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  1. Article ; Online: The effect of protein-enriched snacks on serum albumin concentration in non-selected haemodialysis patients.

    Deleaval, Patrik / Guillaume, Jean / Bernollin, Anne-Lise / Lorriaux, Christie / Hurot, Jean-Marc / Major, Brice / Mehdi, Manolie / Chazot, Charles

    Journal of nephrology

    2020  Volume 34, Issue 4, Page(s) 1291–1299

    Abstract: Objective: Serum albumin level is not only one of the protein-energy wasting criteria but also a powerful marker of mortality in patients on haemodialysis (HD) treatment. The study aimed to assess the effect of a protein-enriched snack given during HD ... ...

    Abstract Objective: Serum albumin level is not only one of the protein-energy wasting criteria but also a powerful marker of mortality in patients on haemodialysis (HD) treatment. The study aimed to assess the effect of a protein-enriched snack given during HD treatment on serum albumin level.
    Design and methods: This prospective, single-centre, observational, non-randomized 16-month study was sub-divided into four 4-month periods. Patients on hemodialysis for more than three months and receiving a regular standard snack (8.8 g of protein) during the HD session were included and assigned during four four-month periods to receive either the standard snack or a protein-enriched snack (28.7 g). Patients were not selected based on nutritional criteria.
    Results: Sixty-six patients completed the study. Serum albumin levels significantly increased, from 3.43 ± 0.28 g/dl in the first period (standard snack) to 3.62 ± 0.32 g/dl (p < 0.0001) in the second period (enriched snack). In the third period (standard snack), albumin levels remained stable (3.61 ± 0.35 g/dl). After the fourth period (enriched snack), serum albumin levels further increased significantly (3.69 ± 0.30 g/dl; p = 0.05 and p = 0.007, respectively). Weight and normalized protein nitrogen appearance remained stable during the 16-month study period.
    Conclusions: This study suggests that the intake of a protein-enriched snack during HD treatment, independently from baseline serum albumin level, could significantly increase their serum albumin levels. Serum albumin level is a powerful predictor of mortality; therefore, this simple and effective action could be of real interest to improve patients' outcomes.
    MeSH term(s) Biomarkers ; Humans ; Nutritional Status ; Prospective Studies ; Renal Dialysis/adverse effects ; Serum Albumin ; Snacks
    Chemical Substances Biomarkers ; Serum Albumin
    Language English
    Publishing date 2020-11-02
    Publishing country Italy
    Document type Journal Article ; Observational Study
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-020-00887-x
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    Zs.A 3369: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  2. Article ; Online: Online-haemodiafiltration vs. conventional haemodialysis: a cross-over study.

    Jean, Guillaume / Hurot, Jean-Marc / Deleaval, Patrik / Mayor, Brice / Lorriaux, Christie

    BMC nephrology

    2015  Volume 16, Page(s) 70

    Abstract: Background: The main short-term advantages of haemodiafiltration (HDF) are supposedly better removal of Beta2-microglobulin (ß2-m) and phosphate, and better haemodynamic stability. The main disadvantage is higher costs. The aim of the study was to ... ...

    Abstract Background: The main short-term advantages of haemodiafiltration (HDF) are supposedly better removal of Beta2-microglobulin (ß2-m) and phosphate, and better haemodynamic stability. The main disadvantage is higher costs. The aim of the study was to compare the clinical and biological parameters associated with HDF and high-flux haemodialysis (HD), using a cross-over design, while maintaining the same dialysis parameters.
    Methods: All patients on a 3 × 4 hours schedule were observed during 3 identical 6-months periods: HDF1 - HD - HDF2. The mean values for the 2 last months of each period were compared.
    Results: A total of 51 patients (76 % males, 45 % diabetic) with a mean age of 74 ± 15 years, and who had been on dialysis for 49 ± 60 months were included. The mean blood flow (329 ± 27 ml/min), dialysate flow (500 ml/min), and convection volumes (21.6 ± 3.2 L) were recorded. Patient medications were not changed. Predialysis blood pressure, phosphataemia, calcaemia, iPTH, Kt/V, nPNA and intradialytic events were similar throughout the 3 periods. Only serum albumin (34. 4 ± 3.6, 35.9 ± 3.4, 34.1 ± 4 g/L, p < 0. 0001) and ß2-m serum levels (26.1 ± 5.4, 28 ± 6, 26.5 ± 5 mg/L, p < 0.001, values shown for HDF1, HD, HDF2, respectively) were significantly lower during the HDF periods. Factor associated with higher delta serum albumin levels between HD and HDF periods was mainly a lower convection volume.
    Conclusion: Comparing HDF and HD, we did not observe any differences in haemodynamic stability or in serum phosphate levels. Only serum ß2-m (-6% vs. HD) and albumin (-5% vs. HD) levels changed. The long-term clinical consequences of these biochemical differences should be prospectively assessed.
    MeSH term(s) Aged ; Aged, 80 and over ; Cross-Over Studies ; Female ; Hemodiafiltration/economics ; Hemodiafiltration/methods ; Humans ; Kidney Failure, Chronic/metabolism ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Phosphates/metabolism ; Prospective Studies ; Renal Dialysis/economics ; Renal Dialysis/methods ; Serum Albumin/metabolism ; Treatment Outcome ; beta 2-Microglobulin/metabolism
    Chemical Substances Phosphates ; Serum Albumin ; beta 2-Microglobulin
    Language English
    Publishing date 2015-05-09
    Publishing country England
    Document type Clinical Study ; Comparative Study ; Journal Article
    ZDB-ID 2041348-8
    ISSN 1471-2369 ; 1471-2369
    ISSN (online) 1471-2369
    ISSN 1471-2369
    DOI 10.1186/s12882-015-0062-0
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  3. Article: Brain Natriuretic Peptide Is a Marker of Fluid Overload in Incident Hemodialysis Patients.

    Chazot, Charles / Rozes, Margaux / Vo-Van, Cyril / Deleaval, Patrik / Hurot, Jean-Marc / Lorriaux, Christie / Mayor, Brice / Zaoui, Eric / Jean, Guillaume

    Cardiorenal medicine

    2017  Volume 7, Issue 3, Page(s) 218–226

    Abstract: Background/aims: Brain natriuretic peptide (BNP) is secreted by cardiomyocytes under stretch condition. High blood levels are associated with decreased patient survival in heart failure patients and in hemodialysis (HD) patients. We report the monthly ... ...

    Abstract Background/aims: Brain natriuretic peptide (BNP) is secreted by cardiomyocytes under stretch condition. High blood levels are associated with decreased patient survival in heart failure patients and in hemodialysis (HD) patients. We report the monthly BNP change in the first months of HD therapy in incident patients and its relationship with fluid removal and cardiac history (CH).
    Methods: All patients starting HD therapy in our unit from May 2008 to December 2012 were retrospectively analyzed. Every month (M1 to M6), BNP was assessed before a midweek dialysis session. CH, monthly pre- and postdialysis blood pressure, and postdialysis body weight were collected.
    Results: A total of 236 patients were included in the analysis. The median BNP at HD start was 593 (175-1,433) pg/mL, with a significant difference between CH- and CH+ patients (291 vs. 731 pg/mL,
    Conclusions: We confirm that in incident HD patients, BNP level is related to fluid excess and cardiac status. The BNP decrease in the first months of HD therapy is related to fluid excess correction. BNP appears as an important tool to evaluate hydration status correction after HD onset.
    Language English
    Publishing date 2017-06
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2595659-0
    ISSN 1664-5502 ; 1664-3828
    ISSN (online) 1664-5502
    ISSN 1664-3828
    DOI 10.1159/000471815
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  4. Article ; Online: Even a Moderate Fluid Removal Rate during Individualised Haemodialysis Session Times Is Associated with Decreased Patient Survival.

    Chazot, Charles / Vo-Van, Cyril / Lorriaux, Christie / Deleaval, Patrik / Mayor, Brice / Hurot, Jean-Marc / Jean, Guillaume

    Blood purification

    2017  Volume 44, Issue 2, Page(s) 89–97

    Abstract: Background: Several studies report that fluid removal rate (FRR) above 10-13 mL/h/kg is associated with increased mortality in haemodialysis (HD) patients.: Aim: The aims of this study are to assess the influence of moderate FRR on survival in a ... ...

    Abstract Background: Several studies report that fluid removal rate (FRR) above 10-13 mL/h/kg is associated with increased mortality in haemodialysis (HD) patients.
    Aim: The aims of this study are to assess the influence of moderate FRR on survival in a cohort of prevalent dialysis patients with various dialysis session times and to challenge the FRR thresholds associated with increased mortality risk reported previously.
    Methods: Interdialytic weight gain (IDWG) and FRR (calculated from ultrafiltration [UF], target weight, and session time prescriptions) were studied in 190 prevalent dialysis patients (female: 42%, mean age: 69.5 years, median vintage: 40.2 months, diabetes: 34.7%, loop diuretic prescription: 5.8%) and averaged during the final quarter of 2010. Patient survival was analysed using Kaplan-Meier and Cox-multivariate analyses.
    Results: The median IDWG, median session time, and median FRR were 2.33 kg (-0.54-4.57), 5.0 h (3.9-8.0 h), 6.8 mL/h/kg (1.3-16.7), respectively, and FRR was ≥10 mL/h/kg in 11.6% of the patients. The Kaplan-Meier analysis showed decreased patient survival when the FRR was above the median (6.8 mL/h/kg; p = 0.012). The FRR was found to be independently associated with increased mortality (hazard ratio 1.15 [95% CI 1.02-1.29]; p = 0.027) using stepwise Cox proportional hazard regression analysis, including age, vintage, gender, body mass index (BMI), serum albumin level, β2-microglobulin level, cardiovascular and diabetes history, and session time. Online haemodiafiltration did not change this result. The role of residual renal function was unlikely because 74% of the patients had a vintage of >18 months, a minority (5.8%) were prescribed loop diuretics (a surrogate of significant urine output) and β2-microglobulin level was not different in patients who were below or above the FRR median.
    Conclusion: We concluded that the FRR threshold above which there is an increased mortality is lower than what has been reported (7.8 mL/h/kg). It raises the question of the hazard of fluid removal and intermittence of standard HD.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Precision Medicine/methods ; Precision Medicine/mortality ; Proportional Hazards Models ; Renal Dialysis/methods ; Renal Dialysis/mortality ; Retrospective Studies ; Survival Analysis ; Time Factors ; Weight Gain ; Young Adult
    Language English
    Publishing date 2017
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 605548-5
    ISSN 1421-9735 ; 0253-5068
    ISSN (online) 1421-9735
    ISSN 0253-5068
    DOI 10.1159/000464346
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    Zs.A 1872: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  5. Article ; Online: Analysis of the kinetics of the parathyroid hormone, and of associated patient outcomes, in a cohort of haemodialysis patients.

    Jean, Guillaume / Souberbielle, Jean-Claude / Zaoui, Eric / Lorriaux, Christie / Hurot, Jean-Marc / Mayor, Brice / Deleaval, Patrik / Mehdi, Manolie / Chazot, Charles

    BMC nephrology

    2016  Volume 17, Issue 1, Page(s) 153

    Abstract: Background: Observational studies have recently associated a decrease in serum parathyroid hormone (PTH) level with a higher rate of mortality among hemodialysis (HD) patients. Decreases in PTH level can result from medical intervention (MPD) and ... ...

    Abstract Background: Observational studies have recently associated a decrease in serum parathyroid hormone (PTH) level with a higher rate of mortality among hemodialysis (HD) patients. Decreases in PTH level can result from medical intervention (MPD) and surgical parathyroidectomy (PTX), or may occur spontaneously, usually associated with an underlying malnutrition-inflammation syndrome (SPD). The aim of our study was to prospectively identify the incidence of decreases in PTH level in a cohort of HD patients and the frequency distribution of the different causes (MPD, PTX and SPD), as well as to evaluate the survival outcomes for each PTH group (MPD, PTX and SPD) compared to patients who did not experience a PTH decrease over the first 36 months of the study (NPD).
    Methods: The 197 patients receiving HD at our center in January 2010, and meeting our eligibility criteria, were enrolled in our prospective study, and were observed for a period of 60 months. A decrease in PTH level >50 % between two successive PTH measurements obtained within an interval <3 months was defined as a significant event. MPD referred to a decrease in PTH due to an increased oral calcium intake, increased dialysate calcium concentration (DCC), increased alfacalcidol use, or use of cinacalcet therapy. A surgical 7/8 PTX was performed in young patients or in patients in whom cinacalcet therapy failed. SPD referred to a decrease in PTH related to a medical or surgical event. Baseline characteristics among patients in each group (MPD, PTX, SPD, and NPD) were evaluated using Fisher's exact test. The 60-month survival was evaluated using Kaplan-Meier and Cox multivariable proportional hazards models. Univariate and multivariate Cox analyzes were used identify variables with mortality. The relative risk of mortality was expressed as a hazard ratio (HR).
    Results: The distribution of the 197 patients forming our four study groups was 34 % in the NPD group, 35 % in the SPD group, 25 % in the MSD group and 6 % in the PTX group. Among patients in the SPD group, the main acute comorbid conditions were peripheral vascular and cardiac complications, sepsis, fractures, and cancers with an increase in serum CRP level (from 14.3 ± 18 to 132 ± 90 mg/L) and a decrease in serum albumin (from 33 ± 4.5 to 28.6 ± 4 g/L). In the MPD group, the main therapeutic change was an increase in DCC, either independently or in association with cinacalcet therapy. The median survival rate among patients was 10 months for SPD, compared to 22 months among patients in the MPD group (p < 0.001). Using multivariable Cox model and taking the NPD group as reference, the risk of mortality was lower among patients in the MPD group (HR, 0.42[0.2-0.87] p = 0.01), with survival being comparable for the SPD and NPD groups (HR, 1.3 [0.75-2.2]). No mortality was observed in the PTX group.
    Conclusion: The poor outcomes associated with SPD, related to acute comorbid conditions, should not lead to undertreat secondary hyperparathyroidism whose appropriate medical or surgical therapies are associated with better outcomes.
    Language English
    Publishing date 2016-10-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041348-8
    ISSN 1471-2369 ; 1471-2369
    ISSN (online) 1471-2369
    ISSN 1471-2369
    DOI 10.1186/s12882-016-0365-9
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  6. Article ; Online: Vascular Calcification Progression Is an Independent Predictor of Mortality in Patients on Haemodialysis.

    Jean, Guillaume / Mayor, Brice / Deleaval, Patrik / Lorriaux, Christie / Hurot, Jean-Marc / Bresson, Eric / Chazot, Charles

    Nephron

    2015  Volume 130, Issue 3, Page(s) 169–174

    Abstract: Background: We previously reported that vascular calcification (VC) score was associated with mortality in patients on haemodialysis (HD) and that a high serum level of parathyroid hormone (PTH) and fibroblast growth factor (FGF)-23 were the only ... ...

    Abstract Background: We previously reported that vascular calcification (VC) score was associated with mortality in patients on haemodialysis (HD) and that a high serum level of parathyroid hormone (PTH) and fibroblast growth factor (FGF)-23 were the only factors associated with VC progression.
    Aim: To assess the impact of VC progression on HD patient survival.
    Methods: The study cohort including 85 HD patients studied between 2006 and 2007 and between 2009 and 2010 was divided into patients with VC progression (PG+, n = 38) and no-progression (PG-, n = 47), based on VC scores measured twice at 3-year intervals (VC1 and VC2). Patients were followed during 3 additional years.
    Results: Kaplan-Meier analysis determined that PG+ displayed increased mortality (hazard ratio (HR): 2.4; 95% confidence interval (CI): 1.12-4.8; p = 0.03). This result was confirmed using a Cox proportional hazards model adjusted for age, dialysis duration, the VC1 score, and the mean FGF-23 and iPTH serum levels (HR: 2.7; 95% CI: 1.12-6.6; p = 0.02).
    Conclusion: VC progression is associated with poor survival in patients on HD, irrespective of a patient's baseline VC score.
    MeSH term(s) Age Factors ; Aged ; Aged, 80 and over ; Cohort Studies ; Disease Progression ; Female ; Fibroblast Growth Factors/blood ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Parathyroid Hormone/blood ; Renal Dialysis/mortality ; Survival Analysis ; Vascular Calcification/etiology ; Vascular Calcification/mortality
    Chemical Substances Parathyroid Hormone ; fibroblast growth factor 23 ; Fibroblast Growth Factors (62031-54-3)
    Language English
    Publishing date 2015
    Publishing country Switzerland
    Document type Journal Article ; Observational Study
    ZDB-ID 207121-6
    ISSN 2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
    ISSN (online) 2235-3186 ; 1423-0186
    ISSN 1660-8151 ; 0028-2766
    DOI 10.1159/000431288
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 169: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  7. Article: Usefulness and feasibility of measuring ionized calcium in haemodialysis patients.

    Jean, Guillaume / Granjon, Samuel / Zaoui, Eric / Deleaval, Patrik / Hurot, Jean-Marc / Lorriaux, Christie / Mayor, Brice / Chazot, Charles

    Clinical kidney journal

    2015  Volume 8, Issue 4, Page(s) 378–387

    Abstract: Background: Measuring blood calcium level is recommended in haemodialysis (HD) patients. The Kidney Disease Improving Global Outcomes position states that the measurement of ionized calcium (ICa) level is preferred, but in the clinical setting, due to ... ...

    Abstract Background: Measuring blood calcium level is recommended in haemodialysis (HD) patients. The Kidney Disease Improving Global Outcomes position states that the measurement of ionized calcium (ICa) level is preferred, but in the clinical setting, due to technical difficulties, total calcium (tCa) level is preferred to ICa.
    Aim: The aim of this study was to test the possibility of delayed ICa analysis using frozen serum, and so to identify the factors associated with predialysis ICa level and compare the ability of tCa and Alb-Ca to predict ICa level and finally to compare the survival rate according to the three calcium measurements.
    Methods: All prevalent HD patients, dialysed by a native AV fistula in a 3 × 4 to 3 × 8 h schedule, had their predialysis ICa, tCa and Alb-Ca levels and usual mid-week biology recorded. Intergroup comparisons between ICa quartile were performed. Bland-Altman plots and linear regression were used to assess the differences between 30 fresh and frozen samples. Survival analyses were performed using ICa and tCa levels.
    Results: Comparing fresh blood and frozen serum samples, linear regression (y = 0.98 + 0.02, r = 0.961) showed that the two methods were quite identical with the same mean ICa value (1.1 ± 0.1 mmol/L, P = 0.45). A total of 160 HD patients were included in the study. Hypocalcaemia, using ICa values, was highly prevalent in our population (40%) whereas hypercalcaemia was observed only in three cases (1.8%). In predicting ICa hypocalcaemia (<1.12 mmol/L, n = 64), the use of tCa was accurate in 48.4% of patients, and the use of Alb-Ca was accurate in only 17.2% of patients; tCa was not a predictive factor for hypercalcaemia (ICa > 1.32 mmol/L, n = 3); Alb-Ca value predicted hypercalcaemia in 2/3 of the patients. In predicting normocalcaemia, the use of tCa values was correct in 92.4% of patients and the use of Alb-Ca values in 88.1% of patients; only younger age (P = 0.03) and female sex (P = 0.01) were associated with higher ICa quartile. None of the three calcium measures was significantly associated with survival rate using log-rank and Cox models adjusted for age, dialysis vintage, diabetes and sex.
    Conclusion: In the present study, we report that (1) delayed ICa measure is feasible in dialysis patients using a freezing technique, (2) hypocalcaemia is highly prevalent in HD patients and poorly predicted by Alb-Ca level, (3) the main factor associated with ICa level is sex of the individual and (4) calcaemia is not associated with survival rate using any of the three methods.
    Language English
    Publishing date 2015-06-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfv039
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    Zs.A 6587: Show issues Location:
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  8. Article ; Online: Comparaison des verrous de cathéters tunnellisés par citrate 4 % et héparine en hémodialyse chronique.

    Chazot, Guillaume / Mehdi, Manolie / Lorriaux, Christie / Deleaval, Patrik / Mayor, Brice / Jean, Guillaume / Chazot, Charles / Lechevallier, Sylvain / Moncel, Oriane / Vo-Van, Cyril / Hurot, Jean-Marc

    Nephrologie & therapeutique

    2017  Volume 14, Issue 1, Page(s) 42–46

    Abstract: Introduction: Citrate 4% is an alternative to heparin as catheter-locking solution in chronic hemodialysis patients. We compared catheter dysfunction episodes, dialysis adequacy, plasminogen-tissular activators use and costs according to catheter- ... ...

    Title translation Comparison of citrate 4% and heparin as tunneled-catheters-locking solution in chronic hemodialysis.
    Abstract Introduction: Citrate 4% is an alternative to heparin as catheter-locking solution in chronic hemodialysis patients. We compared catheter dysfunction episodes, dialysis adequacy, plasminogen-tissular activators use and costs according to catheter-locking solution in our centre.
    Methods: Prospective, monocentric, cohort study (NephroCare Tassin-Charcot) on 49 prevalent patients in chronic hemodialysis. Two main groups were formed according to the prescription of catheter-locking solution at the beginning of the study (03/02/2016) and followed until 05/10/2016: heparin (n=26) and citrate (n=22).
    Results: The number of diabetic patients was higher in the citrate group (12/22) than in the heparin one (5/26; P=0.025). The 2 groups were comparable for the other studied variables. We didn't observe any difference in terms of catheter-dysfunction (4.23 versus 4.14% in heparin and citrate groups, respectively; P=1.0) and dialysis adequacy. The prescription of citrate was associated with lower TPA uses (1/604 versus 14/946; P=0.022) and lower costs (1.42 € for one session versus 2.94 €).
    Conclusion: Administration of citrate 4% as a catheter-locking solution is not inferior to heparin in terms of catheter-dysfunction episodes, is associated with similar dialysis adequacy results, lower plasminogen-tissular activators uses and reduced costs in chronic prevalent hemodialysed patients.
    MeSH term(s) Adult ; Aged ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Anticoagulants/economics ; Catheters, Indwelling/adverse effects ; Catheters, Indwelling/economics ; Citric Acid/administration & dosage ; Citric Acid/adverse effects ; Citric Acid/economics ; Cohort Studies ; Equipment Failure/statistics & numerical data ; Female ; Heparin/administration & dosage ; Heparin/adverse effects ; Heparin/economics ; Humans ; Male ; Middle Aged ; Prospective Studies ; Renal Dialysis/adverse effects ; Renal Dialysis/economics ; Renal Dialysis/methods
    Chemical Substances Anticoagulants ; Citric Acid (2968PHW8QP) ; Heparin (9005-49-6)
    Language French
    Publishing date 2017-11-27
    Publishing country France
    Document type Comparative Study ; Journal Article
    ZDB-ID 2229575-6
    ISSN 1872-9177 ; 1769-7255
    ISSN (online) 1872-9177
    ISSN 1769-7255
    DOI 10.1016/j.nephro.2017.02.015
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  9. Article ; Online: Target weight gain during the first year of hemodialysis therapy is associated with patient survival.

    Chazot, Charles / Deleaval, Patrik / Bernollin, Anne-Lise / Vo-Van, Cyril / Lorriaux, Christie / Hurot, Jean-Marc / Mayor, Brice / Jean, Guillaume

    Nephron. Clinical practice

    2014  Volume 126, Issue 3, Page(s) 128–134

    Abstract: Background: Hemodialysis (HD) patients are exposed to a high risk of death. Nutritional status has been recognized as a key factor for patient survival. Nutritional markers have been shown to improve after HD onset. In this study we have analyzed the ... ...

    Abstract Background: Hemodialysis (HD) patients are exposed to a high risk of death. Nutritional status has been recognized as a key factor for patient survival. Nutritional markers have been shown to improve after HD onset. In this study we have analyzed the dynamics of target weight (TGW) change and the evolution of other nutritional parameters during the first year of HD treatment and their influence on patients' outcomes.
    Methods: We have analyzed a retrospective cohort of incident patients starting HD therapy between January 2000 and January 2009, and studied the values and changes in TGW, interdialytic weight gain (IDWG), predialysis systolic blood pressure, serum albumin, protein intake, C-reactive protein (CRP) from the start and first week (W1), W8, W12, W26 and W52 in patients who survived the first year of therapy. We have analyzed the relationship between TGW changes with other nutritional parameters and the patient survival.
    Results: Among the cohort including 363 patients starting HD therapy, 251 (age 65.8 ± 14.8 years, 93 female/158 male, diabetes 36%) survived at least 1 year after dialysis onset and were followed for 44.9 months. During the first 8 weeks, the TGW decreased by 6.5 ± 5.6% (initial TGW change). The initial TGW change was correlated with IDWG at W12 and W26, and with changes in serum albumin and nPNA (normalized protein equivalent of nitrogen appearance) between HD W1 and W52 (respectively +7.8 and +11.4%). From W8 to W52, the TGW increased by +1.9 ± 7.4% (secondary TGW change). The Kaplan-Meier analysis displayed a significantly better survival in patients above the median (+2.3%) of the secondary TGW change (respectively -3.6 ± 5.2% and +7.6 ± 4.5%). The two groups above and below this median were not different according to age, diabetes or cardiovascular event history but the patients above the median had a significant higher IDWG and protein intake. In the Cox model analysis the patient overall mortality was related to age (p < 0.0001), to the secondary TGW change (p = 0.0001), and to the CRP level at W52 (p < 0.0001).
    Conclusions: The initial fluid removal was related to nutritional markers. The secondary TGW change during the first year of HD treatment calculated after the initial phase of fluid removal was identified as a strong predictor of survival. It was associated with a better food intake whereas the patient case mix was not different. These data highlight the importance of nutrition and food intake in the first year of dialysis therapy and the need for nutritional follow-up and support in incident HD patients. It stresses the need in understanding the key factors associated with food intake in this setting.
    MeSH term(s) Aged ; Blood Pressure ; C-Reactive Protein/metabolism ; Dietary Proteins/administration & dosage ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Nutritional Status ; Renal Dialysis ; Retrospective Studies ; Serum Albumin/metabolism ; Weight Gain
    Chemical Substances Dietary Proteins ; Serum Albumin ; C-Reactive Protein (9007-41-4)
    Language English
    Publishing date 2014
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 207121-6
    ISSN 1660-2110 ; 1423-0186 ; 2235-3186 ; 1660-8151 ; 0028-2766
    ISSN (online) 1660-2110 ; 1423-0186 ; 2235-3186
    ISSN 1660-8151 ; 0028-2766
    DOI 10.1159/000362211
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  10. Article: Brain Natriuretic Peptide Is a Marker of Fluid Overload in Incident Hemodialysis Patients

    Chazot, Charles / Rozes, Margaux / Vo-Van, Cyril / Deleaval, Patrik / Hurot, Jean-Marc / Lorriaux, Christie / Mayor, Brice / Zaoui, Eric / Jean, Guillaume

    Cardiorenal Medicine

    2017  Volume 7, Issue 3, Page(s) 218–226

    Abstract: Background/Aims: Brain natriuretic peptide (BNP) is secreted by cardiomyocytes under stretch condition. High blood levels are associated with decreased patient survival in heart failure patients and in hemodialysis (HD) patients. We report the monthly ... ...

    Institution NephroCare Tassin-Charcot, Sainte-Foy-lès-Lyon F-CRIN, Investigation Network Initiative - Cardiovascular and Renal Clinical Trialist, Nancy, and Cerballiance, Sainte-Foy-lès-Lyon, France
    Abstract Background/Aims: Brain natriuretic peptide (BNP) is secreted by cardiomyocytes under stretch condition. High blood levels are associated with decreased patient survival in heart failure patients and in hemodialysis (HD) patients. We report the monthly BNP change in the first months of HD therapy in incident patients and its relationship with fluid removal and cardiac history (CH). Methods: All patients starting HD therapy in our unit from May 2008 to December 2012 were retrospectively analyzed. Every month (M1 to M6), BNP was assessed before a midweek dialysis session. CH, monthly pre- and postdialysis blood pressure, and postdialysis body weight were collected. Results: A total of 236 patients were included in the analysis. The median BNP at HD start was 593 (175-1,433) pg/mL, with a significant difference between CH- and CH+ patients (291 vs. 731 pg/mL, p < 0.0001). Mortality was significantly higher in patients in the higher BNP tertile. BNP decreased significantly between M1 and M2 and then plateaued. The BNP change between M1 and M2 and between M1 and M6 was significantly correlated with the initial fluid removal. Applying stepwise multiple regression, the BNP change between M1 and M2 was significantly and independently related to fluid removal. The BNP level at M6 was also related to patient survival. Conclusions: We confirm that in incident HD patients, BNP level is related to fluid excess and cardiac status. The BNP decrease in the first months of HD therapy is related to fluid excess correction. BNP appears as an important tool to evaluate hydration status correction after HD onset.
    Keywords Hemodialysis ; Incident patients ; Fluid overload ; Brain natriuretic peptide ; Survival
    Language English
    Publishing date 2017-04-29
    Publisher S. Karger AG
    Publishing place Basel, Switzerland
    Document type Article
    Note Original Paper
    ZDB-ID 2595659-0
    ISSN 1664-5502 ; 1664-3828
    ISSN (online) 1664-5502
    ISSN 1664-3828
    DOI 10.1159/000471815
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