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Biomedical subjects

D Fouque

Publications and source records attributed to D Fouque.

At least 37 records · Page 2Linked to original sources
PubMed2000

Nutritional aspects in hemodialysis.

The results of cross sectional studies throughout the world indicate that maintenance hemodialysis patients are at risk of malnutrition. Longitudinal studies show that malnutrition is associated with a reduced life expectancy mainly because of cardiovascular and infectious complications. Several factors are responsible for malnutrition of hemodialysis patients. Protein-energy intake is often reduced because of inappropriate dietary restrictions, anorexia, and taste alterations, promoting malnutrition in most patients entering dialysis. Intercurrent illnesses and frequent hospitalizations add to meal disturbances. A state of persistent catabolism may result from acidosis, resistance to anabolic factors such as growth hormone, insulin, and insulin-like growth factor-1, as well as a chronic inflammatory state caused by dialysis membrane and fluid bioincompatibility. In addition, losses of nutrients, including glucose, amino acids, proteins, and vitamins, occur during the dialysis treatment. Careful monitoring of dietary intakes is mandatory even in predialysis patients. In hemodialysis patients, the dose of dialysis should be adapted to correct acidosis and to relieve anorexia caused by accumulation of uremic toxins and hyperleptinemia. When malnutrition is established, active therapeutic interventions should take place, including intradialytic parenteral nutrition if oral supplementation has failed to improve nutritional status. Anabolism has been observed during the administration of recombinant growth hormone and insulin-like growth factor-1. Emerging therapeutic strategies against malnutrition may also involve a short period of daily dialysis.

Humans↗
PubMed2000

Guest editorial

Explore the source record for details and available documents.

Journal Article↗
PubMed2000

Heparins and blood polymorphonuclear stimulation in haemodialysis: an expansion of the biocompatibility concept.

BACKGROUND: At the concentrations used in haemodialysis and in a dose-dependent way, unfractionated heparin (UFH) and, to a lesser degree, a low-molecular-weight heparin (LMWH) stimulate polymorphonuclear cells (PMN) in vitro, and could act in synergy with the stimulatory effect of dialysis membranes in vivo. To examine this hypothesis, we studied the effects of different heparin types and regimens on blood PMNs during haemodialysis sessions. METHODS: Ten haemodialysed patients were studied during regular dialysis sessions on a cellulose triacetate membrane (CT 110 G; 1.10 m(2); Baxter), with four different random heparin protocols: one high-UFH regimen (HHR) at 90 IU/kg body-weight (b.w.) and one low-UFH regimen (LHR) at 50 IU/kg b.w., and with a LMWH (nadroparin calcium) at 85 (HHR) or 45 (LHR) IU/kg b.w. Blood granulocytes, platelet counts, and plasma granulocyte degranulation products (elastase, lactoferrin) were measured serially during 4 h dialysis sessions. RESULTS: After 10 min, the reduction in PMNs with UFH was 29.5% for HHR (P<0.01) and 28.5% for LHR (P<0.01), and only 16.8 and 18.6% with LMWH (NS), significantly higher for HHR with UFH than with LMWH (P<0.01). At 60 min, the elastase increase with HHR was greater, 61% with UFH (P<0.01) and 37.8% with LMWH (P<0.01), significantly higher than LHR for UFH (P<0.05) or LMWH (P<0.05). The overall decrease in platelets (with LMWH P<0.01) and the overall increase in lactoferrin (P<0.001) were not different between heparinization procedures. CONCLUSION: Under a conventional heparin regimen, the PMN variation during the course of the dialysis session suggests a more biocompatible effect of LMWH over UFH. In addition, the variation of elastase favours the lower dose, whatever the type of heparin. Heparin type and dose should therefore be considered in studies addressing biocompatibility in haemodialysis: a low dose of LMWH may be viewed as a better biocompatible treatment with regard to leukocyte stimulation.

Adult↗
PubMed2000

Low protein diets delay end-stage renal disease in non-diabetic adults with chronic renal failure.

BACKGROUND: The objective of this study was to determine the efficacy of low protein diets in delaying the need to start maintenance dialysis based on an analysis of published literature. METHODS: The search strategy involved a Medline and Embase search from January 1966 through to June 1999, congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since 1985, International Society of Nephrology since 1987) and direct contacts with investigators. The selection criteria included randomized trials comparing two different levels of protein intake in adult patients suffering from moderate to severe renal failure, followed for at least 1 year. Patients with diabetic nephropathy were excluded. Seven trials were selected from 40 studies since 1975. A total of 1494 patients were analysed: 753 had received reduced protein intake and 741 a higher protein intake. The numbers of 'renal deaths' (defined as the need for starting dialysis, the death of a patient or kidney transplant during the trial) were collected. RESULTS: 242 renal deaths were recorded, 101 in the low protein diet and 141 in the higher protein diet group, giving an odds ratio of 0.61 with a 95% confidence interval of 0.46 to 0.83 (P=0.006). CONCLUSION: Reducing protein intake in patients with chronic renal failure reduces the occurrence of renal death by about 40% as compared with larger or unrestricted protein intake. The optimal level of protein intake cannot be confirmed from these studies.

Chronic Disease↗
PubMed2000

[How to produce systematic reviews of excellent quality and to define evidence-based nephrology].

Since recent years, a number of systematic reviews have been published in the renal field. These publications will be used to develop the concept of evidence based nephrology. The design and quality of renal systematic reviews relies on technical skills and efficient trials search. The reasons for discrepancies that are sometimes reported between systematic reviews and controlled clinical trials are now better understood and may be partly explained by inadequate trial recovery and publication biases. The applicability of evidence findings is not always an easy task on patients level. The example of the low protein diet in chronic renal failure highlights such caveats. However, producing high level systematic reviews in the renal field may be of great help to clarify the use of controversial treatments and to design new studies in the renal field.

Evidence-Based Medicine↗
PubMed1999

Peritoneal clearance of leptin in continuous ambulatory peritoneal dialysis.

Leptin is a 16-kd protein that increases energy expenditure and limits food intake. Serum leptin (S-leptin) is elevated in dialysis patients, and little data have been reported on leptin clearance (Cl) during dialysis. We analyzed the peritoneal dialysis (PD) Cl of leptin in 15 continuous ambulatory peritoneal dialysis (CAPD) patients and compared the results to beta(2)-microglobulin (beta(2)-m), urea, and creatinine PD Cl. S-leptin was significantly elevated (Kruskal-Wallis, P < 0.005) in CAPD women (58.4 +/- 42.4 [SE] microg/L, n = 5) as compared with CAPD men (13.9 +/- 7.1, n = 10) and with healthy women (11.0 +/- 1.4, n = 13) and men (5.1 +/- 0. 9, n = 14). Correlations were found between percent of fat mass and S-leptin (P < 0.05); between S-leptin and the 24-hour PD leptin (P < 0.05); and between dialysate-to-plasma (D/P) beta(2)-m and D/P leptin (P < 0.01). PD leptin Cl (1.80 +/- 0.43 mL/min/1.73 m(2)) was higher than beta(2)-m Cl (1.22 +/- 0.31) (P < 0.01), but reduced as compared with urea Cl (8.84 +/- 1.20) (P < 0.005) and creatinine Cl (7.71 +/- 0.99) (P < 0.005). These results indicate that leptin is eliminated through the peritoneum membrane. However, peritoneal leptin clearance, as beta(2)-m, appears to be clearly restricted as compared with peritoneal transport of smaller molecules. Hence, leptin could use the same diffusion transport pathway as beta(2)-m. In addition, leptin, which has a higher molecular weight than beta(2)-m, was significantly more eliminated into the peritoneal dialysate. More studies are necessary to clarify whether this is an active leptin elimination process by peritoneal secretion or by a different restriction coefficient of diffusion through the peritoneum membrane.

Aged↗
PubMed1999

Twenty-five years of experience with out-center hemodialysis.

UNLABELLED: Twenty-five years of experience with out-center hemodialysis. BACKGROUND: Out-center hemodialysis (HD) offers patients a better quality of life, a greater independence, and a better rehabilitation opportunity. A lower mortality than with other modalities of dialysis has been reported. In addition, in France the charges paid depend on the modality of dialysis, out-center HD being the less expensive, and savings are also accomplished through fewer patient transports, which are additionally reimbursed. We present a 25-year experience of out-center HD. METHODS: We retrospectively studied the clinical records of 471 patients treated between 1974 and 1997 in a single nonprofit organization operating regional home HD (H-HD) and facilities for self-care HD (SC-HD). Survival results were analyzed according to: (a) causes of end-stage renal disease, (b) age at the start of HD, (c) period of start of HD, (d) modality of HD (H-HD, SC-HD), and (e) a subgroup of 174 patients defined at risk because they were contraindicated for transplantation. RESULTS: The mean age at the start of HD increased from 31.2 +/- 9.7 (mean +/- SD) years in 1974 to 52.6 +/- 13.5 years in 1997. Causes of the end of treatment were: (a) transplantation (63%), (b) transfer (20%), and (c) death (17%). The overall survival was 90% at 5 years, 77% at 10 years, 62% at 15 years, and 45% at 20 years, and, for the group at risk, 78%, 62%, 46%, and 31%, respectively. Cox proportional hazard analyses showed that risk factors were older age, diabetes, and renal vascular diseases. CONCLUSION: If adequate choice is given, out-center HD offers a reliable and safe modality of dialysis with better survival results than survival in full-care in-center HD. In addition, out-center HD ensures a striking financial benefit as compared with the higher costs if the same patients were treated with full-care in-center HD. These modalities should be encouraged for all HD patients who are able to be treated by out-center modalities.

Adult↗
PubMed1999

Evidence-based nephrology.

Systematic reviews and meta-analyses are the best approaches available for summarizing the available evidence concerning the efficacy of therapies. Although the renal field has been slow to use these techniques, they are being used increasingly. In March 1997, the Cochrane Renal Group was formed, and this group aims to produce and maintain up to date systematic reviews of the evidence on the effectiveness of therapies used to treat patients with renal diseases. This group is part of the Cochrane Collaboration which is an international structure grouping collaborators together, with the aim of preparing, maintaining and disseminating systematic reviews of the effects of health care in all areas of medicine.

Clinical Trials as Topic↗
PubMed1999

Interstitial alpha-smooth muscle actin: a prognostic marker in membranous nephropathy.

AIM: Membranous nephropathy in adults causes 20% of nephrotic syndromes. Spontaneous outcome of this glomerulopathy is difficult to evaluate from clinical and histological data. Some patients can achieve complete remission, while others develop progressive renal failure. In this study we assessed alpha-smooth muscle actin (alpha-SMA) expression in renal interstitial myofibroblasts as a marker to predict the outcome of membranous nephropathy. PATIENTS AND METHODS: Renal function tests in tandem with alpha-SMA immunolabelling were performed on 25 patients with a mean follow-up of 7.2+/-5.6 years. The intensity of interstitial alpha-SMA (ialpha-SMA) immunostaining was compared to changes in glomerular filtration rate (GFR) evaluated by inulin clearance, between the time of diagnosis (GFR1) and the end of follow-up (GFR2). RESULTS: A significant correlation (r = 0.62, p<0.001) was found, between the intensity of interstitial myofibroblasts, immunolabeling and GFR at the end of follow-up. Moreover, the annual GFR variation and the annual percentage of GFR variation were correlated to interstitial myofibroblast labeling (respectively r = 0.62, p<0.001; r = 0.67, p<0.001). In addition, the importance of proteinuria, initial GFR impairment and fibrosis were confirmed as prognostic criteria. CONCLUSION: This study strongly shows that ialpha-SMA expression is a useful and early prognostic marker in the evolution of membranous nephropathy.

Actins↗
PubMed1998

Acute leptin regulation in end-stage renal failure: the role of growth hormone and IGF-1.

BACKGROUND: Leptin, a recently discovered peptide involved in nutrient intake and energy expenditure, has been shown to be abnormally regulated in certain conditions such as obesity. In chronic renal failure, leptin appears to be increased. However, little is known about leptin regulation during chronic renal failure (CRF). METHODS: We measured serum leptin in eight well nourished, chronic hemodialysis patients (seven males, one female) receiving anabolic factors for three days as either recombinant insulin-like growth factor-1 (rhIGF-1) or a combination of recombinant growth hormone (rhGH) plus recombinant IGF-1, in a random cross-over trial. RESULTS: Serum leptin values were in the range of normal volunteers matched for body mass index. As reported in other conditions, serum leptin was strongly correlated with patients dry body wt (P = 0.01) and body fat (P = 0.0001). Both treatments affected serum leptin in a rapid and opposite manner. RhIGF-1 decreased serum leptin from 11.2+/-20.8 (SD) to 4.3+/-3.8 microg/liter (P = 0.011), whereas the combination of rhGH + rhIGF-1 increased serum leptin from 7.4+/-9.4 to 21.0+/-32.9 microg/liter (P = 0.011). Regression analyses indicated a linear regression between serum leptin and insulin variations after treatment. CONCLUSIONS: This study shows for the first time that both rhIGF-1 and rhGH acutely regulate serum leptin in dialysis patients. Whether leptin changes are explained by the concomitant insulin variation should be further studied under renal failure conditions.

Adult↗
PubMed1998

Growth factors: future prospects in renal failure.

Chronic renal failure is associated with an abnormal growth hormone/insulin-like growth factor-1 axis. In addition, nutritional status strongly regulates this axis. Because these hormones are involved in growth in children and maintenance of a normal body composition in adults, experimental and clinical studies have tested the metabolic effects of these recombinant growth factors. Various conditions in which these growth factors have been administered have been reported, such as the recovery of acute renal failure, protein metabolism in chronic renal failure, growth improvement in uremic children, the increase in renal function in nondialyzed uremic patients, and the potential treatment of malnutrition in adult maintenance dialysis patients.

Adult↗
PubMed1998

Effects of recombinant growth factors on energy expenditure in maintenance hemodialysis patients.

We compared the metabolic effects of recombinant human (rh) insulin-like growth factor (IGF)-1 or a combination of rhIGF-1 + rh growth hormone (GH) on resting energy expenditure (REE) in 8 maintenance hemodialysis (MHD) patients. Seven males and 1 female (aged 41.6 +/- (SD) 12.4) with no evidence of malnutrition (BMI 21.6 +/- 2.2 kg/m2, serum albumin 45 +/- 2 g/l, serum IGF-1 359 +/- 165 microg/l) received either rhIGF-1 (80 microg/kg/day) or rhIGF-1 (80 microg/kg/day) + rhGH (50 microg/kg/day) for 3 days in a random crossover design. REE and the respiratory quotient (RQ) were measured at rest before and after the 3-day treatment. The results confirmed that MHD patients have a REE not different from normal individuals. REE was strongly correlated with lean body mass but not with fat mass. rhIGF-1 treatment did not modify REE despite doubling serum IGF-1 values, whereas a combined rhIGF1 + rhGH treatment significantly increased REE by 11% (p < 0.001). There was no change in RQ under both treatments, in response to a proportionate increase in VCO2 and VO2. These results show that energy expenditure is mainly dependent upon lean body mass in well-nourished MHD patients. The metabolic effects of rhIGF-1 and rhGH on energy expenditure may differ in response to their opposite effects on lipid oxidation and insulin regulation.

Adult↗
PubMed1998

[Use of insulin-like growth factor-I (IGF-I) in the treatment of acute renal insufficiency].

Despite numerous progresses, including extracorporeal epuration, acute renal failure (ARF) remains associated with a high level of mortality and morbidity, particularly in intensive care unit. Experimental research on different acute renal failure models has clearly shown that growth factors and particularly Insulin-like Growth Factor I (IGF-I) can reduce renal injury, improve renal recovery and even reduce mortality. IGF-I, that is locally produced in injured renal tubules, promotes the proliferation and differentiation of new tubular cells. Moreover, IGF-I carriers (IGFBPs) and IGF-I receptor are altered in ARF and modify the growth factor bioactivity. To date, only two clinical trials studied IGF-I treatment in the ARF condition. Other studies are required to demonstrate a role for IGF-I in treating or preventing acute renal failure.

Acute Kidney Injury↗