Prevention of tunneled cuffed catheter dysfunction with prophylactic use of taurolidine locking solution containing urokinase : a prospective and randomized placebo-controlled trial

C

COSMOS: the dialysis scenario of CKD-MBD in Europe

Background Chronic kidney disease-mineral and bone disorders (CKD-MBD) are important complications of CKD5D patients that are associated with mortality. Methods COSMOS is a multicentre, open cohort, prospective, observational 3-year study carried out in haemodialysis patients from 20 European countries during 2005-07. The present article describes the main characteristics of the European dialysis population, the current practice for the prevention, diagnosis and treatment of secondary hyperparathyroidism and the differences across different European regions. Results The haemodialysis population in Europe is an aged population (mean age 64.8 ± 14.2 years) with a high prevalence of diabetes (29.5%) and cardiovascular disease (76.0%), and 28.7% of patients have been on haemodialysis more than 5 years. Patients from the former Eastern countries are younger (59.3 ± 14.3 versus 66.0 ± 13.9), having a lower proportion of diabetics (24.1 versus 30.7%). There were relevant differences in the frequency of measurement of the main CKD-MBD biochemical parameters [Ca, P and parathyroid hormone (PTH)] and the Eastern countries showed a poorer control of these biochemical parameters (K/DOQI and K/DIGO targets). Overall, 48.0% of the haemodialysis patients received active vitamin D treatment. Calcitriol use doubled that of alfacalcidiol in the Mediterranean countries, whereas the opposite was found in the non-Mediterranean countries. The criteria followed to perform parathyroidectomy were different across Europe. In the Mediterranean countries, the level of serum PTH considered to perform parathyroidectomy was higher than in non-Mediterranean countries; as a result, in the latter, more parathyroidectomies were performed in the year previous to inclusion to COSMOS. Conclusions The COSMOS baseline results show important differences across Europe in the management of CKD-MB

Les oedemes. Le syndrome nephrotique.

SCOPUS: cp.jinfo:eu-repo/semantics/publishe

Vingt ans de recherche dans le domaine de l'hémodialyse: La contribution du Service de Néphrologie de l'Hôpital Erasme

This article summarizes the contribution of the Department of Nephrology, Dialysis, and renal Transplantation to the research in the field of haemodialysis during the last twenty years. The most important contributions are devoted, on the one hand, to the infections and immune defenses of the dialysis patient, on the other hand, to the biocompatibility of the materials used for haemodialysis and to the adverse reactions of the patient to these materials.SCOPUS: sh.jinfo:eu-repo/semantics/publishe

Synthèse de monokines et expression leucocytaire de molécules d'adhérence (Mac 1), du récepteur à l'endotoxine (CD14) et de l'antigène leucocytaire commun (CD45) induites par l'hémodialyse: études in vivo et in vitro sur le rôle de la nature chimique de la membrane de dialyse et de la contamination bactérienne du dialysat

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

COMPLICATIONS RENALES DU DIABETE

Many diabetic patients will develop a nephropathy that will eventually result in end-stage renal failure. The early stage ('incipient') of diabetic nephropathy generally appears after 5 to 20 years of diabetes and is characterized by microalbuminuria (30 to 300 mg/day), which is only detectable by sensitive radioimmuno-enzymatic methods. When a frank proteinuria develops (500 mg/day), the glomerular filtration rate inexorably declines, resulting in terminal renal failure after several years. The onset of microalbuminuria or the elevation of blood pressure (above 120-140/80 mmHg) are predictive of a poor evolution and require appropriate preventive therapeutic interventions. These include an optimal control of hyperglycaemia, dietary proteins and salt restriction, and prescription of antihypertensive drugs, with a particular benefit ascribed to angiotensin converting enzyme inhibitors (and maybe to certain calcium channel blockers). These interventions have been proven efficient to prevent or slow down the evolution of diabetic nephropathy.SCOPUS: sh.jinfo:eu-repo/semantics/publishe

Respective role of haemosiderosis and desferrioxamine therapy in the risk from infection of haemodialysed patients

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Continuous hemofiltration in severe sepsis: Is it beneficial?

SCOPUS: re.jinfo:eu-repo/semantics/publishe

Plan d'investigation d'une insuffisance rénale aiguë.

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Geographical variability of patient characteristics and treatment patterns affect outcomes for incident hemodialysis patients

Background: Geographical differences in disease prevalence and mortality have been described in the general population and in chronic kidney disease patients in Europe. In this secondary analysis of the Membrane Permeability Outcome (MPO) study, we addressed differences in patient and treatment patterns, and whether these affect patient outcomes. Methods: Participating countries were grouped according to geographical location; thus study centers in France, Greece, Italy, Portugal and Spain were allocated to southern Europe (n=499), and those in all other countries (Belgium, Germany, Poland and Sweden) to northern Europe (n=148). Descriptive analysis of patient and treatment patterns at study start, as well as survival analysis, was performed. Results: In patients from the northern European countries, a higher prevalence of diabetes mellitus and of cardiovascular disease was observed than in those from southern Europe (diabetes 35.1% vs. 21.0%, p=0.0007; cardiovascular disease 40.5% vs. 22.8%, p<0.0001). In northern Europe, 23% of patients started hemodialysis with a catheter for vascular access, while in southern European centers, only 13% did so (p=0.0042). Kaplan-Meier survival analysis revealed a lower probability for both all-cause and cardiovascular mortality in southern Europe (log-rank test p<0.001). In a Cox proportional hazards model, a higher mortality risk was estimated for the northern European patients after adjustment for age, sex, membrane permeability, comorbidity index and vascular access (hazard ratio = 1.831; 95% confidence interval, 1.282-2.615; p=0.0009). Conclusions: Our study patients from northern Europe showed a higher risk profile than those from southern Europe. However, only some of the factors can be modified in attempts to lower the mortality risk in this geographical area.0SCOPUS: ar.jinfo:eu-repo/semantics/publishe