M. Allouache | Université Paris Descartes (original) (raw)

Papers by M. Allouache

Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 1983

The measures taken to prevent peritonitis in patients undergoing CAPD depend on the routes of bac... more The measures taken to prevent peritonitis in patients undergoing CAPD depend on the routes of bacterial invasion of the peritoneum (Table I). Although we do not know the exact contribution of each route to the development of peritonitis, the intraluminal probably is the most important. Table la gives an estimate of the contribution of each route of access to such development. For practical purposes the means of prevention have been classified according to the routes of infection they attempt to block.

Journal of Vascular Surgery, 2020

Objective: The aim of this study was to report our midterm results of percutaneous arteriovenous ... more Objective: The aim of this study was to report our midterm results of percutaneous arteriovenous fistula (pAVF) creation using the Ellipsys (Avenu Medical, San Juan Capistrano, Calif) device and to present technical recommendations and our algorithm of pAVF maintenance. Methods: A single-center comprehensive database of all consecutive predialysis and end-stage renal disease patients who had a pAVF creation with the Ellipsys device was reviewed retrospectively. Study end points included technical success, maturation, functional patency, and required interventions. Results: Between May 2017 and July 2019, there were 234 patients (mean age, 64 years; 148 male [63%]) who had a pAVF created. Technical success was achieved in 232 individuals (99%), and average duration of the procedure was 15 minutes (7-35 minutes). Average follow-up was 252 days (range, 83-696 days). The 1-year primary, primary assisted, and secondary patency rates were 54%, 85%, and 96%, respectively. Average pAVF flow was 923 mL/min (range, 425-1440 mL/min). There were no significant adverse events related to the procedure. Only three patients (1%) required a later conversion of the pAVF anastomosis to a surgical fistula. Twenty-four (10%) patients required superficialization of deep outflow veins because of difficult cannulation. Average maturation time was 4 weeks (range, 1-12 weeks). Fourteen patients (6%) had early (<2 weeks after creation) cannulation of the pAVF. Conclusions: The Ellipsys pAVF device allows the rapid and safe creation of a reliable autogenous access. Rates of technical success, patency, and maturation were excellent. For patients unsuited for a distal radiocephalic arteriovenous fistula, it should be considered the next preferred access option.

Comparison of Surgical Versus Percutaneously Created Arteriovenous Hemodialysis Fistulas

Journal of Vascular Surgery, 2021

OBJECTIVE The aim of this study is to compare the results between percutaneous arteriovenous fist... more OBJECTIVE The aim of this study is to compare the results between percutaneous arteriovenous fistulae (p-AVF) created with the Ellipsys® device and surgical arteriovenous fistulae (s-AVF). METHODS A single center retrospective comparative study of the first 107 patients that had a p-AVF creation with the Ellipsys® system between May 2017 and May 2018 with an equal number of consecutive s-AVF patients that had an access created in our center during the same time period. Primary endpoints included maturation and patency rates. Secondary endpoints were reinterventions, risk of infection, steal syndrome and aneurysm formation. RESULTS Demographics, hypertension and diabetes were similar for both groups. The only difference between groups was that more p-AVF patients were already receiving hemodialysis (61% vs 47%; P <0.05). p-AVFs had superior maturation rates at 6 weeks (65% vs 50%; P=0.01). Primary patency rates were higher for s-AVF 12 months (86% vs 61%; P<0.01), however primary patency was comparable between the two groups at 24 months (52% vs 55%; P=0.48). There was no significant difference in secondary patency rates at 12 (90% vs 91%) or 24 months (88% vs 91). At 2 year follow up, the rate of percutaneous reinterventions was similar but s-AVFs required more frequent surgical revisions (36% vs 17%; P=0.01). Issues with wound healing and infections were more frequent for s-AVF (9% vs 0.9%; P <0.01). CONCLUSIONS Fistulae created percutaneously with Ellipsys® have superior maturation rates and similar patency with s-AVFs created in an experienced high-volume vascular surgery practice. pAVFs had a lower risk for wound healing issues, infection and surgical revision. Larger, prospective randomized multicenter studies are needed in order to confirm these findings.

Nephrology Dialysis Transplantation, May 1, 2022

Clinical Journal of the American Society of Nephrology, 2008

Background and objectives: Light chain (AL) and secondary (AA) amyloidosis usually present as a s... more Background and objectives: Light chain (AL) and secondary (AA) amyloidosis usually present as a systemic disease frequently involving the kidney and leading to ESRD. Data regarding patients with AA or AL amyloidosis undergoing dialysis remain scarce. Design, setting, participants, & measurements: We retrospectively studied patients with AA or AL amyloidosis who started dialysis in five French centers between January 1, 1995 and December 31, 2005. Results: We identified 19 patients with AL and 20 patients with AA amyloidosis undergoing dialysis. Patients with AL amyloidosis had shorter time from diagnosis to dialysis (25.2 versus 69.3 mo, P < 0.05) and more extrarenal amyloidosis, especially cardiac (63.2 versus 5%, P < 0.0001). Mean duration of follow-up was 37.4 and 31.8 mo for patients with AL and AA amyloidosis, respectively. Fifteen patients (78.9%) with AL and three patients (15%) with AA amyloidosis died on dialysis. Median survival was shorter in patients with AL (26 mo) than AA amyloidosis [not definable (ND)] (P < 0.02). Sepsis and cardiac deaths were the main causes of mortality. Prognosis factors for death at 1 yr were AL type (P < 0.01), cardiac amyloidosis [odds ratio (OR) ‫؍‬ 18, P < 0.01], heart failure (OR ‫؍‬ 8, P < 0.04), and shorter time from diagnosis to dialysis (6.1 versus 56 mo, P < 0.03). Multivariate analysis indicated that AL type (P ‫؍‬ 0.02), but not cardiac amyloidosis was independently associated with global mortality. Conclusions: Survival of patients with amyloidosis undergoing dialysis, especially AL type, is probably better than previously reported. However, mortality is higher in AL than AA type, especially in the setting of cardiac involvement.

Anticorps monoclonaux anti SARS-Cov2 chez des patients hémodialysés chroniques

Néphrologie & Thérapeutique

Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 1989

The treatment of end-stage renal diabetic nephropathy, remains a challenge. A large experience al... more The treatment of end-stage renal diabetic nephropathy, remains a challenge. A large experience allows us to clearly outline the advantages and the drawbacks of continuous ambulatory peritoneal dialysis (CAPO) and continuous cyclic peritoneal dialysis (CCPO). Eighty-one patients, mean age 51.3 years, were treated over the last 9 years by CAPO-CCPO. Extrarenal complications, mainly vascular lesions, were present in this high-risk group of patients. The technique was modified in order to inject intraperitoneally, 4 times per day, insulin to control blood glucose level in CAPO patients. Actuarial survival was 92% at 1 year, 50% at 4 years mainly influenced by age: 85% survival at 2 years in 35 patients aged less than 50 years old and 62% at 2 years in 46 patients aged more than 50 years old. The main causes of death were of cardiovascular origin: myocardial infarction, stroke, atherosclerotic vasculopathy. The main causes of transfer to hemodialysis were due to technical complications. ...

Lipoprotein(a) in Patients Treated by Continuous Ambulatory Peritoneal Dialysis

American Journal of Kidney Diseases, 1993

Lipoprotein(a) [Lp(a)] has been identified as an independent, inherited risk factor for atheroscl... more Lipoprotein(a) [Lp(a)] has been identified as an independent, inherited risk factor for atherosclerotic vascular disease. An elevation of Lp(a) plasma levels has been documented in several series of uremic patients submitted to maintenance dialysis treatment methods or after renal transplantation. We have measured the plasma levels of Lp(a) using an enzyme-linked immunosorbent enzyme method in 19 patients treated with continuous ambulatory peritoneal dialysis (CAPD). Mean (+/- SD) concentration of Lp(a) was significantly higher in the patients than in the 19 healthy controls (51 +/- 48 mg/dL v 16 +/- 15 mg/dL, P < 0.005). No significant differences in Lp(a) levels were found between diabetic patients (n = 5) and nondiabetic patients (n = 14) or between patients who had (n = 6) or had not (n = 13) suffered a previous major cardiovascular complication. No correlation was evident between Lp(a) levels and the patients' ages, period of time on CAPD treatment, or any other lipid-lipoprotein investigated parameter. The mechanisms accounting for the elevation of Lp(a) levels in CAPD patients as well as the specific value of increased Lp(a) concentration as a cardiovascular risk predictor in uremic patients remain thus far speculative. Additional experimental and clinical studies are warranted before the administration of drugs to attempt to lower Lp(a) levels in CAPD patients can be recommended.

Clinical Journal of the American Society of Nephrology, 2012

Background L-carnitine levels decrease rapidly and steadily with duration of hemodialysis, and ca... more Background L-carnitine levels decrease rapidly and steadily with duration of hemodialysis, and carnitine depletion can impair response to recombinant human erythropoietin (rHuEPO). The study hypothesis was that L-carnitine supplementation during the first year of hemodialysis would improve this response. Design, setting, participants, & measurements From October 2006 through March 2010, this multicenter, randomized, double-blinded study assigned 92 incident hemodialysis patients to receive placebo or 1 g of intravenous L-carnitine after each dialysis session for 1 year. The primary outcome measure compared the groups for rHuEPO resistance index (EPO-RI), defined as weekly rHuEPO doses (IU/kg body weight divided by hemoglobin level) (g/dl). Results In the L-carnitine group, carnitine concentration increased from a mean 6 SD of 79651 mmol/L to 2586137 mmol/L; in the placebo group, it declined from 68625 mmol/L to 53624 mmol/L (interaction group 3 time, P,0.001). Carnitine deficiency affected about 30% of the patients in the placebo group during the study period. EPO-RI varied from 15.8611.3 to 9.565.8 IU/kg per g/dl in the placebo group and from 20.6612.8 to 15.6615.9 IU/kg per g/dl in the L-carnitine group, for a mean variation of 23.94612.5 IU/kg per g/dl and 22.98615.5 IU/kg per g/dl, respectively (P=0.7). After adjustment for baseline characteristics, the EPO-RI course was similar in each group (difference between groups, P=0.10; interaction group 3 time, P=0.9). Conclusions Carnitine levels decrease by about 11%633% during the first year of hemodialysis. Treatment of incident hemodialysis patients with L-carnitine does not improve their response to rHuEPO.

HIV-associated nephropathy: outcome and prognosis factors. Groupe d' Etudes Néphrologiques d'Ile de France

Journal of the American Society of Nephrology : JASN, 1998

Records of 102 patients with biopsy-proven HIV-associated nephropathy (HIVAN) admitted to 18 hosp... more Records of 102 patients with biopsy-proven HIV-associated nephropathy (HIVAN) admitted to 18 hospitals in the Paris area from 1984 through 1996 were retrospectively reviewed. Demographics and clinical and laboratory features of the cohort were determined, and prognostic factors of renal and patient survival were analyzed. Renal and patient survival curves were estimated with the actuarial method. Prognostic factors were assessed by uni- and multidimensional analyses based on Cox regression models. Values were expressed as median with interquartile. The total population (median age 34) included 97% blacks and 71.5% males. Median patient follow-up was 165 d (range, 43 to 493). At the time of renal biopsy, median values of serum creatinine, proteinuria, and CD4+ cell count were 496 micromol/L, 6.5 g/24 h, and 48.5 cells/mm3, respectively. Fifteen patients were given steroids after the onset of HIVAN. Overall patient survival at 0.5, 1, and 3 yr was 73 +/- 5, 55 +/- 6, and 38 +/- 7%, re...

HIV-associated nephropathy: outcome and prognosis factors. Groupe d' Etudes Néphrologiques d'Ile de France

Journal of the American Society of Nephrology

Réponse à la vaccination contre le SARS-CoV-2 chez des patients hémodialysés chroniques

Néphrologie & Thérapeutique

Utilisation de la ceftazidime chez le patient hémodialysé chronique en sepsis : étude prospective observationnelle

Néphrologie & Thérapeutique

213 elderly uremic patients over 75 years of age treated with long-term peritoneal dialysis: a French multicenter study

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 1996

We report our experience in 213 elderly patients over 75 years treated by peritoneal dialysis (PD... more We report our experience in 213 elderly patients over 75 years treated by peritoneal dialysis (PD) as first and exclusive dialysis therapy. The mean age at start of PD was 79.4 +/- 3.6 years, and the cumulative time on PD was 4551 months (mean time: 21.4 +/- 19.8 months). Twenty-six patients lived in institutions and 187 lived at home. Thirty patients had an effective autonomy with the ability to carry on normal activities. One hundred and two patients were cared for by a private nurse at home, and 46 patients were cared for in a family environment. Most cases were treated by three exchanges per day (152 cases) and used a nondisconnect system (175 cases) on account of absence of autonomy. The rate of peritonitis per patient-month was one episode per 16.8 patient-months. Patient survival (Kaplan-Meier curves) was 74%, 59%, 45%, and 19% at one, two, three, and five years, respectively. The causes of death were various with a higher frequency of cardiovascular causes (48.3% of the 116 ...

Is overhydration in CAPD patients a contraindication to renal transplantation?

Advances in peritoneal dialysis. Conference on Peritoneal Dialysis

Over a 14 year period, 56 of 415 CAPD patients (34 male, 22 female), aged 42.7 +/- 11 years, unde... more Over a 14 year period, 56 of 415 CAPD patients (34 male, 22 female), aged 42.7 +/- 11 years, underwent renal transplantation (TR). A cadaver kidney was used in 53 patients (kidney-pancreas in 2), and a human leucocyte antibody (HLA) identical related donor organ was used in 3. Underlying renal diseases were chronic glomerulonephritis in 30 patients, diabetic nephropathy in 10, interstitial nephropathy in 5, vascular in 4, polycystic kidney in 3, and undetermined in 4. Mean duration of CAPD prior to TR was 13 months (2-56 months). A three-week peritonitis episode-free interval was requested prior to TR. At year 1, actuarial patient and graft survival (96% and 86%, respectively), plasma creatinine, and number of rejection episodes were not different from those recorded in patients treated with hemodialysis (HD) prior to TR. At TR, pulmonary artery pressure (PAP) was elevated (average 21.1 +/- 7.4 mm Hg), > or = 25 mm Hg and > or = 30 mm Hg in 36% and 14.6% of CAPD patients, respectively. Post-TR, HD was performed in 4 patients; no peritoneal infection occurred. Postoperative sonography disclosed ascitis in 12.7% of CAPD patients. The PD catheter was removed two months post-TR. Hemodynamic findings at TR suggest a frequently underestimated overhydration in CAPD patients, which should be detected and treated in order to reduce acute cardiovascular complications at TR.

Prospective randomized study about Y connectors in CAPD patients

The crucial role of medical and nursing staff in the care of chronic peritoneal dialysis patients

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 1997

Insulin prescription, glycemic control, and diabetic complications in diabetics treated by continuous ambulatory peritoneal dialysis

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 1993

Role of acetate in loss of ultrafiltration during CAPD

Contributions to nephrology, 1987

Peritoneal Versus Extra-Corporeal Dialysis for Diabetic Uremic Patients: Where Do We Stand in the Early Nineties?

New Therapeutic Strategies in Nephrology, 1991