Meta-Analysis of the Composition of Human Intestinal Gases.

BACKGROUND: Understanding intestinal gases volume and composition may contribute to diagnosing digestive diseases and the microbiome's status. This meta-analysis aimed to define the composition of human intestinal gases and changes associated with diet. METHODS: Studies were identified by systematic research of the MEDLINE(Ovid), Scopus, and Cochrane databases. Studies that measured the concentration of intestinal gases in healthy adult humans were retrieved. The JBI critical appraisal tool was used to evaluate the risk of bias. The primary outcomes analysed were the concentration of the most prevalent colonic gases. Participants were divided into groups according to dietary fibre content. RESULTS: Eleven studies were included. The following gases were identified in similar concentrations across all studies (mean ± standard deviation): nitrogen (65.1 ± 20.89%), oxygen (2.3 ± 0.98%), carbon dioxide (9.9 ± 1.6%), hydrogen (2.9 ± 0.7%), and methane (14.4 ± 3.7%). Differences according to the dietary fibre were observed, with a positive correlation between fibre and volume of gas produced, particularly in fermented gases (carbon dioxide, hydrogen, and methane). DISCUSSION: The meta-analysis has found defined concentrations of the five most common gases present in human colonic gas. Limitations included heterogenic methodologies, a low number of participants, and few recent studies. These findings may be helpful in diagnostic applications where colonic gas volume and composition are crucial factors, including functional disorders, microbiome analyses, and bowel perforation diagnostics.

Antiplatelet and oral anticoagulant therapies in chronic hemodialysis patients: prescribing practices and bleeding risk.

PURPOSE: Results of previous studies assessing the risk of bleeding associated with prescription of antiplatelet (AP) and/or oral anticoagulant (AC) therapy to hemodialysis patients are conflicting. Our purpose was to describe practices for prescription of AP and AC in hemodialysis patients in the Lorraine region, and to assess their effect on the risk of major bleeding events. METHODS: All adults with chronic kidney disease who began a first renal replacement therapy by hemodialysis in 2009 or 2010 in one of the 12 dialysis centers in Lorraine were included in the Thrombosis and Hemorrhage in HemoDialysis patients (T2HD) study and followed up until 30 June 2013. The association of each treatment (AP, AC, AP + AC) with the risk of major bleeding was estimated by three Cox proportional hazard models with an inverse probability of treatment weighting on a propensity score, considering the untreated patients as the reference. RESULTS: Among 502 patients included, 227 (45.2%) received an AP, 68 (13.5%) an AC, 81 (16.1%) a combination AP + AC, and 126 (25.1%) were untreated. As compared with untreated patients, those given AP (HR 5.52, 95% CI [3.11-9.80]), AC (HR: 4.15, 95% CI: [3.46-4.99]), and AP + AC (HR: 5.59, 95% CI [2.62-11.91]) were at greater risk of major bleeding events. CONCLUSIONS: The risk of major bleeding is higher in patients receiving an oral AC compared with untreated patients and those receiving an AP agent. A combination of the two drugs does not seem to increase the risk. Copyright © 2016 John Wiley & Sons, Ltd.

[T2HD Study. Oral anticoagulants and antiplatelet agents: Practices, benefits, and risks in the chronic hemodialysis population. Observational data]. / Étude T2HD. Anticoagulants oraux et antiagrégants plaquettaires : pratiques, bénéfices et risques chez l'hémodialysé chronique. Données observationnelles.

INTRODUCTION: Chronic hemodialysis patients have disorders of hemostasis associated with End Stage Renal Disease, cardiovascular disease, and treatments they receive. They have more thrombotic and bleeding events than the general population. The balance of risks and benefits of drugs is not precisely defined. The aim of this study is to describe the practices patterns concerning oral anticoagulants (AVK) and antiplatelet agents (APA), and to investigate their impact on the survival and the occurrence of thrombotic and bleeding events. METHODS: Based on REIN registry, we performed a multicenter study of 502 incident patients on hemodialysis in Lorraine from 2009 to 2010. Until June 2013, we collected retrospectively the prescription of oral anticoagulants and APA, the occurrence of thrombotic or hemorrhagic events. RESULTS: During follow-up, there were 550 events, including 454 thrombotic events and 96 bleeding events. The most common event was the dialysis vascular access thrombosis; 60.8% of patients were treated with APA, and 29.5% with AVK. Bleeding and thrombosis occurred the most in the APA plus AVK patient group. Events had often recurrences. Patients survived longer in no anticoagulant or antiplatelet group, but with no statistic difference. DISCUSSION: Although literature is centered on bleeding events, we found a more significant occurrence of thrombosis than bleeding. Patients without APA or AVK have less comorbidities, less bleeding and thrombotic events, and better survival. Analytic description of our data is expected to get a risk/benefit ratio of APA and AVK treatment in their different uses.

Impact of free light chain hemodialysis in myeloma cast nephropathy: a case-control study.

New very high permeability dialysis membranes have been developed to enable the clearance of free light chains in myeloma cast nephropathy. These new dialysis techniques, in combination with chemotherapy, should allow improved prognosis in patients with myeloma cast nephropathy. We report a prospective observational study comparing patients who underwent hemodialysis in our center in 2009 for cast nephropathy revealing multiple myeloma vs. patients treated for the same condition during the same period in other centers in our region. The main difference in the management protocols was the use of high cutoff (HCO) membranes in our center. We described the clinical features, the management protocols, and the outcomes as of June 1, 2010. In 2009, five patients were treated for myeloma cast nephropathy with HCO hemodialysis in our center. At 386 ± 100 days follow-up, one patient died, while three of the five patients recovered their renal function, allowing cessation of hemodialysis. During the same period, five patients were treated for myeloma cast nephropathy in other centers in our region. At 398 ± 131 days follow-up, four patients died, and none of the patients recovered renal function, allowing cessation of hemodialysis. In our study, light chain clearance allowed recovery of renal function and cessation of hemodialysis in three of five patients with acute kidney injury secondary to myeloma cast nephropathy. A randomized trial comparing this technique with conventional hemodialysis techniques should be conducted to raise the level of proof for this therapeutic option. The overall prognosis, including quality of life and cost-effectiveness, of HCO hemodialysis should also be examined.

[Workload during hemodialysis sessions]. / Description de la charge de soins en séance d'hémodialyse.

In recent years, the population of dialysis patients has become frailer and older. Patients present with more comorbid conditions and experience more complications during their follow-up. The aim of the present study is to describe the workload of the dialysis center during hemodialysis sessions and determine whether comorbidities are associated with increased workload. We conducted a retrospective multicentric study on a sample population of 123 patients selected from a dialysis population within a regional network. We described hospitalizations and HD sessions during a 1-year follow-up. We collected data on 19 prescriptions and events occurring during HD sessions. We described two HD care profiles (easy and difficult) and looked for variables linked with these profiles. We found that age more or equal to 60 years, elevated C-reactive protein and HD catheters are associated with difficult HD care. Surprisingly, apart from heart failure, comorbidities were not linked to greater workload during HD sessions. The development of HD care profiles should be helpful in early detection of frailer patients. This could have concrete applications such as better allocation of human and material resources and better training for the dialysis staff.

Metformin-associated lactic acidosis in an intensive care unit.

INTRODUCTION: Metformin-associated lactic acidosis (MALA) is a classic side effect of metformin and is known to be a severe disease with a high mortality rate. The treatment of MALA with dialysis is controversial and is the subject of many case reports in the literature. We aimed to assess the prevalence of MALA in a 16-bed, university-affiliated, intensive care unit (ICU), and the effect of dialysis on patient outcome. METHODS: Over a five-year period, we retrospectively identified all patients who were either admitted to the ICU with metformin as a usual medication, or who attempted suicide by metformin ingestion. Within this population, we selected patients presenting with lactic acidosis, thus defining MALA, and described their clinical and biological features. RESULTS: MALA accounted for 0.84% of all admissions during the study period (30 MALA admissions over five years) and was associated with a 30% mortality rate. The only factors associated with a fatal outcome were the reason for admission in the ICU and the initial prothrombin time. Although patients who went on to haemodialysis had higher illness severity scores, as compared with those who were not dialysed, the mortality rates were similar between the two groups (31.3% versus 28.6%). CONCLUSIONS: MALA can be encountered in the ICU several times a year and still remains a life-threatening condition. Treatment is restricted mostly to supportive measures, although haemodialysis may possess a protective effect.