The Interleukin-6 Gene Promoter Polymorphism -174 and Atherosclerotic Events in Overweight Transplanted Patients

Chronic inflammation plays a pivotal role in atherosclerosis. We hypothesized that combining overweight and a greater genetic capacity to produce IL-6 predicted by IL-6 gene promoter polymorphism at position -174 (G→C) may allow to identify individuals exhibiting higher IL-6 and C-reactive protein (CRP) concentrations with a higher risk of atherosclerotic events (AE). The occurrence of AE was analyzed with respect to body mass index, IL-6 gene promoter polymorphism at position -174 (G→C), and other relevant risk factors, retrospectively, in 217 renal transplant recipients and, prospectively, in 132. Circulating IL-6 concentrations were closely related to BMI (r = 0.55, P = .0005). In overweight patients, serum IL-6 concentration was found to be significantly lower in C carriers than in GG patients (4.2 [1.0–5.1] versus 7.3 pg/mL [4.4–100]; P = .025). The incidence of AE was higher in overweight GG patients (29.5% versus 10.1%; P = .0003). In multivariate analysis, overweight-GG had an increased risk to develop AE (HR 2.96 [95% CI 1.09–8.04], P = .034 in the retrospective cohort, and HR 2.99 [95% CI 0.92–9.33], P = .069 in the prospective cohort). All these data are consistent with a role for both genetic and environmental determinants of inflammation (white adipose tissue mass) in the development of AE in renal transplanted patients

No evidence of association between NOD2/CARD15 gene polymorphism and atherosclerotic events after renal transplantation.

International audienceStable renal transplant recipients (RTR) display high rates of atherosclerotic events (AE). Innate immunity and especially vascular inflammation play a role in the pathogenesis of atherosclerosis. It is illustrated both by an increased occurrence of postrenal transplant cardiovascular events in patients with elevated levels of C-reactive protein and by a correlation between posttransplant AE and Toll-like receptor-4 Asp299Gly polymorphism. Here, we analyze the influence NOD2/CARD15 gene polymorphism since NOD2 can modulate macrophage pro-inflammatory activity and macrophage is present in early atherosclerotic lesions. The incidence of single nucleotide polymorphism (SNP) in the three major polymorphic region of NOD2 gene (SNP8, SNP12 and SNP13) was assessed in 182 RTR and the correlation between such polymorphism and the development of AE was analyzed. No correlation was observed between NOD2 gene polymorphism and the occurrence of AE after renal transplantation. NOD2 gene polymorphism thus does not appear to influence cardiovascular complications in RTR

Prevention of Post-Transplant Diabetes Mellitus: Towards a Personalized Approach

Post-transplant diabetes is a frequent complication after transplantation. Moreover, patients suffering from post-transplant diabetes have increased cardiovascular morbidity and reduced survival. Pathogenesis mainly involves beta-cell dysfunction in presence of insulin resistance. Both pre- and post-transplant risk factors are well-described, and some of them may be corrected or prevented. However, the frequency of post-transplant diabetes has not decreased in recent years. We realized a critical appraisal of preventive measures to reduce post-transplant diabetes

La dialyse péritonéale dans le traitement de l'insuffisance cardiaque réfractaire

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

Neutropénie après transplantation rénale (incidence, facteurs de risque et conséquences cliniques)

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

[Genetic polymorphisms: how to interpret studies?].

International audienceDuring the last years, publications upon potential association between genetic polymorphisms and clinical outcomes have exponentially increased. Conflicting results between similar studies have contributed to seriously distrust the validity of this approach. This review emphasizes on intrinsic properties of SNP and methodological prerequisites for such studies

Impact du volume de diurèse et du nombre d’échanges sur le risque de péritonite en dialyse péritonéale continue ambulatoire dans le RDPLF

Introduction Peritonitis is still a frequent complication among patients undergoing peritoneal dialysis (PD) and it’s associated with a significant morbimortality. The aim of our study was to investigate the impact of diuresis volume and number of exchanges (NE) on continuous ambulatory peritoneal dialysis (CAPD) related peritonitis risk. Methods This study was performed with data from the French peritoneal dialysis registry (RDPLF). We included every incident patient in the registry from January 2010 to November 2019 who had at least an adequacy evaluation. Peritonitis risk was assessed firstly by estimating a peritonitis rate per year undergoing PD and secondly by focusing on time to first peritonitis, taking into account competing risks (kidney transplantation, switch to hemodialysis, PD withdrawal whatever the cause or death). Patients whose diuresis was <500mL/24 hours were considered oliguric. Results We included 620 patients in our analysis. The mean age was 72,9 (standard deviation (SD)=15,1). Two hundred and six (39,55%) had at least one peritonitis episode. No difference was observed between oliguric patients and the others. However, we noticed an increased risk in patients with a NE≥22 per week (HR=1,55, P=0,0005 and HR=1,47, P=0,02 considering competing risks). We also observed a lower risk in diabetic patients HR=0,74, p=0,02 and HR=0,77, p=0,0497). Conclusion We didn’t find any impact of diuresis volume on peritonitis risk. Whereas, the NE seems to be a considerable risk factor, especially when it’s superior to 22 per week.IntroductionLes péritonites constituent une complication fréquente en dialyse péritonéale (DP) et sont associées à une morbi-mortalité importante. L’objectif de notre travail était d’étudier l’impact du volume de diurèse et du nombre d’échanges hebdomadaires (EH) sur le risque de péritonite chez des patients français en dialyse péritonéale continue ambulatoire (DPCA). MéthodesCe travail a été effectué à partir des données du Registre de Dialyse Péritonéale de Langue Française (RDPLF). Nous avons inclus tous les patients du registre incidents en DPCA entre janvier 2010 et 30 novembre 2019 ayant eu au moins un bilan d’adéquation. Le risque de péritonite a été évalué d’une part en calculant pour chaque patient un taux de péritonite par année en DP, d’autre part en s’intéressant au délai de survenue de la première péritonite en prenant en compte les risques compétitifs (transplantation, transfert en hémodialyse, arrêt de la DP, quel qu’en soit la cause, et décès). Les patients ayant une diurèse inférieure à 500mL/jour étaient considérés oliguriques. Résultats Nous avons inclus 620 patients dans nos analyses. L’âge moyen était de 72,9 ans (écart type (ET) 15,1). Deux cent quarante-six patients (39,55%) ont eu au moins une péritonite. Aucune modification significative du risque de péritonite n’a été mise en évidence chez les patients oliguriques. En revanche, il a été montré un risque accru de péritonite chez les patients ayant plus de 22 EH (HR=1,55, P=0,0005 et HR=1,47, P=0,02 en prenant en compte les risques compétitifs). Il a également été observé un effet protecteur du diabète (HR=0,74, p=0,02 et HR=0,77, p=0,0497). ConclusionNous n’avons pas montré d’effet du volume de diurèse sur le risque de péritonite. Le nombre d’EH semble constituer un facteur de risque important dès lors que celui-ci est supérieur ou égal à 22

Metabolic syndrome and atherosclerotic events in renal transplant recipients.

International audienceBACKGROUND: Metabolic syndrome (MS) is a known cardiovascular risk factor in the general population. We explored the influence of MS on the occurrence of atherosclerotic events (AEs) after renal transplantation. METHODS: Three hundred thirty-seven renal transplant recipients were included in the study. Various parameters (e.g., anthropometric and biological) were measured 1 year after transplant. RESULTS: One year after transplant, 32% of the study population met criteria for MS. Older age, male gender, pretransplant high body mass index, and an increase in body mass index>or=5% in the first year after transplant were predictive factors for development of MS at 1 year after transplant. Forty-two patients (12.4%) experienced AEs during the 8 years of follow-up. The cumulated incidence of AEs was greater in patients with MS compared with others without MS (25% vs. 7%; P<0.001). In multivariate analysis, patients with MS at 1 year after transplant had an increased risk of AE (hazard ratio 3.40, 95% confidence interval 1.58-7.32, P=0.002). Older age, low creatinine clearance, high C-reactive protein level, and a past history of cardiovascular disease were other independent risk factors for AE. CONCLUSIONS: Similar to the general population, MS is an independent risk factor for AE after renal transplantation. Relevant preventive measures targeting different aspects of MS would then have a potential impact on prevalence of AE in this population

Description de 3 cas de patients polykystiques ayant debuté la dialyse péritonéale en post-operatoire d’une néphrectomie avec mise en place simultanée du cathéter de dialyse péritonéale.

Peritoneal dialysis (PD) initiation can be difficult in patients developing end stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (ADPKD) when these patients need nephrectomy to prepare kidney transplantation. Here we describe the cases of 3 adult patients followed in the nephrology ward of Besançon in 2017 and 2018 for ESRD due to ADPKD and who began peritoneal dialysis in the post-operative period following nephrectomy with simultaneous peritoneal catheter implantation. The data were collected retrospectively.Among the three patients included, all began PD during the first month after being operated on, without requiring hemodialysis. Mean delay between nephrectomy and PD start was 8.7 days. The renal-replacement therapy was begun following a continuous ambulatory PD (CAPD) technique with small volumes (1.5L), then was carried on with automated PD (APD) technique with small volumes. The mean delay between nephrectomy and the establishment of a standard APD program was 24.3 days. No major complications were reported at the establishment of PD, particularly there were no dialysate leaks. On a long term view, technical survival was good since 2 patients are still treated by PD whereas one patient has been transplanted. Adequacy criteria were satisfactory. To conclude, our group of 3 patients shows very interesting results about PD start in the post-operative period after nephrectomy with simultaneous PD catheter implantation in polycystic patients.L’initiation de la dialyse péritonéale (DP) pour les patients polykystiques peut s’avérer compliquée lorsqu’une néphrectomie est nécessaire pour préparer la greffe rénale. Nous présentons ici l’étude rétrospective de 3 patients adultes suivis dans le service de néphrologie de Besançon sur la période 2017-2018 pour une insuffisance rénale chronique stade 5 en rapport avec une polykystose rénale autosomique dominante (PKAD) et ayant débuté la DP en post-opératoire d’une néphrectomie avec mise en place simultanée d’un cathéter de DP. Sur les 3 patients, tous ont pu débuter la DP dans le 1er mois post-opératoire, sans avoir recours à l’hémodialyse. Le délai moyen entre la néphrectomie et l’initiation de la DP était de 8,7 jours. La DP était débutée en DPCA avec de petits volumes (1,5 litre), puis la DPA était initiée à petits volumes ; le délai moyen entre la néphrectomie et la mise en place d’un programme de DPA « standard » s’élevait en moyenne à 24,3 jours. Aucune complication majeure n’était rapportée, notamment pas de fuite de liquide de DP. A long terme, la survie de la technique était bonne puisqu’une patiente est sortie de la technique par le biais de la greffe, les 2 autres patients sont encore en DP. Les critères d’adéquation étaient satisfaisants pour les 3 patients. Pour conclure, cette série de 3 cas donne des résultats très encourageants quant à l’initiation de la DP en post-opératoire d’une néphrectomie avec pose simultanée de cathéter de DP chez les patients polykystiques. Cet article est mis à disposition selon les termes de la Licence Creative Commons Attribution 4.0 International