioxidants to reduce glycation phenomenon and to increase the antioxidant defence system by targeting mitochondria will be discussed. Food and pharmaceutical companies share the same challenge, they must act now, urgently and energetically.
Acupuncture in Medicine, 2004
Kidney and Dialysis, 2022
Background: Due to their immunocompromised conditions, hemodialysis (HD) patients are at high ris... more Background: Due to their immunocompromised conditions, hemodialysis (HD) patients are at high risk of being infected with SARS-CoV-2 with poor clinical outcomes. We explored safety, efficacy and variability factors associated with vaccine immune response in these patients. Methods: From 18 January to 30 April 2021, 87 HD patients were enrolled in this study and subdivided in two sub-groups: SARS-CoV-2 positive prior to vaccination and naïve patients. The vaccination protocol included two intramuscular shots of the mRNA vaccine at a 28-day interval. The vaccine response was evaluated one month after the first and second shots by measuring anti-S antibody titers. Findings: 44% of the patients studied, were women; median age was 58 years. One month after the first shot, 64.3% of patients had anti-S antibody titers < 50 U/mL while 96.5% had anti-S antibody titers > 250 U/mL one month after the second shot. We show that the anti-SARS-CoV-2 spike mRNA vaccine elicits a great tolerab...
Abstract: Between 2015 and 2017 there was a 40% increase in daily hemodialysis, according to the ... more Abstract: Between 2015 and 2017 there was a 40% increase in daily hemodialysis, according to the REIN database. This increase concerns 1% of patients and the private sector remains under-represented. Our retrospective study aims to describe the clinical features, the organizational and medico-economic specificities of this technique in a private hemodialysis center. Methods: We included 12 dialyzed patients trained on Nx Stage® machine from February 2020 to April 2021. Data were retrospectively obtained through review of our electronic medical records (EUCLID®). Results: Of the 12 patients trained, 11 dialyzed from home, with an average follow-up of 9 months (1-14). The average age was 45 with a sex ratio of 4/8 (M/W), and a median Charlson score of 3 (2-4). The average residual urinary output was 700 mL/24h, and 50% of patients were anuric. 100% of patients had an arteriovenous fistula and were cannulated using the buttonhole technique. 9 patients are on a transplant list. One pati...
Background Maintenance hemodialysis (MHD) patients have a high risk of initial mortality from COV... more Background Maintenance hemodialysis (MHD) patients have a high risk of initial mortality from COVID-19. However, long-term consequences of this disease in the MHD population are poorly described. We report the clinical presentation, outcome and long-term follow-up of MHD patients affected by COVID-19, in a multicentric cohort from the Paris, France area. Methods Retrospective analysis of clinical presentation and long-term follow-up of MHD patients affected by COVID-19 in 19 MHD centers in the Paris, France area. Results In this cohort of 248 patients with an initial mortality rate of 18%, age, comorbidities, dyspnea and previous immunosuppressive treatment were associated with death <30d. Among the 203 surviving patients following the acute phase, long-term follow-up (median 180d) was available for 189 (93%) patients. Major adverse events occurred in 30 (16%) patients during follow-up, including 12 deaths (6%) after a median of 78d from onset of symptoms. Overall, cardiovascular...
Introduction Administration of low-molecular-weight heparins (LMWHs) is necessary for preventing ... more Introduction Administration of low-molecular-weight heparins (LMWHs) is necessary for preventing extracorporeal circuit thrombosis during hemodialysis. A substantial amount of LMWH is removed with online hemodiafiltration (OL-HDF) when administered through the inlet site of the extracorporeal circuit. Consequently, administration of LMWH at the outlet site appears to be more efficient. In this study we aimed to compare the effects of nadroparin calcium (NAD) administered through the outlet versus the inlet port site in postdilution OL-HDF and assess the NAD dose reduction. Methods Forty-nine hemodialysis patients were included in 3 consecutive 6-week studies as follows: phase I, inlet port line; phase II, outlet port line; and phase III, outlet port line with reduced dose. We evaluated clotting in the hemodialyzer and venous bubble trap, the dialysis dose (Kt/V), and substitution volume. Results Thirty four percent, 63%, and 66% were categorized as “white” during phases I, II, and I...
Nephrology Dialysis Transplantation
Background and Aims Several studies showed that DHHD improved survival and quality of life and al... more Background and Aims Several studies showed that DHHD improved survival and quality of life and allowed a lower cost for health system. The aim of this study was to describe our first experience of DHHD in our dialysis center. Method We included 9 dialyzed patients trained on Nx Stage® machine (Fresenius Medical Care) from February to December 2020. Data was retrospectively obtained through review of our medical electronic records (Euclid®). Results Among 9 patients trained, 8 were installed at home, with an average follow up of 7 months. 6 patients were dialyzed in self hemodialysis facilities. The mean age was 45 years (28-71), 6 women, BMI: 24 kg/m2 (21-30), dialysis vintage: 5 years and 7 patients are on transplant list. The Charlson score was: 5 (4-8), 5 patients had a residual diuresis> 500 ml/d. The average training duration was 5 weeks (4-8). Our training program targeted the self-puncture of AVF and the self-assembly of the machine by the patient. 100% of AVF were cannula...
Kidney International, 2009
Néphrologie & Thérapeutique, 2019
Nephrology Dialysis Transplantation, May 1, 2022
CHF patients had more episodes of hospitalization due to heart failure (HR 2.93, 95% CI 1. 49-5.7... more CHF patients had more episodes of hospitalization due to heart failure (HR 2.93, 95% CI 1. 49-5.76; P <0.01). However, compared with patients without CHF, the all-cause hospitalization risk was not much higher in CHF patients (HR 1.09, 95% CI 0.90-1.33; P = 0.39). CONCLUSION: In this prospective cohort study, the prevalence of CHF was identified to be around one quarter, and all-cause mortality in patients with combined CHF and HD was found to be higher. CHF was associated with an increased risk of all-cause mortality and a cause-specific hospitalization risk in HD patients. The associations were not affected by adjustment for several potential confounding factors. Thus, CHF is found to be an outcome predictor for HD patients, and measures should be adopted to improve care for these patients to improve their survival.
Néphrologie & Thérapeutique, 2020
Introduction La correction de l’anemie (Hb, coefficient de saturation de la transferrine, ferriti... more Introduction La correction de l’anemie (Hb, coefficient de saturation de la transferrine, ferritinemie) par des agents stimulants l’erythropoiese (ASE) et du fer injectable (F.IV) necessite une anticipation de la reponse attendue au 3e mois (delta Hb). Un modele predictif (Reseau de Neurones Artificiels [RNA]) facilite cette gestion. Il est nomme « Anemia Control Module » (ACM). Nous evaluons dans cette etude pilote son effet sur la prise en charge de l’anemie en hemodialyse. Description Etude prospective en HD (110 patients/9 mois) evaluant la capacite a predire le « delta Hb » au troisieme mois apres administration d’ASE/F.IV. Donnees biologiques recueillies a l’aide du logiciel Euclid : patients non selectionnes, presentant des evenements intercurrents (saignement, transfusion, inflammation, hospitalisation). Les pratiques medicales sont homogenes (Hb 10–12 g/dL, ferritinemie 400–600 μg/L, coef. saturation de la transferrine 25–30 %). Les propositions de l’ACM sont validees par le prescripteur. Methodes Nous avons utilise le module ACM de juin 2019 a avril 2020 et analyse prospectivement son impact sur la prise en charge de l’anemie (Hb, dose d’ASE) dans les centres NephroCare de Villejuif et Bievres. Resultats Les donnees Euclid (âge, comorbidites, modalite de dialyse, poids, CRP, Hb, ferritinemie, coefficient de saturation de la transferrine, doses d’ASE/F.IV) permettent de verifier la capacite du modele a predire le « delta Hb » au 3e mois. Entre juin 2019 et avril 2020, le pourcentage de patients dans la cible d’Hb augmente de 66 a 88 % (+21 %) et de 57 a 78 % (+22 %). Simultanement, les doses d’epoietine β ont diminue de 30 %. Conclusion Cette etude pilote a permis de valider la place du RNA dans notre pratique. Nos resultats indiquent une augmentation du pourcentage de patients dans la cible therapeutique avec une reduction du besoin en epoietine β. Le RNA a ete generalise en pratique courante sur nos unites NephroCare.
Néphrologie & Thérapeutique, 2020
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Néphrologie & Thérapeutique, 2018
Néphrologie & Thérapeutique, 2019
Néphrologie & Thérapeutique, 2019
Nephrology Dialysis Transplantation, 2019
Background Fluid overload is frequent among hemodialysis (HD) patients. Dialysis therapy itself m... more Background Fluid overload is frequent among hemodialysis (HD) patients. Dialysis therapy itself may favor sodium imbalance from sodium dialysate prescription. As on-line hemodiafiltration (OL-HDF) requires large amounts of dialysate infusion, this technique can expose to fluid accumulation in case of a positive sodium gradient between dialysate and plasma. To evaluate this risk, we have analyzed and compared the fluid status of patients treated with HD or OL-HDF in French NephroCare centers. Method This is a cross-sectional and retrospective analysis of prevalent dialysis patients. Data were extracted from the EUCLID5 data base. Patients were split in 2 groups (HD and OL-HDF) and compared as whole group or matched patients for fluid status criteria including predialysis relative fluid overload (RelFO%) status from the BCM®. Results 2242 patients (age 71 years; female: 39%; vintage: 38 months; Charlson index: 6) were studied. 58% of the cohort were prescribed post-dilution OL-HDF. Co...
Néphrologie & Thérapeutique, 2016
Introduction Les chelateurs des phosphates (CP) en hemodialyse (HD) constituent une part signific... more Introduction Les chelateurs des phosphates (CP) en hemodialyse (HD) constituent une part significative de la prise medicamenteuse journaliere. Celle-ci peut influencer l’adherence et par consequent le controle de l’hyperphosphatemie (HP). L’HP est associee a une surmortalite, aussi l’adherence aux CP doit etre evaluee et les facteurs de « non adherence » corriges. L’adherence peut etre estimee a l’aide d’une enquete patient utilisant un questionnaire valide. L’objectif de cette etude est d’evaluer en HD, au sein des centres de dialyse Nephrocare, l’adherence des patients aux CP et ses facteurs limitants. Patients et methodes Un questionnaire derive de l’echelle de Morisky est applique aux patients (IDE ou auto-evaluation perdialytique) ; ont ete collectes les donnees demographiques, le nombre de cp/j, la connaissance du patient sur l’HP et ses complications, l’adherence au CP et les facteurs susceptibles de l’influencer. Resultats Au total, 1290 patients repondeurs (âge moyen 69 ans), 47 % sont en dialyse depuis + de 3 ans, 48 % ont une prescription medicamenteuse de 8 a + de 12 cp/j, 63 % declarent « connaitre le phosphore », 67 % n’en connaissent pas les complications, 46 % des patients declarent une posologie de CP de 3 a 8+ cp/j, 71 % des patients declarent une « adherence totale » au CP. Parmi les non-adherents, 50 % « oublient » et 16 % « ne tolerent pas » leur CP. L’augmentation de la posologie du CP est associee a une augmentation non significative de l’adherence. L’âge, l’anciennete en HD, le centre de dialyse n’influencent pas l’adherence au CP. Discussion Les posologies et les « motifs de non-adherence » declares sont conformes a ceux de DOPPS. La correlation positive entre « posologie du CP » et « adherence » infirme DOPPS mais confirme l’etude de Neri et al. [1] . Dans cette etude, la relation entre « posologie du CP » et « adherence » est appreciee par un facteur global dit « charge de l’ensemble du traitement oral ». Ce facteur n’a pas ete evalue dans notre questionnaire et pourrait expliquer cette relation inattendue entre posologie et adherence [2] . Conclusion Les notions admises que « l’adherence est liee au nombre de comprimes prescrits » et qu’une « posologie reduite ameliorerait l’adherence » doivent etre nuancees. Cette etude confirme ainsi l’importance de l’education therapeutique en nephrologie/dialyse.
Néphrologie & Thérapeutique, 2015
Introduction L’acetate de calcium (AC) est disponible en IRC-5D en France depuis 2010 dans la che... more Introduction L’acetate de calcium (AC) est disponible en IRC-5D en France depuis 2010 dans la chelation des phosphates. En 2012, une etude monocentrique comparant AC et carbonate de calcium (CC) indique un controle de la phosphatemie equivalent tout en reduisant l’apport de calcium element (CaE) de 60 % pour l’AC. Cette etude vise a comparer AC et CC dans une etude multicentrique. Patients et methodes Etude menee aupres de 28 centres d’hemodialyse suivant des patients sous CC. L’AC a ete introduit en remplacement du CC (M0). Nous avons compare le dernier bilan realise a MO sous CC a celui realise au 6e mois sous AC (M6). Notre objectif etait de comparer l’apport de CaE et le controle de la phosphatemie et du calcium total sous AC versus CC. Resultats Deux cent quatre-vingt-treize patients (70,3 ans ± 14) suivis sous AC dans 28 centres. A M6, la posologie moyenne d’AC = 3,8 cp ± 2. Les caracteristiques demographiques sont conformes aux donnees REIN. Les donnees biologiques entre les M0 et M6 sont presentees dans le Tableau 1 . Discussion A M6, la dose de CaE est reduite de 57 %, le controle de la phosphatemie est similaire versus M0. La calcemie moyenne n’est pas modifiee. Les frequences des calcemies > 2,60 mmol/L et Phophatemies > 1,5 mmol/L ne sont pas modifiees. A M6, PTH et 25 OH vit D sont stables. Conclusion Cette etude multicentrique (i.e., strategies therapeutiques differentes) confirme que l’AC controle la phosphatemie de facon similaire au CC pour une dose reduite en CaE.
Néphrologie & Thérapeutique, 2014
Néphrologie & Thérapeutique, 2012
Trois erreurs se sont glissé es dans le volume 8, numé ro1/2012 de Ne´phrologie & The´rapeutique.... more Trois erreurs se sont glissé es dans le volume 8, numé ro1/2012 de Ne´phrologie & The´rapeutique. À la fin du paragraphe de la section 3.8. Marqueurs biochimiques du remodelage osseux, page 50, il fallait lire : Ce rapport n'est modifié ni par le traitement par cinacalcet ni par son interruption avec des valeurs mé dianes respectivement à 6,6 et 7,1 nmol/mmol de cré atinine (Tableau 2). Dans le Tableau 1, la ré partition quotidienne des prises du 6 e patient est de 30-00-00 et non pas 60-00-00. Dans le Tableau 2, le test de Wilcoxon M0-M4, p des paramè tres biochimiques TmPi/DFG est de 0,01 et non pas de < 0,001. Nous prions les auteurs et nos lecteurs de nous excuser de cette erreur. Né phrologie & Thé rapeutique 8 (2012) 126-127 Tableau 1 Caracté ristiques initiales des patients.
Pathologie Biologie, 2010
Glycation and oxidative stress are two important processes known to play a key role in complicati... more Glycation and oxidative stress are two important processes known to play a key role in complications of many disease processes. Oxidative stress, either via increasing reactive oxygen species (ROS), or by depleting the antioxidants may modulate the genesis of early glycated proteins in vivo. Maillard Reactions, occur in vivo as well as in vitro and are associated with the chronic complications of diabetes, aging and age-related diseases. Hyperglycaemia causes the autoxidation of glucose, glycation of proteins, and the activation of polyol metabolism. These changes facilitate the generation of reactive oxygen species and decrease the activity of antioxidant enzymes such as Cu,Zn-superoxide dismutase, resulting in a remarkable increase of oxidative stress. A large body of evidence indicates that mitochondria alteration is involved and plays a central role in various oxidative stress-related diseases. The damaged mitochondria produce more ROS (increase oxidative stress) and less ATP (cellular energy) than normal mitochondria. As they are damaged, they cannot burn or use glucose or lipid and cannot provide cell with ATP. Further, glucose, amino acids and lipid will not be correctly used and will accumulate outside the mitochondria; they will undergo more glycation (as observed in diabetes, obesity, HIV infection and lipodystrophia). The objective of this paper is to discuss how to stop the vicious circle established between oxidative stress, Maillard Reaction and mitochondria. The potential application of some antioxidants to reduce glycation phenomenon and to increase the antioxidant defence system by targeting mitochondria will be discussed. Food and pharmaceutical companies share the same challenge, they must act now, urgently and energetically.
Acupuncture in Medicine, 2004
Kidney and Dialysis, 2022
Background: Due to their immunocompromised conditions, hemodialysis (HD) patients are at high ris... more Background: Due to their immunocompromised conditions, hemodialysis (HD) patients are at high risk of being infected with SARS-CoV-2 with poor clinical outcomes. We explored safety, efficacy and variability factors associated with vaccine immune response in these patients. Methods: From 18 January to 30 April 2021, 87 HD patients were enrolled in this study and subdivided in two sub-groups: SARS-CoV-2 positive prior to vaccination and naïve patients. The vaccination protocol included two intramuscular shots of the mRNA vaccine at a 28-day interval. The vaccine response was evaluated one month after the first and second shots by measuring anti-S antibody titers. Findings: 44% of the patients studied, were women; median age was 58 years. One month after the first shot, 64.3% of patients had anti-S antibody titers < 50 U/mL while 96.5% had anti-S antibody titers > 250 U/mL one month after the second shot. We show that the anti-SARS-CoV-2 spike mRNA vaccine elicits a great tolerab...
Abstract: Between 2015 and 2017 there was a 40% increase in daily hemodialysis, according to the ... more Abstract: Between 2015 and 2017 there was a 40% increase in daily hemodialysis, according to the REIN database. This increase concerns 1% of patients and the private sector remains under-represented. Our retrospective study aims to describe the clinical features, the organizational and medico-economic specificities of this technique in a private hemodialysis center. Methods: We included 12 dialyzed patients trained on Nx Stage® machine from February 2020 to April 2021. Data were retrospectively obtained through review of our electronic medical records (EUCLID®). Results: Of the 12 patients trained, 11 dialyzed from home, with an average follow-up of 9 months (1-14). The average age was 45 with a sex ratio of 4/8 (M/W), and a median Charlson score of 3 (2-4). The average residual urinary output was 700 mL/24h, and 50% of patients were anuric. 100% of patients had an arteriovenous fistula and were cannulated using the buttonhole technique. 9 patients are on a transplant list. One pati...
Background Maintenance hemodialysis (MHD) patients have a high risk of initial mortality from COV... more Background Maintenance hemodialysis (MHD) patients have a high risk of initial mortality from COVID-19. However, long-term consequences of this disease in the MHD population are poorly described. We report the clinical presentation, outcome and long-term follow-up of MHD patients affected by COVID-19, in a multicentric cohort from the Paris, France area. Methods Retrospective analysis of clinical presentation and long-term follow-up of MHD patients affected by COVID-19 in 19 MHD centers in the Paris, France area. Results In this cohort of 248 patients with an initial mortality rate of 18%, age, comorbidities, dyspnea and previous immunosuppressive treatment were associated with death <30d. Among the 203 surviving patients following the acute phase, long-term follow-up (median 180d) was available for 189 (93%) patients. Major adverse events occurred in 30 (16%) patients during follow-up, including 12 deaths (6%) after a median of 78d from onset of symptoms. Overall, cardiovascular...
Introduction Administration of low-molecular-weight heparins (LMWHs) is necessary for preventing ... more Introduction Administration of low-molecular-weight heparins (LMWHs) is necessary for preventing extracorporeal circuit thrombosis during hemodialysis. A substantial amount of LMWH is removed with online hemodiafiltration (OL-HDF) when administered through the inlet site of the extracorporeal circuit. Consequently, administration of LMWH at the outlet site appears to be more efficient. In this study we aimed to compare the effects of nadroparin calcium (NAD) administered through the outlet versus the inlet port site in postdilution OL-HDF and assess the NAD dose reduction. Methods Forty-nine hemodialysis patients were included in 3 consecutive 6-week studies as follows: phase I, inlet port line; phase II, outlet port line; and phase III, outlet port line with reduced dose. We evaluated clotting in the hemodialyzer and venous bubble trap, the dialysis dose (Kt/V), and substitution volume. Results Thirty four percent, 63%, and 66% were categorized as “white” during phases I, II, and I...
Nephrology Dialysis Transplantation
Background and Aims Several studies showed that DHHD improved survival and quality of life and al... more Background and Aims Several studies showed that DHHD improved survival and quality of life and allowed a lower cost for health system. The aim of this study was to describe our first experience of DHHD in our dialysis center. Method We included 9 dialyzed patients trained on Nx Stage® machine (Fresenius Medical Care) from February to December 2020. Data was retrospectively obtained through review of our medical electronic records (Euclid®). Results Among 9 patients trained, 8 were installed at home, with an average follow up of 7 months. 6 patients were dialyzed in self hemodialysis facilities. The mean age was 45 years (28-71), 6 women, BMI: 24 kg/m2 (21-30), dialysis vintage: 5 years and 7 patients are on transplant list. The Charlson score was: 5 (4-8), 5 patients had a residual diuresis> 500 ml/d. The average training duration was 5 weeks (4-8). Our training program targeted the self-puncture of AVF and the self-assembly of the machine by the patient. 100% of AVF were cannula...