Evaluation of a predictive model of end-stage kidney disease in a French-based cohort.

BACKGROUND: The risk of ESKD is highly heterogeneous among renal diseases, and risk scores were developed to account for multiple progression factors. Kidney failure risk equation (KFRE) is the most widely accepted, although external validation is scarce. The objective of this study was to evaluate the usefulness of this score in a French case-control cohort and test the pertinence of the proposed thresholds. METHODS: A retrospective case-control study comparing a group of patients starting renal replacement therapy (RRT) to a group of patients with CKD stages 3-5. Multivariate analysis to assess the predictors of ESKD risk. Discrimination of 4-, 6- and 8-variable scores using ROC curves and compared with eGFR alone and albumin/creatinine ratio (ACR) alone. RESULTS: 314 patients with a ratio of 1 case for 1 control. In multivariate analysis, increasing age and higher eGFR were associated with a lower risk of ESKD (OR 0.62, 95% CI 0.48-0.79; and OR 0.72, 95% CI 0.59-0.86, respectively). The log-transformed ACR was associated with a higher risk of ESKD (OR 1.25 per log unit, 95% CI 1.02-1.55). The 4-variable score was significantly higher in the RRT group than in the CKD-ND group, and was more efficient than the eGFR (AUROC 0.66, 95% CI 0.60-0.72, p = 0.018) and the log-transformed ACR (AUROC 0.63 95% CI 0.60-0.72, p = 0.0087) to predict ESKD. The 6-variable score including BP metrics and diabetes was not more discriminant as the 4-variable score. The 8-variable score had similar performance compared with the 4-score (AUROC 8-variable score: 0.70, 95% CI 0.64-0.76, p = 0.526). A 40% and 20% score thresholds were not superior to eGFR < 15 and 20 mL/min/1.73 m2, respectively. A 10% threshold was more specific than an eGFR < 30 mL/min/1.73 m2. CONCLUSION: KFRE was highly discriminant between patients progressing to ESKD vs those non-progressing. The 4-variable score may help stratify renal risk and referral in the numerous patients with stage 3 CKD. Conversely, the proposed thresholds for creating vascular access or preemptive transplantation were not superior to eGFR alone.

Prevalence of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis and Spatial Association With Quarries in a Region of Northeastern France: A Capture-Recapture and Geospatial Analysis.

OBJECTIVE: Silica is an environmental substance strongly linked with autoimmunity. The aim of this study was to assess the prevalence of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and renal limited vasculitis, in a northeastern region of France and to evaluate whether there was a geospatial association between the localization of quarries in the region and the prevalence of these AAVs. METHODS: Potential AAV patients were identified using 3 sources: hospital records, immunology laboratories, and the French National Health Insurance System. Patients who resided in the Alsace region of France as of January 1, 2016 and who fulfilled the American College of Rheumatology criteria for GPA or the 2012 Chapel Hill Consensus Conference definitions for GPA or MPA were included. Incomplete case ascertainment was corrected using a capture-recapture analysis. The spatial association between the number of cases and the presence of quarries in each administrative entity was assessed using regression analyses weighted for geographic region. RESULTS: Among 910 potential AAV patients, we identified 185 patients fulfilling inclusion criteria: 120 patients with GPA, 35 patients with MPA, and 30 patients with renal limited vasculitis. The number of cases missed by any source as estimated by capture-recapture analysis was 6.4 (95% confidence interval [95% CI] 3.6-11.5). Accordingly, the estimated prevalence in Alsace in 2016 was 65.5 GPA cases per million inhabitants (95% CI 47.3-93.0), 19.1 MPA cases per million inhabitants (95% CI 11.3-34.3), and 16.8 renal limited vasculitis cases per million inhabitants (95% CI 8.7-35.2). The risk of AAV was significantly increased in communities with quarries (odds ratio 2.51 [95% CI 1.66-3.80]), and geographic-weighted regression analyses revealed a significant spatial association between the proximity to quarries and the number of GPA cases (P = 0.039). In analyses stratifying the AAV patients by ANCA serotype, a significant association between the presence of quarries and positivity for both proteinase 3 ANCAs (P = 0.04) and myeloperoxidase ANCAs (P = 0.03) was observed. CONCLUSION: In a region with a high density of quarries, the spatial association between the presence of and proximity to quarries and the prevalence of AAVs supports the idea that silica may have a role as a specific environmental factor in this disease.

Correction to: Efficacy and safety of an innovative prolonged-release combination drug in patients with distal renal tubular acidosis: an open-label comparative trial versus standard of care treatments.

The published version of the article unfortunately contained a mistake.

Efficacy and safety of an innovative prolonged-release combination drug in patients with distal renal tubular acidosis: an open-label comparative trial versus standard of care treatments.

BACKGROUND: Distal renal tubular acidosis (dRTA), due to impaired acid secretion in the urine, can lead to severe long-term consequences. Standard of care (SoC) oral alkalizers, requiring several daily intakes, are currently used to restore normal plasma bicarbonate levels. A new prolonged-release formulation, ADV7103, has been developed to achieve a sustained effect with an improved dosing scheme. METHODS: In a multicenter, open-label, non-inferiority trial (n = 37), patients with dRTA were switched from SoC to ADV7103. Mean plasma bicarbonate values and proportion of responders during steady state therapy with both treatments were compared, as were other blood and urine parameters, as well as acceptability, tolerability, and safety. RESULTS: When switching from SoC to ADV7103, the number of daily intakes was reduced from a median of three to twice daily. Mean plasma bicarbonate was increased and non-inferiority of ADV7103 was demonstrated (p < 0.0001, per protocol), as was statistical superiority (p = 0.0008, intention to treat [ITT]), and the response rate increased from 43 to 90% with ADV7103 (p < 0.001, ITT). Urine calcium/citrate ratio was reduced below the threshold for risk of lithogenesis with ADV7103 in 56% of previously non-responders with SoC (p = 0.021, ITT). Palatability was improved (difference [95% CI] of 25 [10.7, 39.2] mm) and gastrointestinal discomfort was reduced (difference [95% CI] of - 14.2 [- 25.9, - 2.6] mm) with ADV7103. CONCLUSIONS: Plasma bicarbonate levels and response rate were significantly higher with ADV7103 than with SoC. Urine calcium/citrate ratio, palatability, and gastrointestinal safety were significantly improved, supporting the use of ADV7103 as first-line treatment for dRTA. TRIAL REGISTRATION: Registered as EudraCT 2013-002988-25 on the 1st July 2013 Graphical abstract.

Metabolic syndrome in haemodialysis patients: prevalence, determinants and association to cardiovascular outcomes.

BACKGROUND: In the general population, metabolic syndrome (MetS) is predictive of major adverse cardiovascular events (MACE). Waist circumference (WC), a component of the MetS criteria, is linked to visceral obesity, which in turn is associated with MACE. However, in haemodialysis (HD) patients, the association between MetS, WC and MACE is unclear. METHODS: In a cross-sectional study of 1000 HD patients, we evaluated the prevalence and characterised the clinical predictors of MetS. The relationship between MetS and its components, alone or in combination, and MACE (coronary diseases, peripheral arteriopathy, stroke or cardiac failure), was studied using receiver operating characteristics (ROC) curves and logistic regression. RESULTS: A total of 753 patients were included between October 2011 and April 2013. The prevalence of MetS was 68.5%. Waist circumference (> 88 cm in women, 102 cm in men) was the best predictor of MetS (sensitivity 80.2; specificity 82.3; AUC 0.80; p <  0.05). In multivariate analysis, MetS was associated with MACE (OR: 1.85; 95CI 1.24-2.75; p <  0.01), but not WC alone. There was a stronger association between the combination of abdominal obesity, hypertriglyceridaemia and low high-density lipoprotein cholesterol with MACE after exclusion of impaired fasting glucose and hypertension. CONCLUSIONS: MetS is frequent and significantly associated with MACE in our haemodialysis cohort and probably in other European dialysis populations as well. In HD patients, a new simplified definition could be proposed in keeping with the concept of the "hypertriglyceridaemic waist".

CERA conversion to darbepoetin alfa in 154 hemodialysis patients.

PURPOSE: Anemia is a common complication in dialysis patients, usually treated with erythropoietin (EPO). Among available EPOs and analogs, continuous erythropoietin receptor activator (CERA) and darbepoetin alfa (DA) are the only two agents with a long duration of action, although they have almost never been formally compared in terms of efficacy. We took advantage of an accidental disruption in CERA supply to study the effect of its replacement with DA in the same patients. METHODS: The clinical and biological characteristics of 154 hemodialysis patients were retrospectively reviewed during the last 3 months on CERA compared to the first 4 months after replacement by DA, both ASE being administered by IV route. The comparison included EPO doses, hemoglobin levels, factors interfering with anemia (iron status assessment, iron doses, inflammation, quality of treatment) and was performed under the Bayesian paradigm. RESULTS: We found no significant differences between the two EPOs in terms of doses or hemoglobin concentrations. Factors that could potentially influence hemoglobin concentrations also did not differ under CERA or DA. The stability of hemoglobin was identical with both EPOs. We provide a conversion factor which allows comparison of cost according to local prices. CONCLUSIONS: We conclude that, in this observational "real life" study, the two EPOs are to be considered as equivalent.

Single-dwell treatment with a low-sodium solution in hypertensive peritoneal dialysis patients.

BACKGROUND: Patients on peritoneal dialysis (PD) may suffer from sodium (Na) and fluid overload, hypertension and increased cardiovascular risk. Low-Na dialysis solution, by increasing the diffusive removal of Na, might improve blood pressure (BP) management. METHODS: A glucose-compensated, low-Na PD solution (112 mmol/L Na and 2% glucose) was compared to a standard-Na solution (133 mmol/L Na and 1.5% glucose) in a prospective, randomised, single-blind study in hypertensive patients on PD. One daily exchange of the standard dialysis regimen was substituted by either of the study solutions for 6 months. The primary outcome (response) was defined as either a decrease of 24-h systolic BP (SBP) by ≥6 mmHg or a fall in BP requiring a medical intervention (e.g. a reduction of antihypertensive medication) at 8 weeks. RESULTS: One hundred twenty-three patients were assessed for efficacy. Response criteria were achieved in 34.5% and 29.1% of patients using low- and standard-Na solutions, respectively (p = 0.51). Small reductions in 24 h, office, and self-measured BP were observed, more marked with low-Na than with standard-Na solution, but only the between-group difference for self-measured SBP and diastolic BP was significant (p = 0.002 and p = 0.003). Total body water decreased in the low-Na group and increased in the control group, but between-group differences were not significant. Hypotension and dizziness occurred in 27.0% and in 11.1% of patients in the low-Na group and in 16.9% and 4.6% in the control group, respectively. CONCLUSIONS: Superiority of low-Na PD solution over standard-Na solution for control of BP could not be shown. The once daily use of a low-Na PD solution was associated with more hypotensive episodes, suggesting the need to reassess the overall concept of how Na-reduced solutions might be incorporated within the treatment schedule.

Effect of adding vildagliptin to insulin in haemodialysed patients with type 2 diabetes: The VILDDIAL study, a randomized, multicentre, prospective study.

AIM: To evaluate the effect of adding the dipeptidyl-peptidase-4 inhibitor vildagliptin to insulin on the glycaemic control of patients with type 2 diabetes undergoing haemodialysis. METHODS: Overall, 65 insulin-treated patients with type 2 diabetes undergoing haemodialysis (HbA1c: 7.3% ± 1.1%; age: 70.5 ± 8.5 years) were randomized (1:1) either to receive vildagliptin 50 mg/day in addition to insulin (vildagliptin-insulin group) or to pursue their usual insulin regimen (insulin-only group). Continuous glucose monitoring (CGM) was performed for 48 ± 6 hours at baseline and at week 12. The primary study endpoint was change from baseline in mean interstitial glucose using CGM. The secondary endpoints included other CGM variables and glucose control markers. RESULTS: After 12 weeks, a greater reduction in mean CGM glucose from baseline was observed in the vildagliptin-insulin group compared with the insulin-only group, although the between-treatment difference was not statistically significant (mean difference [CI 95%]: -0.96 mmol/L [-2.09; 0.18] vs. -0.29 mmol/L [-1.29; 0.76], P = 0.32). However, a significant decrease from baseline in HbA1c, glycated albumin and insulin daily doses was observed in the vildagliptin-insulin group versus the insulin-only group (-0.6% [-1.19; -0.1], P < 0.01), in the vildagliptin-insulin group versus no change in the insulin-only group (-130.6 µmol/L [-271; 10.7] vs. +36.2 µmol/L [-164.4; 236.9], P = 0.04 and - 5.9 IU/day [-1.8; 7.1] vs. +1.1 IU/day [-14.5; 16.6], P = 0.01, respectively). There was no significant difference in the percentage of time spent in hypoglycaemia using CGM, occurrence of severe hypoglycaemia or number of adverse events. CONCLUSION: In this study, vildagliptin added to insulin improved glycaemic control with an associated insulin-sparing effect in patients with type 2 diabetes undergoing haemodialysis and was well tolerated.

Acute renal failure related to high doses of acyclovir (15 mg/kg/8 h) during treatment of varicella zoster virus encephalitis.

Varicella zoster virus (VZV) is less susceptible than herpes simplex virus to acyclovir. The optimal acyclovir regimen during VZV encephalitis remains unknown. We report two cases of acute renal failure after an increase in acyclovir dosage from 10 mg to 15 mg/kg/8 h during the treatment of VZV encephalitis according to French guidelines.

[Charlotte Tassé and Bernadette Lépine, Fully-Fledged Founders of l'Institut Albert-Prévost]. / Charlotte Tassé et Bernadette Lépine, fondatrices à part entière de l'Institut Albert-Prévost.

In September 1919, just a few weeks after its opening, Dr. Albert Prévost's sanatorium welcomed its first nurse. Charlotte Tassé was only 26 years old. She was coming back from six months of specialized training in the US and had accepted to help for only two weeks. She will stay 44 years! Quickly become essential to Dr. Prévost, who was very busy with his responsibilities at the Université de Montréal and l'Hôpital Notre-Dame, the young nurse established herself as the heart of this small mental health facility. When the neurologist died, in 1926, she ensured that the sanatorium survive, helped by a new young recruit named Bernadette Lépine. Twenty years after, in 1945, the two nurses saved the institution from bankruptcy by buying it with their own funds. Then, they deeply transformed its organisation and reinforced its training offer, managing to transform it, in a few years only, in one of the most important and avant-garde mental health care and training centers in Québec. However, the arrival of a young and ambitious psychiatrist named Camille Laurin, at the end of the 1950s, knocked the long-standing stability of the institution and then quickly made the important role of the nurses forget. Based on the study of unpublished archives, this paper relates the story of these women and their major contribution to the history of Albert-Prévost Institut.

[From Neurology to Psychoanalysis: Evolutions and Continuity of the Psychotherapeutic Care Model of the Sanatorium Prévost]. / De la neurologie à la psychanalyse : évolutions et continuité du modèle de prise en charge psychothérapeutique du Sanatorium Prévost.

Since its opening, in July 1919, Dr. Albert Prévost's sanatorium tried to stand out from others' health care institutions, by offering a therapeutic mainly based on psychotherapy. Far from big and overcrowded asylums or physical therapies, as electrotherapy, used in others private clinics, Dr. Albert Prévost (1881-1926) wanted an institution where he could practice this new form of care he had discovered in Paris and which was yet more and more in vogue in the US. This will to keep the sanatorium at the avant-garde of the science of spirit remained, even after Prevost's death. Indeed, the Sanatorium Prévost, which became the Institut Albert-Prévost in 1955, was during all its existence, a space of experimentation and valorization of the psychiatric sciences' latest discoveries. This is what we want to demonstrate in this paper by following the path and realisations of the sanatorium main physicians, from the founders of francophone Québec neurology like Albert Prévost, Edgar Langlois (1893-1941), Roma Amyot (1899-1980) and Jean Saucier (1899-1968) to the first Québec psychoanalysts Karl Stern (1906-1975), Victorin Voyer (1917-1975) or Camille Laurin (1922-1999). We will yet see that the Sanatorium Albert-Prévost has always been at the cutting edge of psychiatric science, while keeping its own psychotherapeutic approach, centered on the patients' care, on which it had been founded.

[Charlotte Tassé (1893-1974), a tireless promoter of the French-Canadian nurses model.] / Charlotte Tassé (1893-1974), infatigable promotrice du modèle de la garde-malade canadienne-française.

A forgotten figure of the history of healthcare as well as Quebec's history, Charlotte Tassé (1893-1974) was a figurehead of the professionalization of Quebecoise nurses. This French-Canadian nurse established and ran two nursing schools, launched and directed a professional reference journal for thirty-five years, actively participated in the development of psychiatric nursing in Quebec, owned and managed one of the most important mental healthcare centers in the country, and also created a new class of nurses in Quebec: practical nurses. One of her main achievements was to establish and defend, with tenacity and persistence and through all her endeavors, a unique nursing model that was specific to Quebec: the French-Canadian nurses model. With its traditional values of care and femininity and avant-gardist representations of the nurses' job, which she dedicated to hospital management, her model contributed to making the history of nurses in Quebec unique and original. This paper focuses on the creation of this model and the active promotion it has benefited from for half a century by recounting, thanks to unpublished archives, the history of Charlotte Tassé's exceptional career.

[The recommendations of nephrologist are poorly followed by the primary care physician. The example of vaccination against hepatitis B]. / Les recommandations des néphrologues sont peu suivies par les médecins traitants. L'exemple de la vaccination contre l'hépatite B.

The relationship between specialist physician and primary care physician (PCP) has been poorly evaluated in France. We have studied the application of a specialist's recommendation by the PCP. Vaccination against hepatitis B in patients with chronic renal failure was the follow-up marker. After consultation, the nephrologist wrote in his report to the PCP that the vaccination was recommended. At the next nephrological consultation, the patient was asked if the PCP had proposed vaccination. The clinical, biological characteristics and history of the patients were recorded as well as number and location of the PCP consultations. Five nephrology centers recruited 315 patients. In 61.6% (194/315) of the cases, the vaccination was not proposed by the PCP. Only the estimated GFR (lowest in vaccinated patients, 29.5 vs. 34.5mL/min/1.73m2), the delay between the two consultations of the nephrologist (shorter in vaccinated patients, 18.7 vs. 22.9 weeks) and the nephrologist's practice center (17.5 to 52% vaccination rate) are statistically significant in univariate analysis. In multivariate analysis, only the center effect persists. The lack of vaccination was argued by a letter from the PCP in 2 cases (1%). In the absence of a direct questioning of the PCP, the reasons for not following the recommendation remain unexplained. Overall, the recommendation of the nephrologist was little followed. Our study can contribute to the reflection on the shared follow-up of patients suffering from chronic diseases.

[Théodore Simon (1873-1961). The career of a psychiatrist involved in the professionalization of psychiatric nurses]. / Théodore Simon (1873-1961). Itinéraire d?un psychiatre engagé pour la professionnalisation des infirmiers et infirmières d'asile.

Well-known for having created the famous Metric Scale of Intelligence along with the psychologist Alfred Binet (1857-1911), what is less known is that Théodore Simon (1873-1961) was also a major actor of the professionalization of psychiatric nurses in France. From his engaged textbook published in 1911 to his journal, explicitly titled ?L'Infirmier Psychiatrique,? which he created in 1953 via the specialized school he founded and directed between 1946 and 1957 at the Maison Blanche hospital in Neuilly-sur-Marne, Simon worked throughout his career for the acknowledgment and the training of those he considered as true partners. This is what we want to demonstrate in this paper, which redraws the forgotten career history of this militant psychiatrist in order to shine a light on his commitment to the professionalization of psychiatric nurses.

[Searching for the Lost Psychiatric Archive. History of the Alfred Binet's Archives Collections]. / À la recherche de l'archive psychiatrique perdue. L'histoire des fonds d'archives d'Alfred Binet (1857-1911).

This paper examines the history of Alfred Binet's Archives. It precises the formation of its different collections. It shows and studies the dispersal which often qualifies psychiatric archives and enlightens the difficulties of the historical work relative to this kind of source.

Obesity and atherosclerotic events in chronic hemodialysis patients: a prospective study.

BACKGROUND: Studies exploring the impact of overweight on mortality have reported controversial results in dialysis patients; some have found overweight to increase mortality, whereas others suggest that it offers a survival advantage. We conducted a prospective study to evaluate the impact of overweight on atherosclerotic events (AE) in dialysis patients with special respect to the malnutrition/inflammation complex syndrome (MICS). METHODS: Five hundred and forty-one hemodialysis patients from 11 dialysis centers in France were included. A number of baseline parameters including traditional and non-traditional cardiovascular (CV) risk factors were measured and the cohort was followed prospectively. RESULTS: Over a mean follow-up of 39 months, 207 patients (38.3%) experienced an AE. Overweight, defined by a body mass index greater than 25 kg/m(2), was associated with increased risk of AEs [RR: 1.68 (CI: 1.11-3.56)], and CV mortality [RR: 1.51 (CI: 1.07-2.13)]. The effect of overweight was different in patients with and without MICS. Age, diabetes, a previous history of CV disease, high serum levels of homocysteine and MICS were also associated with an increased risk of AEs. CONCLUSIONS: Similar to the general population, overweight contributes to an increased risk for AEs and CV mortality in hemodialysis patients. The presence or absence of MICS can modify the impact of overweight on development of AEs and mortality in this population.

Radio-opaque fecal impaction and pseudo-occlusion in a dialyzed patient taking lanthanum carbonate.

Lanthanum therapy is an efficient therapy of hyperphosphoremia by chelating phosphore in the digestive tract. Lanthanum is a silvery white metallic element that belongs to group 3 of the periodic table. This drug is lightly absorbed and has low water solubility. It should be borne in mind that abdominal X-rays of patients taking lanthanum carbonate may have a radio-opaque appearance typical of imaging agents. This characteristic is suggested to confirm adherence of the patient by doing an abdominal X-ray. We describe in our case a particular good compliant patient with slow digestive transit, which ends by pseudo-occlusion.

[Frederic Dubois D'Amiens, physician-philosopher. An example of the thought of the Royal Society of Medicine of Bordeaux in 1830]. / Frederic dubois d'Amiens, médecin-philosophe. L'exemple de la question de la Société Royale de Médecine de Bordeaux de 1830.

Frédéric Dubois d'Amiens (1799-1873) was perpetual secretary of the Academy of Medicine between 1847 and 1873. He remained famous in the history of the medicine for his Praises as well as for his criticism of the animal magnetism. But people often do not know that he won in 1830 the competition of the Royal Society of Medicine of Bordeaux concerning the distinction of hypochondria and hysteria. Nevertheless, the winning report, published in 1833 under the title A Philosophical history of hypochondria and hysteria, is the most accomplished work of Dubois d'Amiens, both by the development of an unexpected historical and philosophical method and by the new description which he gives of hypochondria. It is from this work that we wish to pay tribute to Dubois d'Amiens.