[Results of therapeutics strategy of protein-energy wasting in chronic hemodialysis: a prospective study during 12 months]. / Résultats des stratégies thérapeutiques au cours de la dénutrition en hémodialyse chronique: étude prospective sur 12 mois.

INTRODUCTION: Undernutrition (UN) in chronic hemodialysis (CHD) is a recurrent complication and constitutes a major public health problem. This work aims to evaluate the effects of our nutritional strategy (NS) developed among malnourished patients (pts) in CHD. This is a prospective observational study conducted for 12 months (M) in a cohort of 132 pts in CHD including 49 women, mean age 66 ± 16 years and the dialysis vintage 72 ± 74 months. This NS is based on the action of a multidisciplinary team; it provides for moderate UN pts one first phase of an optimization of protein and energy intake in the daily meals; then depending on the clinical course a second phase of oral supplementation at home. For severe UN pts, the optimization of daily meals and the oral supplements at home are reinforced with perdialytic oral supplementation. This modality was also prescribed for moderate UN pts with poor compliance at home. In case of loss of appetite, anorexia, gastrointestinal intolerance or inadequate oral intakes the relay is made by the intradialytic parenteral nutrition (IPN). Methods consist in the evaluation of the serum albumin (ALB), CRP, normalized PCR (nPCR), and Kt/V ratio of urea at baseline (day (D) 0) and at endpoint (M12). The ALB was measured by immunoturbidimetry. Three nutritional profiles were defined, severe UN if ALB ≤ 35 g/L, moderate UN if 35

[Secondary hyperparathyroidism and anemia. Effects of a calcimimetic on the control of anemia in chronic hemodialysed patients. Pilot Study]. / Hyperparathyroïdie secondaire et anémie. Effets d'un calcimimétique sur le contrôle de l'anémie des hémodialysés chroniques. Étude pilote.

UNLABELLED: The main cause of resistance to erythropoiesis-stimulating agents (ESA) used for treatment of anemia in chronic hemodialysed patients (CHP) is the iron deficiency, absolute or functional. Secondary hyperparathyroidism (SHPT) is a secondary factor of resistance. Indeed, it has been reported in the literature an improvement of anemia parameters after surgical parathyroidectomy (PTX). The objective of this study is to assess in CHP, the impact of the correction of SHPT by a calcimimetic, cinacalcet (CI), (which is considered as a pharmacological PTX) on the response to ESA, measured by the erythropoietin resistance index (ERI). Twenty-two CHP with severe SHPT documented by an intact parathyroid hormone (iPTH) above 800pg/mL were included in this prospective pilot study. Mineral bone metabolism, anemia and nutritional parameters were measured baseline and after 6 months of treatment by CI. The effect on anemia was assessed at the end of study by the ERI, the change in Hb concentration, and the proportion of patients with Hb levels above 11g/dL. RESULTS: At the end of study there was a significant decrease (M6 vs M0) in iPTH (1302 vs 674pg/mL or -48%, p=0.006), serum calcium (2.39 vs 2.15mmol/L or -10%), serum phosphate (2 vs 1.7mmol/L or -15%), serum calcium-phosphorus product (CaxP) (4.8 vs 3.8mmol(2)/L(2) or - 20% (p<0.05), and the number of patients with CaxP>4.4mmol(2)/L(2) (64 vs 32%, p<0.05). The level of bone alkaline phosphatase remained stable during the study (28 vs 27 IU/L). The Hb levels increased from 11 to 11.4g/dL, as did the proportion of patients whose Hb concentration reached 11g/dL or higher (50 vs 70%, p<0.05) without important change of the median weekly ESA dosis in the majority of patients, 18 cases (81%) vs four (19%). Two subgroups were identified from the median decreases in iPTH (delta iPTH) between M0 and M6, Group 1 (delta iPTH≥400pg/mL, n=10) and group 2 (delta iPTH<400pg/mL, n=12): in group 1, we found a correlation between the decrease in iPTH by CI and the stability or decrease in ERI (group 1), at comparable dose of dialysis, nutritional and iron intakes and inflammatory profiles; in group 2 without a significant effect of CI on PTH reduction the levels of ERI and ESA dosis were more elevated. CONCLUSION: A treatment by calcimimetic improves the control of anemia by ESA in CHP and interferes positively on a cause of secondary resistance to ESA represented by SHPT. The mechanism of these effects could be linked to the decreased of bone marrow fibrosis and inflammation and to the triptych formed by the reduction in iPTH, CaxP and phosphate.

Aging process on spectrally determined spontaneous baroreflex sensitivity: a 5-year prospective study.

The interindividual age-related decrease in baroreflex sensitivity (BRS) was reported in many cross-sectional studies. However, the long-term intraindividual decrease in BRS has never been confirmed by longitudinal studies. Data obtained from a 5-year prospective study designed to assess the 5-year stress effects on blood pressure (BP) provided the opportunity to assess longitudinal aging process on spectrally determined BRS (S-BRS) using the cross spectral analysis. This analysis was carried out in 205 men aged between 18 and 50 years who had 2 valid beat to beat BP recordings (Finapress) at a mean 5-year interval. At inclusion and at end of follow-up, S-BRS was significantly correlated with age (r=-0.50, P<0.001, r=-0.33, P<0.001 respectively). Interestingly, the slopes and the intercepts were not significantly different at a 5-year interval. This result is in favor of the good reproducibility of S-BRS. The attenuation with age of S-BRS was calculated at 3.6% a year. This decrease was slightly higher than the one obtained with the baseline data (2.3% per year). This longitudinal study provided, for the first time, an estimate of the slope of the age-related physiological S-BRS decrease in a mid-aged healthy male population. Our findings reinforce the interest of evaluating spontaneous BRS reported to predict hypertension and cardiovascular events in various populations.

Predicted creatinine clearance to evaluate glomerular filtration rate in black Caribbean subjects.

BACKGROUND AND METHODS: Although Caribbean people have been a lesser-studied ethnic group than other populations, they have a high burden of hypertension and renal disease. Because Caribbean people have a greater muscle mass than Caucasians, this study examined the accuracy of creatinine-based estimates (creatinine clearance; C(cr) and Cockcroft-Gault formula; C-G Cl) of glomerular filtration rate (GFR) in 38 Caribbeans who were matched for age, gender, and GFR, with 38 Caucasian subjects. Patients were considered black Caribbean if at least one of two parents was of black Caribbean origin. GFR values ranging from 5 to 140 ml/min/1.73 m(2) were measured by inulin clearance. Results were compared using linear correlations and the Bland and Altman methodology to provide better estimates of value dispersion. RESULTS: Correlation coefficients between C-G Cl and GFR were highly significant in both black Caribbean subjects (r=0.83, P<0.001) and Caucasians (r=0.84, P<0.001). Similar coefficients were obtained between C(cr) and GFR (r=0.89, P<0.001 and r=0.90, P<0.001, respectively). In spite of these strong correlations, the Bland and Altman representation highlighted huge intra-individual variations in GFR estimation by C-G Cl and by C(cr) in both ethnic groups. The underestimation of GFR by C-G Cl was significant in black Caribbeans (-8.6+/-20 ml/min/1.73 m(2), P<0.001) but not in Caucasians (-5.6+/-20.7 ml/min/1.73 m(2)). C(cr) overestimation of GFR was significant both in Caribbeans (8.7+/-16.8 ml/min/1.73 m(2), P<0.001) and in Caucasians (7.2+/-15.7 ml/min/1.73 m(2), P<0.01). CONCLUSIONS: The C-G formula for estimating GFR yields similar clinical values in black Caribbeans and in Caucasians, but the same limitations were observed in both ethnic groups.