Is home blood pressure monitoring feasible and well accepted in nephrectomized patients for renal cancer? (STAFF study).

AIMS: Few studies have looked at blood pressure (BP) evolution after nephrectomy, except for in living kidney donors with no clinical relevant modifications. STAFF is a pilot, open-label, observational study to evaluate the feasibility of following BP by home blood pressure monitoring (HBPM) after nephrectomy for cancer. MAJOR FINDINGS: 56 patients (66.1% previously treated for hypertension) were included between November 1, 2011, and December 31, 2012; 95.8% of the patients realized five of six primary end-points in HBPM, but the last monitoring session at 6 months was often lacking (60%) probably because of a lack of understanding. When BP was controlled before surgery, 36% of the patients underwent new hypertension or hypertension dysregulation, without any correlating factor found; 33% of the patients presented the presence of proteinuria or an increase during the follow-up. Previous hypertension or high body mass index were risk factors for proteinuria increase (p = 0.036 and 0.032) but not treatment by an renin-angiotensin system blocker. There was no statistical link between HTA control and proteinuria. CONCLUSION: Our study shows that most patients undergoing nephrectomy for cancer are able to follow HBPM. It should be encouraged for detecting high BP or proteinuria, especially if antiangiogenic therapies are envisaged because of the supplementary risk of hypertension and proteinuria induced by these treatments.

[QuiPO: who inject EPO?]. / QuiPO : qui administre les EPO en prédialyse ?

INTRODUCTION: Erythropoiesis Stimulating Agents (ESA) are largely prescribed before dialysis stage to chronic kidney disease patients. In accordance to current international guidelines, lots have been made by pharmacological companies in order to improve self management of ESAs: subcutaneaous administration, pencil devices, mutidose cartridges, low injection volume, very fine needles, once a month injections but none is currently known on the percentage of patients who actually do self administration of ESAs. PATIENTS AND METHODS: We conducted a simple prospective questionnaire study in different nephrology departments in France, on pre-dialysis patients. Questionnaires have been fulfilled by randomly selected French nephrologists during visits with outpatients treated by ESA. Costs have been evaluated by ESA and nurse visit direct costs in euros and compared by a Wilcoxon test. RESULTS: Within 6 months, 143 questionnaires of outpatients have been completed. The characteristics of the population are as followed: 53% men, mean age 66.4±16.9 y/o, 38.6% of diabetics, mean estimated Glomerular Filtration Rate (eGFR by MDRD formula) 22.8±11.6 mL/min/1.73 m(2). ESAs are prescribed as follow: Aranesp(®) (50.3%), Mircera(®) (36.3%), NeoRecormon(®) (10.5%), Eprex(®) (2.1%) and Retacrit(®) (0.7%). ESA self administration concerns only 24.8% of the patients their while most of the patients (70.2%) ask a nurse for injection without any differences between ESAs (P=0.24), sex (P=0.81) or presence of diabetes (P=0.78). ESA self administration is more frequent for working patients (56.8% versus 34.7%; P=0.0002). Moreover, for 86.7% of the patients, nurse comes at home and in 60% of the cases only for this injection. Finally, 42% of the patients feel improvement as soon as a couple of hours after injection whatever ESA used (0-45 days). In addition, mean haemoglobin level is 11.4±1.3g/dL, mean ferritinemia is 229±211UI/mL. Non surprisingly, nurse injection regimen is more expensive than self injection (P=0.0016). DISCUSSION: This simple questionnaire shows that despite efforts made to improve ESA self administration, a minority of patients are in fact proceeding to ESA self administration. Asking for a nurse, does not help patient to be independent, and increases health cost. Efforts have to be made in order to help patients for ESA self administration.