Prise en charge et résultats des patients hémodialysés chronique au CHU de Montpellier (20 ans d'expérience)

Introduction. La mortalité en hémodialyse chronique est d'environ 15% par an. Un dépistage précoce des patients à risque de mortalité est indispensable. Notre objectif est de déterminer les facteurs de risque de mortalité présents lors de la prise en charge en dialyse. Patients et méthodes. Nous avons analysé rétrospectivement 381 patients qui ont dialysé plus de 6 mois à Montpellier entre 1990 et 2010. Pour décrire la population et son évolution, nous avons séparé la cohorte en deux groupes. Les patients qui dialysent depuis moins de 6 mois lors de leur arrivée dans un de nos deux centres (groupe incident, n=219) et les autres (groupe prévalent, n=162). Pour les patients du groupe incident, nous avons déterminé la valeur pronostique des différentes comorbidités et des paramètres biologiques présents lors de l'instauration de l'hémodialyse. Résultats. Au cours du temps, l'âge et les comorbidités des patients augmentent. La mortalité est principalement d'origine cardiovasculaire (38,8%), Le sexe féminin est protecteur. Un âge supérieur à 65 ans, la présence d'un antécédent cardiovasculaire et un index de Charlson supérieur à 5 sont associés à la mortalité. Après ajustement, les patients avec l'index de créatinine et le pourcentage de masse maigre les plus faibles, ont une augmentation du risque de mortalité globale (Hazard Ratio = 1,95 [1,18-3,20] et 1,73 [1,05-2,83] respectivement). Le taux de catabolisme protidique et la dose de dialyse ne sont pas associés à la mortalité. Conclusion. La dénutrition protidique est un important facteur de risque de mortalité en hémodialyse. Nos résultats soulignent l'intérêt des marqueurs issus de la modélisation de la cinétique de la créatinineMONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF

Heparin-free renal replacement therapy for chronic hemodialyzed patients at high risk for bleeding: a comparison of on-line predilution hemodiafiltration with conventional hemodialysis

International audienceIn chronic hemodialysis patients with high risk of bleeding, optimal anticoagulation of the extracorporeal circuit is challenging. Heparin-free hemodialysis (HD) with heparin-coated AN69ST dialyzer is now considered as a good option and recommended by experts. Predilutional hemodiafiltration (HDF) may represent also a feasible alternative but has been poorly investigated. In this study, our aim was to evaluate the performance of on-line automated predilution heparin-free HDF as compared to conventional heparin-free HD with a heparin-coated membrane

Modélisation Hybride Polynomiale du Décrochage pour la Dynamique Longitudinale d'un Drone

International audienceModeling the longitudinal dynamics of a fixed-wing unmanned aerial vehicle (UAV) at high angles of attack is not an easy task. Indeed, when the airplane approaches stall, non-linear effects appear, including transient behaviors and an aerodynamic hysteresis. Although some models are present in the literature to address these aspects, they are usually aerodynamics-based and often too complex for analysis and control applications. Therefore, this paper presents a new hybrid polynomial formulation for the modeling of the aerodynamic coefficients. In addition, a Linearly Constrained Least Squares (LCLS) process guaranteeing continuity at the mode transitions is proposed for the identification of the model. The Hybrid Polynomial Stall Model (HPSM) is finally identified on experimental wind tunnel data, showcasing its ability to accurately predict a UAV's dynamics.Modéliser la dynamique longitudinale d'un drone à voilure fixe n'est pas tâche aisée à hauts angles d'incidence. En effet, lorsque l'appareil approche du décrochage des effets non-linéaires apparaissent, notamment des phénomènes transitoires et une hystérésis aérodynamique. Bien que divers modèles sont présents dans la littérature pour modéliser ces aspects, ils sont souvent basés sur des connaissances aérodynamiques et trop complexes pour des applications d'analyse et de commande. C'est pourquoi ce papier présente une nouvelle modélisation hybride polynomiale pour les coefficients aérodynamiques. De plus, un processus d'identification par moindres carrés sous contrainte linéaire garantissant la continuité lors du changement de mode est proposé. Le modèle est enfin identifié sur des données expérimentales en soufflerie, montrant son aptitude à prédire le comportement d'un drone

Successful treatment of a Streptococcus pneumoniae- associated haemolytic uraemic syndrome by eculizumab

International audienceHaemolytic uraemic syndrome (HUS) is a rare complication of invasive infection by Streptococcus pneumoniae (SP-HUS), especially in adults. Here we report an unusual case of a 53-year-old man presenting SP-HUS with severe multivisceral involvement. After failure of supportive care and plasma exchanges, eculizumab (anti-C5 antibody) resulted in a favourable outcome

Electrolytes-Enriched Hemodiafiltration Solutions for Continuous Renal Replacement Therapy in Acute Kidney Injury: A Crossover Study

International audienceAIMS:To evaluate the capability of an electrolytes-enriched solution to prevent metabolic disorders during continuous veno-venous hemodiafiltration (CVVHDF).METHODS:Serum biochemistry and clinical tolerance were compared during CVVHDF treatments with an electrolyte-enriched (Phoxilium) or standard solutions in 10 acute renal failure patients.RESULTS:As compared to standard fluids, serum potassium and phosphate levels were maintained in the normal range with Phoxilium without any supplementation but total serum calcium levels were significantly lower. Bicarbonatemia was slightly higher (24-26 vs. 21.5-24.5 mmol/l, p 7.44). Despite the absence of glucose in the Phoxilium solution, blood glucose levels and glucose supplementation were similar between treatments. Clinical tolerance and efficiency of CVVHDF sessions were comparable.CONCLUSION:Phoxilium effectively prevented hypophosphatemia and hypokalemia during CVVHDF. It was, however, associated with a slight metabolic acidosis and hypocalcemia compared with conventional solutions

Short- and Long-Term Outcome of Chronic Dialyzed Patients Admitted to the ICU and Assessment of Prognosis Factors

International audienceObjectives: Data about end-stage kidney disease patients admitted to the ICU are scarce, dated, and mostly limited to short-term survival. The aim of this study was to assess the short- and long-term outcome and to determine the prognostic factors for end-stage kidney disease patients admitted to the ICU.Design: Prospective observational study.Setting: Medical ICUs in two university hospitals.Patients: Consecutive end-stage kidney disease patients admitted in two ICUs between 2012 and 2017.Intervention: None.Measurements and Main Results: Renal replacement therapy variables, demographic, clinical, and biological data were collected. The requirement of mechanical ventilation and vasopressive drugs were also collected. In-ICU and one-year mortality were estimated and all data were analyzed in order to identify predictive factors of short and long-term mortality. A total of 140 patients were included, representing 1.7% of total admissions over the study period. Septic shock was the main reason for admission mostly of pulmonary origin. Median Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score were at 63 and 6.7, respectively. In-ICU, hospital, and 1-year mortality were 41.4%, 46.4%, and 63%, respectively. ICU mortality was significantly higher as compared with ICU control group non-end-stage kidney disease (25% vs 41.4%; p = 0.005). By multivariate analysis, the short-term outcome was significantly associated with nonrenal Sequential Organ Failure Assessment score, and with the requirement of mechanical ventilation or/and vasoconstrictive agents during ICU stay. One-year mortality was associated with increased dialysis duration (> 3 yr) and phosphatemia (> 2.5 mmol/L), with lower albuminemia (< 30 g/L) and nonrenal Sequential Organ Failure Assessment greater than 8.Conclusions: End-stage kidney disease patients presented frequently severe complications requiring critical care that induced significant short- and long-term mortality. ICU and hospital mortality depended mainly on the severity of the critical event reflected by Sequential Organ Failure Assessment score and the need of mechanical ventilation and/or catecholamines. One-year mortality was associated with both albuminemia and phosphatemia and with prior duration of chronic dialysis treatment, and with organ failure at ICU admission

Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients

International audienc

Factors associated with meropenem pharmacokinetic/pharmacodynamic target attainment in septic critically ill patients treated with extended intermittent infusion or continuous infusion

International audienc

Social comparisons across cultures II: Change and stability in self-views across cultures: Experimental evidence

n/