Pub Date : 2022-12-01DOI: 10.1016/j.nephro.2022.10.002
Serigne Gueye , Martin Gauthier , Rayane Benyahia , Lucas Trape , Souad Dahri , Clément Kounde , Thomas Perier , Louiza Meklati , Imene Guelib , Maria Faye , Lionel Rostaing
Germinal center regulation pathways are often involved in lymphomagenesis and myelomagenesis. Most of the lymphomas (and multiple myeloma) derive from post-germinal center B-cells that have undergone somatic hypermutation and class switch recombination. Hence, B-cell clonal expansion can be responsible for the presence of a monoclonal component (immunoglobulin) of variable titer which, owing to physicochemical properties, can provoke pathologically defined entities of diseases. These diseases can affect any functional part of the kidney, by multiple mechanisms, either well known or not. The presence of renal deposition is influenced by germinal gene involved, immunoglobulin primary structure, post-translational modifications and microenvironmental interactions. The two ways immunoglobulin can cause kidney toxicity are (i) an excess of production (overcoming catabolism power by proximal tubule epithelial cells) with an excess of free light chains within the distal tubules and a subsequent risk of precipitation due to local physicochemical properties; (ii) by structural characteristics that predispose immunoglobulin to a renal disease (whatever their titer). The purpose of this manuscript is to review literature concerning the pathophysiology of renal toxicities of clonal immunoglobulin, from molecular B-cell expansion mechanisms to immunoglobulin renal toxicity.
{"title":"Les néphropathies associées aux immunoglobulines monoclonales : de l’expansion clonale B à la toxicité rénale des immunoglobulines pathologiques","authors":"Serigne Gueye , Martin Gauthier , Rayane Benyahia , Lucas Trape , Souad Dahri , Clément Kounde , Thomas Perier , Louiza Meklati , Imene Guelib , Maria Faye , Lionel Rostaing","doi":"10.1016/j.nephro.2022.10.002","DOIUrl":"10.1016/j.nephro.2022.10.002","url":null,"abstract":"<div><p>Germinal center regulation pathways are often involved in lymphomagenesis and myelomagenesis. Most of the lymphomas (and multiple myeloma) derive from post-germinal center B-cells that have undergone somatic hypermutation and class switch recombination. Hence, B-cell clonal expansion can be responsible for the presence of a monoclonal component (immunoglobulin) of variable titer which, owing to physicochemical properties, can provoke pathologically defined entities of diseases. These diseases can affect any functional part of the kidney, by multiple mechanisms, either well known or not. The presence of renal deposition is influenced by germinal gene involved, immunoglobulin primary structure, post-translational modifications and microenvironmental interactions. The two ways immunoglobulin can cause kidney toxicity are (i) an excess of production (overcoming catabolism power by proximal tubule epithelial cells) with an excess of free light chains within the distal tubules and a subsequent risk of precipitation due to local physicochemical properties; (ii) by structural characteristics that predispose immunoglobulin to a renal disease (whatever their titer). The purpose of this manuscript is to review literature concerning the pathophysiology of renal toxicities of clonal immunoglobulin, from molecular B-cell expansion mechanisms to immunoglobulin renal toxicity.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 591-603"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10351266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.1016/S1769-7255(23)00004-4
Nicolas Gautier , Maxence Ficheux , Patrick Henri , Antoine Lanot , Clémence Béchade , Bénédicte Allard
L’épuration extra-rénale est un traitement contraignant qui impacte fortement la qualité de vie des patients. L’hémodialyse à domicile (HDD) permet de maintenir un certain confort de vie tout en permettant d’améliorer les conditions d’épurations, notamment avec la pratique quotidienne ou encore nocturne de l’hémodialyse. La venue de systèmes avec cycleur dans les années 2010 pour l’ hémodialyse à domicile apporte un nouvel essor pour ce type de technique. La pratique à bas débit de dialysat avec l’optimisation de l’espace de stockage, la simplification de l’utilisation des générateurs et l’apparition d’outils de télésurveillance rendent plus accessible cette technique de dialyse, si bien que l’on peut espérer dans les prochaines années pouvoir proposer cette technique à n’importe quel patient atteint d’insuffisance rénale chronique requérant l’épuration extra-rénale.
Dialysis is a restrictive treatment with a significant impact on the quality of life of patients. Home hemodialysis (HHD) allows to maintain quality of life while improving the conditions of purification, in particular with the daily or even nocturnal practice of hemodialysis. The arrival of systems with a cycler in the 2010s for home hemodialysis brings a new dynamism for this type of technique. The practice with dialysate low flow with the optimization of storage space, the simplification of the use of generators and the emmergence of telemonitoring tools increases the accessibility of this dialysis technique, so that we can hope in the coming years to be able to offer this dialysis modality to any patient with chronic renal failure requiring extra-renal purification.
Pub Date : 2022-12-01DOI: 10.1016/S1769-7255(22)00649-6
Hugo Bakis , Pierre Pfirmann , Christian Combe , Claire Rigothier
Les inhibiteurs du cotransporteur sodium-glucose de type 2 (iSGLT2) constituent une avancée considérable dans la prise en charge des patients diabétiques, des patients insuffisants cardiaques et des patients ayant une maladie rénale chronique (MRC). Des études contrôlées randomisées ont montré une réduction significative du risque cardiovasculaire chez des patients diabétiques de type 2 ou insuffisants cardiaques à fraction d’éjection altérée. Ces études retrouvaient une diminution de la dégradation de la fonction rénale, inspirant des études contrôlées randomisées chez des patients MRC : CREDENCE, DAPA-CKD et EMPA-KIDNEY. Les iSGLT2 sont associés à une diminution de l’évolution de la MRC vers la suppléance, de la pente de DFG et de l’albuminurie. Chez les patients MRC protéinuriques avec ou sans diabète, les études DAPA-CKD et EMPA-KIDNEY ont démontré l’effet néphroprotecteur. Cet effet ne semble pas être retrouvé pour les patients non protéinuriques. Pour les autres néphropathies, des études complémentaires sont nécessaires pour confirmer les premiers résultats chez les patients protéinuriques non diabétiques de type 2.
L’indication des iSGLT2, en association aux bloqueurs du SRAA à doses maximales tolérées, paraît donc indéniable dans une optique de néphroprotection optimale chez les patients MRC diabétiques de type 2 ou albuminuriques ou insuffisants cardiaques. Leur prescription doit se faire en adjonction des traitements et des mesures de néphroprotection et de cardioprotection conventionnels. La tolérance est bonne. Cependant, une éducation et une surveillance particulière concernant les risques infectieux génitaux et d’acidocétose euglycémique (patients diabétiques) doivent être mises en place.
Ainsi, l’arsenal thérapeutique pour les patients MRC s’étoffe, permettant d’envisager une personnalisation des traitements en fonction de la néphropathie sous-jacente.
Inhibitors of sodium glucose co-transporter type 2 (iSGLT2) constitute a considerable advance in the management of patients with diabetes, heart failure and with chronic kidney disease (CKD). Randomized controlled studies have shown a significant reduction of cardiovascular risk in diabetic type 2 and/or heart failure with reduced ejection fraction patients. These studies observed a risk reduction of worsening nephropathy, leading to randomized controlled studies in CKD patients : CREDENCE, DAPA-CKD and EMPA-KIDNEY. iSGLT2 are associated with a slower progression toward end-stage kidney disease, a lower slope of GFR and a lower rate of albuminuria. In CKD patients with proteinuria either diabetic or not, the DAPA-CKD and the EMPA-KIDNEY studies have demonstrated a nephroprotective effect. This effect has not been found for patients without proteinuria. For the other nephropathies, further studies are required to confirm results obt
Pub Date : 2022-12-01DOI: 10.1016/S1769-7255(22)00648-4
Sarah Azancot , Pablo Ureña-Torres , Charles Chazot , Maxime Touzot
Le prurit associé à la maladie rénale chronique (MRC) est une complication fréquente et invalidante notamment chez le patient dialysé. Sa prise en charge aussi bien sur le plan physiopathologique que diagnostique et thérapeutique reste encore insatisfaisante.
Cette revue générale abordera l’ensemble des traitements disponibles et utilisés pour traiter le prurit associé à la MRC en soulignant les évidences cliniques et les limites de chaque thérapie. Une mise au point sur l’importance des récepteurs opioïdes dans la physiopathologie du prurit sera l’occasion de discuter de ces thérapies nouvelles. En effet, ces dernières ont donné un regain d’espoir dans le diagnostic et la prise charge du prurit.
Chronic Kidney Disease associated Pruritus (CKD-aP) is a well-established and frequent complication observed in patient with CKD, especially in dialysis patients. However, the management of CKD-aP remains a challenge as the pathophysiology and research studies are too small. Finally, there are a few proposed treatment options with significant clinical benefits.
This general review will summarize all the available treatments for the CKD-aP and will highlight the clinical efficacy and limits of the current drugs. Notably, we will focus on the implication of the opioid receptor in the pathophysiology of the CKD-aP and the recently Kappa opioid receptor agonist.
Pub Date : 2022-12-01DOI: 10.1016/S1769-7255(23)00005-6
Natalia Target
L’hémodialyse à domicile (HDD) est associée étroitement au développement de l’hémodialyse (HD) en centre, étant instaurée progressivement et au fur et à mesure que la survie des patients dialysés augmentait avec le progrès de la technique et des recherches scientifiques. Elle a connu l’apogée il y a cinquante ans puis un déclin progressif. De nos jours il existe un renouveau pour l’HDD et les bénéfices cliniques et de qualité de vie que l’on lui attribue. La pratique est déjà solide dans plusieurs pays à l’internationale et en France la tendance est croissante. Cependant, l’HD en centre reste largement majoritaire et l’on signale plusieurs obstacles au développement de l’HDD. Dans cet article nous abordons notamment le contexte des situations cliniques complexes (insuffisance cardiaque, cathéter veineux central) des situations qui peuvent pouvant se présenter dans la pratique quotidienne pouvant mettre et remettre en cause un projet d’HDD.
Home hemodialysis (HHD) is closely associated with the development of in-center hemodialysis (HD), being introduced gradually as the survival of dialysis patients increased with the progress of technology and scientific research. It peaked fifty years ago and then gradually declined. Nowadays there is a revival of HHD highlighting the clinical and quality of life benefits attributed to it. The practice is already solid in several countries internationally and in France the trend is growing up. However, in-center HD remains largely majority and several obstacles to the development of HHD are reported. In this article we address in particular the complex clinical context (heart failure, central venous catheter) of situations that may arise in daily practice that may call into question a HHD project.
In haemodialysis patients the length of bleeding times after fistula cannulation is an easy and fairly used method of monitoring vascular access. In the most cases, compression is performed manually by nurses and the use of haemostatic dressing is common. As data in the literature are scares, we have decided to develop a quality improvement program in our hemodialysis center to manage this issue.
Material and methods
After informed consent, 35 hemodialysis outpatients were selected in order to study the bleeding time using haemostatic dressing or not during two weeks in a cross over schema. The dialysis schedule was unchanged and comparative analysis of parameters such as blood flow rate or anticoagulant treatment were done between the groups.
Results
Compression times with and without hemostatic dressing were not different (12.6 min and 12.9 min, respectively). Patients with an anticoagulation during the dialysis session greater than 0.35 IU/kg/session had a longer bleeding time (12.75 min vs 11.75 min; P = 0.008).
Conclusion
In our evaluation, the use of haemostatic dressings is not associated with a real shorter bleeding time. Their use generate an additional cost estimated on average at 164 euros/year/patient. Patients and team realized that compression time is important for fistula monitoring and using compresses does not really increase this time.
在血液透析患者中，瘘管插管后的出血时间长短是一种简便、合理的血管通路监测方法。在大多数情况下，压迫是由护士手动执行，使用止血敷料是常见的。由于文献中的数据令人恐慌，我们决定在我们的血液透析中心制定一个质量改进计划来管理这个问题。材料与方法经知情同意后，选择35例血透门诊患者，采用交叉模式研究两周内使用止血敷料和不使用止血敷料的出血时间。透析计划不变，并对两组血流量、抗凝治疗等参数进行比较分析。结果使用止血敷料和不使用止血敷料的压迫时间无明显差异(分别为12.6 min和12.9 min)。透析期间抗凝治疗剂量大于0.35 IU/kg/次的患者出血时间更长(12.75 min vs 11.75 min;p = 0.008)。结论在我们的评估中，止血敷料的使用与真正缩短出血时间无关。他们的使用产生的额外费用估计平均为164欧元/年/名患者。患者和团队意识到压缩时间对瘘管监测很重要，使用压缩并没有真正增加这一时间。
{"title":"Évaluation de nos pratiques professionnelles : apport des pansements hémostatiques dans l’hémostase de la fistule artério-veineuse ?","authors":"Lila Ghouti-Terki , Angelo Testa , Gaëlle Lefrançois , Sophie Parahy , Irina Oancea , Géraldine De Geyer d’Orth , Rachida Begri , Stéphanie Coupel","doi":"10.1016/j.nephro.2022.04.004","DOIUrl":"10.1016/j.nephro.2022.04.004","url":null,"abstract":"<div><h3>Introduction</h3><p>In haemodialysis patients the length of bleeding times after fistula cannulation is an easy and fairly used method of monitoring vascular access. In the most cases, compression is performed manually by nurses and the use of haemostatic dressing is common. As data in the literature are scares, we have decided to develop a quality improvement program in our hemodialysis center to manage this issue.</p></div><div><h3>Material and methods</h3><p>After informed consent, 35 hemodialysis outpatients were selected in order to study the bleeding time using haemostatic dressing or not during two weeks in a cross over schema. The dialysis schedule was unchanged and comparative analysis of parameters such as blood flow rate or anticoagulant treatment were done between the groups.</p></div><div><h3>Results</h3><p>Compression times with and without hemostatic dressing were not different (12.6 min and 12.9 min, respectively). Patients with an anticoagulation during the dialysis session greater than 0.35 IU/kg/session had a longer bleeding time (12.75 min vs 11.75 min; <em>P</em> <!-->=<!--> <!-->0.008).</p></div><div><h3>Conclusion</h3><p>In our evaluation, the use of haemostatic dressings is not associated with a real shorter bleeding time. Their use generate an additional cost estimated on average at 164 euros/year/patient. Patients and team realized that compression time is important for fistula monitoring and using compresses does not really increase this time.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 627-633"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10337264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic kidney disease is a significant public health problem worldwide. However, the causes of chronic kidney disease in Iran are unclear. This systematic review and meta-analysis identified the causes of chronic kidney disease in the general population of Iran. International databases (PubMed, Web of Science, Scopus, and Google Scholar) and national databases (Scientific Information Database and Magiran) were searched for studies published until March 1, 2018. The quality of the studies was assessed using the checklist developed by Hoy et al. Of 2518 retrieved studies, 26 studies involving 34,683 patients with chronic kidney disease stages 1 to 5 were included in the meta-analysis. The mean age of the cohort was 53.6 ± 15.02 years. The results of the random-effects model showed that the three leading causes of chronic kidney disease were diabetes, hypertension, and glomerulonephritis, with an overall prevalence of 27.7%, 27.6%, and 6.4%, respectively. These results indicate the importance of addressing these risk factors at the national level to reduce disease prevalence.
慢性肾脏疾病是一个全球性的重大公共卫生问题。然而，伊朗慢性肾脏疾病的病因尚不清楚。本系统综述和荟萃分析确定了伊朗普通人群中慢性肾脏疾病的原因。检索了国际数据库(PubMed、Web of Science、Scopus和Google Scholar)和国家数据库(科学信息数据库和Magiran)，检索了2018年3月1日之前发表的研究。使用Hoy等人制定的检查表评估研究的质量。在2518项被检索的研究中，26项研究包括34,683名慢性肾脏疾病1至5期患者被纳入meta分析。队列的平均年龄为53.6±15.02岁。随机效应模型结果显示，糖尿病、高血压和肾小球肾炎是导致慢性肾脏疾病的三大主要原因，总体患病率分别为27.7%、27.6%和6.4%。这些结果表明，在国家一级处理这些风险因素以降低疾病流行的重要性。
{"title":"Causes of chronic kidney disease in the general population of Iran: A systematic review and meta-analysis","authors":"Mehran Hesaraki , Razieh Behzadmehr , Hamideh Goli , Hosein Rafiemanesh , Mahboobe Doostkami","doi":"10.1016/j.nephro.2022.09.001","DOIUrl":"10.1016/j.nephro.2022.09.001","url":null,"abstract":"<div><p><span><span>Chronic kidney disease is a significant </span>public health<span> problem worldwide. However, the causes of chronic kidney disease in Iran are unclear. This systematic review and meta-analysis identified the causes of chronic kidney disease in the general population of Iran. International databases (</span></span><em>PubMed</em>, <em>Web of Science</em>, <em>Scopus</em>, and <em>Google Scholar</em>) and national databases (<em>Scientific Information Database</em> and <em>Magiran</em>) were searched for studies published until March 1, 2018. The quality of the studies was assessed using the checklist developed by Hoy et al. Of 2518 retrieved studies, 26 studies involving 34,683 patients with chronic kidney disease stages 1 to 5 were included in the meta-analysis. The mean age of the cohort was 53.6<!--> <!-->±<!--> <!-->15.02 years. The results of the random-effects model showed that the three leading causes of chronic kidney disease were diabetes, hypertension, and glomerulonephritis, with an overall prevalence of 27.7%, 27.6%, and 6.4%, respectively. These results indicate the importance of addressing these risk factors at the national level to reduce disease prevalence.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 584-590"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10352211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine the hospital frequency of diabetic patients with a rapid decline in their renal function, to look for the associated factors.
Method
Descriptive and analytical cross-sectional study carried out over 12 months (May 1, 2019 to April 31, 2020). Were included all patients aged 18 and over, having achieved at least 3 creatinine during the previous 2 years but spaced at least 6 months apart and having an eGFR calculated from their last creatinine greater than 30 mL/min by the formula of CDK-EPI. We evaluated the eGFR by the CDK-EPI formula using the calculator developed by the Poitiers University Hospital and the Inserm unit of the Francophone Diabetes Society.
Results
A total of 80 patients medical files were retained. The rapid decline in renal function was found in 28 patients, either a frequency of 35%. The sex ratio M/F was 1.5. The mean age was 62.93 years (range 18–85 years). Hypertension was the most common comorbidity (92.5%). The very high cardiovascular risk was predominant in 82.5% of cases. The very high renal risk was found in 20 patients, either 25%. Univariate and multivariate analysis showed that the rapid decline in renal function was associated with very high cardiovascular risk (P = 0.037) and glomerular filtration rate (P˂0.001).
Conclusion
this study showed a high hospital frequency of the rapid decline in renal function in Togo (35%). Our results have identified the very high cardiovascular risk and glomerular filtration rate as risk factors. The originality of our study was the demonstration of the high proportion of very high cardiovascular risk (82.5%) and very high renal risk (25%) in the evaluation of renal and cardiovascular risk.
{"title":"Déclin rapide de la fonction rénale chez les patients diabétiques à Lomé (Togo)","authors":"Yawovi Mawufemo Tsevi , Kossi Kodjo , Abago Balaka , Daniel Amah Amede , Sodjehoun Apeti , Kokou Motte , Komi Dzidzonu Nemi , Kodjo Agbeko Djagadou , Abdou Razak Moukaila , Mohaman Awalou Djibril","doi":"10.1016/j.nephro.2022.03.007","DOIUrl":"10.1016/j.nephro.2022.03.007","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the hospital frequency of diabetic patients with a rapid decline in their renal function, to look for the associated factors.</p></div><div><h3>Method</h3><p>Descriptive and analytical cross-sectional study carried out over 12 months (May 1, 2019 to April 31, 2020). Were included all patients aged 18 and over, having achieved at least 3 creatinine during the previous 2 years but spaced at least 6 months apart and having an eGFR calculated from their last creatinine greater than 30 mL/min by the formula of CDK-EPI. We evaluated the eGFR by the CDK-EPI formula using the calculator developed by the Poitiers University Hospital and the Inserm unit of the Francophone Diabetes Society.</p></div><div><h3>Results</h3><p>A total of 80 patients medical files were retained. The rapid decline in renal function was found in 28 patients, either a frequency of 35%. The sex ratio M/F was 1.5. The mean age was 62.93 years (range 18–85 years). Hypertension was the most common comorbidity (92.5%). The very high cardiovascular risk was predominant in 82.5% of cases. The very high renal risk was found in 20 patients, either 25%. Univariate and multivariate analysis showed that the rapid decline in renal function was associated with very high cardiovascular risk (<em>P</em> <!-->=<!--> <!-->0.037) and glomerular filtration rate (<em>P</em>˂0.001).</p></div><div><h3>Conclusion</h3><p>this study showed a high hospital frequency of the rapid decline in renal function in Togo (35%). Our results have identified the very high cardiovascular risk and glomerular filtration rate as risk factors. The originality of our study was the demonstration of the high proportion of very high cardiovascular risk (82.5%) and very high renal risk (25%) in the evaluation of renal and cardiovascular risk.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 643-649"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10357219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.1016/j.nephro.2022.07.400
Guillaume Jean , Jean-Christophe Lifante , Éric Bresson , Jean-Marie Ramackers , Guillaume Chazot , Charles Chazot
Introduction
Secondary hyperparathyroidism remains the main complication of mineral and bone metabolism in patients with chronic kidney disease. In case of resistance to medical treatment (native and active vitamin D, calcium and calcimimetics), surgical parathyroidectomy is indicated. The aim of this retrospective study is to show the evolution of the incidence and results of surgical parathyroidectomy in our center between 1980 and 2020 as patient characteristics, diagnostic and therapeutic strategies have changed.
Patients and methods
We collected data from dialysis patients who had a first surgical parathyroidectomy between 2000 and 2020 (period 2) in the same surgical department and compared them with historical data between 1980 and 1999 (period 1) operated in one other center.
Results
In period 1, 53 surgical parathyroidectomy were performed (2.78/year, 0 to 5, 8.5/1000 patients-year) vs.56 surgical parathyroidectomy in period 2 (2.8/year, 0 to 9, 8/1000 patients-year). The patients of the 2 periods were comparable except for the higher dialysis vintage in period 1 (149 ± 170 vs.89 ± 94 months; P = 0.02). In comparison with dialysis patients not requiring surgical parathyroidectomy during the same period, patients who had surgical parathyroidectomy were younger, had higher dialysis vintage and lower diabetes prevalence, but more frequently carriers of glomerulopathy or polycystosis. Systematically performed in period 2, cervical ultrasound identified at least one visible gland in 78.6% of cases while the scintigraphy, performed only in 66% of cases, found at least one gland in 81% of cases. Twelve months after surgery, PTH > 300 pg/mL (marker of secondary hyperparathyroidism recurrence or surgery failure) was present in 30% of patients in period 1 vs. 5.3% in period 2. Hypoparathyroidism was also more frequently observed in period 2 (35.7 vs. 18.8%). Surgical complications were also higher in period 1.
Conclusion
Despite therapeutic and strategic advances, severe secondary hyperparathyroidism is still as common as ever. It is favored by excessively high PTH targets, by suboptimal prevention before dialysis and poor tolerance of calcimimetics. The surgical parathyroidectomy is effective and safe in the hands of a specialized team with an ultrasound and scintigraphic preoperative assessment.
{"title":"Évolution de l’incidence et des résultats à 12 mois de la parathyroïdectomie : 40 ans d’expérience dans un centre de dialyse avec deux services de chirurgie successifs","authors":"Guillaume Jean , Jean-Christophe Lifante , Éric Bresson , Jean-Marie Ramackers , Guillaume Chazot , Charles Chazot","doi":"10.1016/j.nephro.2022.07.400","DOIUrl":"10.1016/j.nephro.2022.07.400","url":null,"abstract":"<div><h3>Introduction</h3><p>Secondary hyperparathyroidism remains the main complication of mineral and bone metabolism in patients with chronic kidney disease. In case of resistance to medical treatment (native and active vitamin D, calcium and calcimimetics), surgical parathyroidectomy is indicated. The aim of this retrospective study is to show the evolution of the incidence and results of surgical parathyroidectomy in our center between 1980 and 2020 as patient characteristics, diagnostic and therapeutic strategies have changed.</p></div><div><h3>Patients and methods</h3><p>We collected data from dialysis patients who had a first surgical parathyroidectomy between 2000 and 2020 (period 2) in the same surgical department and compared them with historical data between 1980 and 1999 (period 1) operated in one other center.</p></div><div><h3>Results</h3><p>In period 1, 53 surgical parathyroidectomy were performed (2.78/year, 0 to 5, 8.5/1000 patients-year) vs.56 surgical parathyroidectomy in period 2 (2.8/year, 0 to 9, 8/1000 patients-year). The patients of the 2 periods were comparable except for the higher dialysis vintage in period 1 (149<!--> <!-->±<!--> <!-->170 vs.89<!--> <!-->±<!--> <!-->94 months; <em>P</em> <!-->=<!--> <!-->0.02). In comparison with dialysis patients not requiring surgical parathyroidectomy during the same period, patients who had surgical parathyroidectomy were younger, had higher dialysis vintage and lower diabetes prevalence, but more frequently carriers of glomerulopathy or polycystosis. Systematically performed in period 2, cervical ultrasound identified at least one visible gland in 78.6% of cases while the scintigraphy, performed only in 66% of cases, found at least one gland in 81% of cases. Twelve months after surgery, PTH > 300 pg/mL (marker of secondary hyperparathyroidism recurrence or surgery failure) was present in 30% of patients in period 1 vs. 5.3% in period 2. Hypoparathyroidism was also more frequently observed in period 2 (35.7 vs. 18.8%). Surgical complications were also higher in period 1.</p></div><div><h3>Conclusion</h3><p>Despite therapeutic and strategic advances, severe secondary hyperparathyroidism is still as common as ever. It is favored by excessively high PTH targets, by suboptimal prevention before dialysis and poor tolerance of calcimimetics. The surgical parathyroidectomy is effective and safe in the hands of a specialized team with an ultrasound and scintigraphic preoperative assessment.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 616-626"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10411926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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