Angiotensin-2 receptors (AT1-R and AT2-R), new prognostic factors for renal clear-cell carcinoma?

International audienceBackground: The growth factor Angiotensin-2 signals through Angiotensin receptor type 1 (AT1-R) in a broad range of cell types and tumours and through the type-2 receptor (AT2-R) in a more restricted group of cell types. Although numerous forms of cancer have been shown to overexpress AT1-R, expression of AT1-R and AT2-R by human renal clear-cell carcinoma (RCCC) is not well understood. In this study, the expression of both angiotensin receptors was quantified in a retrospective series of RCCC and correlated with prognostic factors.Methods: Angiotensin receptor type 1 and AT2-R expressions were quantified on tumour tissues by immunohistochemistry (IHC), western blot and quantitative reverse transcriptase PCR (qRT–PCR). IHC results were correlated to Fuhrman's grade and patient progression-free survival (PFS).Results: A total of 84 RCCC were analysed. By IHC, AT1-R and AT2-R were expressed to a greater level in high-grade tumours (AT1-R: P<0.001, AT2-R: P<0.001). Univariate analysis showed a correlation between PFS and AT1-R or AT2-R expression (P=0.001). By multivariate analysis, only AT2-R expression correlated with PFS (HR 1.021, P=0.006) and cancer stage (P<0.001). By western blot, AT1-R and AT1-R were also found to be overexpressed in higher Fuhrman's grade (P<0.01 and P=0.001 respectively). By qRT–PCR, AT1-R but not AT2-R mRNA were downregulated (P=0.001 and P=0.118, respectively).Conclusion: Our results show that AT1-R and AT2-R proteins are overexpressed in the most aggressive forms of RCCC and that AT2-R expression correlates with PFS. AT1-R or AT2-R blockage could, therefore, offer novel directions for anti-RCCC therapy

Utilisation du dialysat au citrate en HDF postdilutionnelle : expérience rétrospective à 1 an sur la sécurité d’utilisation et l’arrêt de l’anticoagulation en séance

National audienceIntroduction L’utilisation du dialysat citraté en HDF post-dilution (HDF-POST) est actuellement controversée. Un effet anticoagulant a été évoqué sans avoir été confirmé. De plus, l’hypocalcémie induite par le citrate oblige à augmenter la concentration en calcium du dialysat sans que les effets au long cours sur le métabolisme osseux ne soient connus. Dans ce travail, nous rapportons notre expérience d’un an d’utilisation. Patients et méthodes Entre le 1er mai 2013 et le 31 avril 2014, tous les patients ayant été traités par bains citratés (Ca2 + 1,65 mEq, citrate 1 mm) en HDF-POST sur générateurs Gambro® (AK-200US et ARTIS) et pour lesquels une diminution de la nadroparine en séance a été réalisée ont été inclus dans cette étude rétrospective monocentrique. Les hémorragies et les coagulations ont été répertoriées ainsi que les données biologiques (calcémie, urée, hémoglobine et PTH) et les traitements administrés. Des tests non paramétriques et des analyses multivariées adaptées ont été utilisés afin d’analyser la survenue d’évènements indésirables et d’évaluer la possibilité d’arrêt de l’anticoagulation en séance. Résultats Seules 2056 séances d’HDF-POST pour 27 patients ont été analysées. Les calcémies, la PTH ainsi que l’utilisation de carbonates de calcium ou d’EPO sont restées stables dans le temps. Soixante-seize coagulations en cours de séance ont été répertoriées et aucune hémorragie. Seuls 5 patients ont pu être dialysés de manière prolongée sans nadroparine, tous étaient traités par AVK. Après analyse multivariée, la diminution et l’arrêt de la nadroparine ont été identifiés comme facteurs de risque de coagulation en séance (RR 6,9–CI 95 % : 1.1–44, p = 0,0396) alors que l’utilisation des AVK et les générateurs ARTIS ont été associés à un moindre risque de coagulation (p &lt; 0,001 et 0,021 respectivement). Discussion L’utilisation d’un dialysat citraté en HDF-POST est sûr et n’induit pas de troubles du métabolisme osseux pour une concentration en calcium de 1,65 mEq. Cependant, le dialysat au citrate ne permet pas de réaliser de séances sans anticoagulant. Conclusion Les dialysats citratés peuvent être utilisés en HDF-POST mais ne permettent pas l’arrêt de l’anticoagulation en séanc

Is Anticoagulation Discontinuation Achievable with Citrate Dialysate during HDF Sessions?

International audienceCitrate dialysate has been developed for few years to replace acetate and HCl concentrates. In Online Postdilution Hemodiafiltration (OL-POST-HDF), several issues are remaining concerning the possibility of stopping anticoagulation during sessions and the side effects of citrate solutions on calcium metabolism. This 1-year monocentric retrospective study included all patients exposed to citrate in OL-POST-HDF with nadroparin decrease for more than one month. Clotting events, serum calcium, PTH, hemoglobin, CRP, depuration parameters, and treatments administrated were recorded for analysis. 27 patients experienced nadroparin decrease and 5 did not receive nadroparin at the end of the study. Nadroparin decrease and withdrawal were both associated with more clotting events whereas the use of vitamin K antagonists was protective. No significant metabolic side effects were observed. Citrate dialysate does not allow anticoagulation discontinuation or decrease but has no significant side effects on mineral bone metabolism or erythropoiesis. © 2016 Thibault Dolley-Hitze et al

Home Dialysis Does Not Have the Monopoly on Low Cost

International audienceEnd-stage kidney disease (ESKD) is a major challenge for health care systems around the world because of its ever-rising rates and the ensuing rise in health care costs. In France, the cost of caring for patients with ESKD was estimated at €4.1 billion in 2019, which is 2.5% of the total budget of the health insurance funds that is spent on 1.4% of the general population.Health care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and desires of patients with ESKD. Patients aspire to remain independent if at all possible, continuing to have a social life and pursue their profession.1, 2, 3The objective of this study was to compare the cost of 4 dialysis modalities that enable patients to play a substantial role in their own care and have social and professional lives. The dialysis modalities include the following: (i) nonassisted hemodialysis in self-care units (scHD), (ii) nonassisted automated peritoneal dialysis (naAPD), (iii) daily home hemodialysis (dhHD), and (iv) non–facility-based nocturnal extended hours hemodialysis (neHD) (Supplementary Population and Method).(introd.