Papers by Pierre-yves Martin
Clinical Journal of The American Society of Nephrology, Jul 27, 2018
Nephrology Dialysis Transplantation, May 1, 2022
Nephrology Dialysis Transplantation, May 1, 2017
CKD is associated with altered cellular immunity due to a variety of factors, including advanced ... more CKD is associated with altered cellular immunity due to a variety of factors, including advanced age, hypoalbuminemia, malnutrition, uremia, and medical immunosuppression. CKD is also known as a risk factor for the development of active tuberculosis (TB). However, the risk factors of the active TB in hemodialysis (HD) patients are still unknown. METHODS: Ninety-nine HD patients who had diagnosed with TB were followed up for 10 years (2006-2016) in a retrospective cohort study. Cox proportional hazards regression analysis was used to determine the risk factors that are associated with each mortality outcome of these patients. RESULTS: Median age was 74.0 year-old and the number of male was 65 (65.7%). During 10 years follow-up, 25 patients were died (22: infection and 3: heart failure). The serum albumin levels of these patients were significantly higher than those of alive patients (2.7 g/dL vs 2.2 g/dL). The HD duration of alive group was shorter than that of death group (38.5 months vs 95.4 months). Furthermore, Cox regression analysis indicated that hypoalbuminemia (lower than 2.1 g/dL) (hazard ratio (HR): 4.61) and HD duration (HR: 1.01) were independent risk factors for HD patients with TB. Gender, age, body mass index, hypophosphatemia, and diabetes were not significant risks of mortality. CONCLUSIONS: Hypoalbuminaemia and HD duration were independent risk factors of HD patients with TB in Japan.
Nephrologie & Therapeutique, Apr 1, 2009
Pour citer cet article : Jotterand V, et al. Glomérulosclérose segmentaire et focale avec collaps... more Pour citer cet article : Jotterand V, et al. Glomérulosclérose segmentaire et focale avec collapsus du flocculus induite par les bisphosphonates ; présentation de deux cas cliniques et revue de la littérature. Néphrologie & Thérapeutique (2008),
PLOS ONE, Dec 30, 2016
Renal interstitial fibrosis and arterial lesions predict loss of function in chronic kidney disea... more Renal interstitial fibrosis and arterial lesions predict loss of function in chronic kidney disease. Noninvasive estimation of interstitial fibrosis and vascular lesions is currently not available. The aim of the study was to determine whether phosphocalcic markers are associated with, and can predict, renal chronic histological changes. We included 129 kidney allograft recipients with an available transplant biopsy in a retrospective study. We analyzed the associations and predictive values of phosphocalcic markers and serum calcification propensity (T 50) for chronic histological changes (interstitial fibrosis and vascular lesions). PTH, T 50 and vitamin D levels were independently associated to interstitial fibrosis. PTH elevation was associated with increasing interstitial fibrosis severity (r = 0.29, p = 0.001), while T 50 and vitamin D were protective (r =-0.20, p = 0.025 and r =-0.23, p = 0.009 respectively). On the contrary, fibroblast growth factor 23 (FGF23) and Klotho correlated only modestly with interstitial fibrosis (p = 0.045) whereas calcium and phosphate did not. PTH, vitamin D and T 50 were predictors of extensive fibrosis (AUC: 0.73, 0.72 and 0.68 respectively), but did not add to renal function prediction. PTH, FGF23 and T 50 were modestly predictive of low fibrosis (AUC: 0.63, 0.63 and 0.61) but did not add to renal function prediction. T 50 decreased with increasing arterial lesions (r =-0.21, p = 0.038). The discriminative performance of T 50 in predicting significant vascular lesions was modest (AUC 0.61). In summary, we demonstrated that PTH, vitamin D and T 50 are associated to interstitial fibrosis and vascular lesions in kidney allograft recipients independently of renal function. Despite these associations, mineral metabolism indices do not show superiority or additive value to fibrosis prediction by eGFR and proteinuria in kidney allograft recipients, except for vascular lesions where T50 could be of relevance.
Scientific Reports, Dec 7, 2016
NADPH oxidase 4 (NOX4) is highly expressed in kidney proximal tubular cells. NOX4 constitutively ... more NADPH oxidase 4 (NOX4) is highly expressed in kidney proximal tubular cells. NOX4 constitutively produces hydrogen peroxide, which may regulate important pro-survival pathways. Renal ischemia reperfusion injury (IRI) is a classical model mimicking human ischemic acute tubular necrosis. We hypothesized that NOX4 plays a protective role in kidney IRI. In wild type (WT) animals subjected to IRI, NOX4 protein expression increased after 24 hours. NOX4 KO (knock-out) and WT littermates mice were subjected to IRI. NOX4 KO mice displayed decreased renal function and more severe tubular apoptosis, decreased Bcl-2 expression and higher histologic damage scores compared to WT. Activation of NRF2 was decreased in NOX4 KO mice in response to IRI. This was related to decreased KEAP1 oxidation leading to decreased NRF2 stabilization. This resulted in decreased glutathione levels. In vitro silencing of NOX4 in cells showed an enhanced propensity to apoptosis, with reduced expression of NRF2, glutathione content and Bcl-2 expression, similar to cells derived from NOX4 KO mice. Overexpression of a constitutively active form of NRF2 (caNRF2) in NOX4 depleted cells rescued most of this phenotype in cultured cells, implying that NRF2 regulation by ROS issued from NOX4 may play an important role in its anti-apoptotic property.
Clinical journal of the American Society of Nephrology : CJASN, Jan 20, 2015
The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but... more The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but not younger, patients with moderate to severe secondary hyperparathyroidism (HPT) who were receiving hemodialysis. To determine whether the lower risk in younger patients might be due to lower baseline CV risk and more frequent use of cointerventions that reduce parathyroid hormone (kidney transplantation, parathyroidectomy, and commercial cinacalcet use), this study examined the effects of cinacalcet in older (≥65 years, n=1005) and younger (<65 years, n=2878) patients. Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) was a global, multicenter, randomized placebo-controlled trial in 3883 prevalent patients on hemodialysis, whose outcomes included death, major CV events, and development of severe unremitting HPT. The age subgroup analysis was prespecified. Older patients had higher baseline prevalence of diabetes mellitus and CV comorbidity. Annualized rat...
Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collabor... more Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCP) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge. Methods: Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years. Results: From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups. Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival. Conclusion: These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD. Background The prevalence of chronic kidney disease (CKD), and subsequent end stage renal disease (ESRD) is on the rise, particularly in patients older than 65 years (1). Despite constant improvements of renal replacement therapies (RRT), the morbidity and mortality of these patients remain high, with a survival of ESRD patients as low as 60% and 30% at 1 and 5 years, respectively (2, 3). Many factors have been related to this poor outcome including late referral to nephrologists (2, 4-6). The two most reported explanations for the association of a late referral with a poor prognosis are a
PubMed, Mar 9, 2006
Background: To examine whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II... more Background: To examine whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are associated with a state of recombinant human erythropoietin (rHuEPO) resistance in hemodialyzed patients. Methods: Cross-sectional study involving all dialysis facilities in French-speaking Switzerland. All patients treated with rHuEPO in March 2001 were included. Demographic, clinical and laboratory data were collected in 515 patients treated with chronic hemodialysis (HD) and rHuEPO. Patients were classified into five groups according to their antihypertensive treatment. The main outcomes of the study were the mean rHuEPO dosage and the prevalence of erythropoietin EPO resistance among the groups. Erythropoietin resistance was defined as a weekly rHuEPO dosage >300 units/kg/wk. Results: The mean rHuEPO dosage and the prevalence of EPO resistance were similar in patients treated with ACEIs (n = 138, mean EPO dosage 109 units/kg/wk, EPO resistance 12%), ARBs (n = 59, mean EPO dosage 120 units/kg/wk, EPO resistance 7%), both (n = 10, mean EPO dosage 109 units/kg/wk, EPO resistance 10%), other drugs (n = 137, mean EPO dosage 110 units/kg/wk, EPO resistance 10%) and no antihypertensive treatment (n = 171, mean EPO dosage 90 units/kg/wk, EPO resistance 9%). Differences were not statistically significant. Patients with rHuEPO resistance were characterized by a higher frequency of hospitalization and a more pronounced inflammatory state. There was no difference in the use of ACEIs and ARBs between patients with and without EPO resistance (37 vs. 41%, ns). Conclusions: Neither the use of ACEIs nor ARBs is associated with a state of rHuEPO resistance among hemodialyzed patients.
Revue médicale suisse, 2023
Transplantation, Jul 1, 2004
In this retrospective analysis, demographic features of a transplantation outpatient clinic that ... more In this retrospective analysis, demographic features of a transplantation outpatient clinic that follows kidney recipients transplanted in both Turkey and different regions of the world, was analyzed. Methods: The patients were divided into 4 main groups: 1. Those being followed up with functioning grafts (n:432), 2. Those who lost their grafts (n:218), 3. Those who died (n: 135) and those who lost to follow up (n:70). Every group was subgrouped as either having cadaver (CT) or live donor transplantation (LT) performed in: A. In our institute (ICT:147, ILT:304) B. Other institutions in Turkey (TCT: 16, TLT:86), C. Foreign countries (FCT:66, FLT:154). Results: The patients with functioning grafts, FLT transplantations (which vast majority was paid transplantations) constituted the second largest group (n:105), following ILT (214.). In the ILT group, five and 10 year graft survival rates were 77% and 45%, respectively and patient survival rates were 87% and 77%, respectively. Considering FLT group, five and 10 year graft survival figures were 65% and 34%, while patient survival rates in these periods were 79% and 65. Patients with paid transplantations were characterized by high risk of unconventional infectious complications in the early period, while mid-term patient and graft survival was somewhat better, than that expected considering the high rate of complications in the early period. Conclusions: Paid organ transplantation should be discouraged and organ donation should be stimulated by every means to avoid potentially fatal unconventional infections of paid transplantation. If patients receive a paid transplant, however, they should be closely followed-up for these complications, since if they can survive the early period, quite reasonable mid-term outcomes can be expected in the long term.
Blood Pressure Monitoring, Oct 1, 2018
Background Few studies have assessed the role of 24-h ambulatory blood pressure monitoring (ABPM)... more Background Few studies have assessed the role of 24-h ambulatory blood pressure monitoring (ABPM) in adults with nondialysis chronic kidney disease (CKD). We examined the potential determinants of left ventricular hypertrophy (LVH) and mass index (LVMI) in this population. Participants and methods We carried out a crosssectional study on 69 stage 3b-5 CKD adults who had ABPM and transthoracic echocardiography performed simultaneously. Hypertension (HT) was defined as 24 h blood pressure (BP) of at least 130/80 mmHg. ABPM parameters considered were BP dipping status, BP load, and the BP night-time/daytime ratio. We performed stepwise backward multivariate linear and logistic regression to assess the determinants of LVH and LVMI. ABPM parameters were considered the main independent variables, whereas HT, angiotensin-converting enzyme inhibitor/angiotensin II receptor antagonist use, glomerular filtration rate of less than 30 ml/min/1.72 m 2 , diabetes, smoking, age, sex, hemoglobin, and parathyroid hormone levels were considered covariates. Results LVH was present in 22 (31.8%) patients. In linear regression analysis, systolic [β = − 13.8, 95% confidence interval (CI) = − 26.3 to − 1.3, P = 0.031] and mean (β = − 13.5, 95% CI = − 25.7 to − 1.2, P = 0.031) nondipping status was associated with increased LVMI. BP load and night-time/ daytime ABPM ratio were not associated with LVMI. In logistic regression analysis, systolic nondipping status (odds ratio = 0.27, 95% CI = 0.08-0.91, P = 0.036) was associated with LVH. Among covariates, estimated glomerular filtration rate of less than 30 ml/min/1.72 m 2 and HT were associated with LVH and increased LVMI. At 1-year follow-up, mean nondipping status on the initial ABPM remained associated significantly with increased LVMI (β = − 19.8, 95% CI = − 36.6 to − 3.0, P = 0.022). Conclusion These data confirm the high incidence of LVH among nonrenal replacement therapy CKD patients and suggest that the nondipping phenomenon on ABPM is associated independently with LVH and increased LVMI in this population.
Ndt Plus, May 10, 2022
Background. Hyperkalaemia is frequent in haemodialysis (HD) patients and associated with increase... more Background. Hyperkalaemia is frequent in haemodialysis (HD) patients and associated with increased cardiovascular mortality. Despite routine clinical use, evidence regarding the efficacy of potassium (K +) binders in HD is scant. We wished to compare the efficacy of patiromer (PAT) and sodium polystyrene sulfonate (SPS) on K + levels in this setting. Methods. We screened patients in three HD centres with pre-HD K + value between 5.0 and 6.4 mmol/L, after an initial 2-week washout period for those previously on K + binders. We included patients in an unblinded two-arm crossover trial comparing SPS 15 g before each meal on non-dialysis days with PAT 16.8 g once daily on non-dialysis days with randomized attribution order and a 2-week intermediate washout period. The primary outcome was the mean weekly K + value. Results. We included 51 patients and analysed 48 with mean age of 66.4 ± 19.4 years, 72.9% men and 43.4% diabetics. Mean weekly K + values were 5.00 ± 0.54 mmol/L, 4.55 ± 0.75 mmol/L and 5.17 ± 0.64 mmol/L under PAT (P = .003), SPS (P < .001) and washout, respectively. In direct comparison, K + values and prevalence of hyperkalaemia were lower under SPS as compared with PAT (P < .001). While the incidence of gastrointestinal side effects was similar between treatments, SPS showed lower subjective tolerability score (6.0 ± 2.4 and 6.9 ± 1.9) and compliance (10.8 ± 20.4% and 2.4 ± 7.3% missed doses) as compared with PAT (P < .001 for both). Conclusion. Both PAT and SPS are effective in decreasing K + levels in chronic HD patients. However, at the tested doses, SPS was significantly more effective in doing so as compared with PAT, despite lower tolerability and compliance. Larger randomized controlled trials should be conducted in order to confirm our findings and determine whether they would impact clinical outcomes.
Research Square (Research Square), Feb 25, 2020
Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collabor... more Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCP) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge. Methods: Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years. Results: From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups. Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival. Conclusion: These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD. Background The prevalence of chronic kidney disease (CKD), and subsequent end stage renal disease (ESRD) is on the rise, particularly in patients older than 65 years (1). Despite constant improvements of renal replacement therapies (RRT), the morbidity and mortality of these patients remain high, with a survival of ESRD patients as low as 60% and 30% at 1 and 5 years, respectively (2, 3). Many factors have been related to this poor outcome including late referral to nephrologists (2, 4-6). The two most reported explanations for the association of a late referral with a poor prognosis are a 4 belated intervention by specialists and complications related to emergency dialysis. A delay in specialised care exposes the patients to possible under-treatment of CKD complications such as cardiovascular disease (CVD), anaemia, bone and mineral disorders and increased susceptibility to infections, or to emergency implementation of RRT, which is associated with increased morbidity and mortality, and duration of hospitalisation (7). In addition, initiation of urgent haemodialysis (HD) instead of planned HD deprives the patient of the possibility to choose another type of RRT such as peritoneal dialysis (PD) (4, 8-11) or pre-emptive renal transplantation (TX) (12). The European Best Practice Guidelines (EBPG) recommend that patients should be referred to nephrologists when creatinine clearance (CCl) < 60 ml/min and imperatively when CCl < 30 ml/min (13). However, "real life" practice shows that early referral to nephrologists of CKD patients is uncommon (3-6). Impact of guidelines on PCPs is difficult to evaluate but is probably limited as most recommendations appear in specialised journals (14). Other important barriers to timely referral are: patient's unawareness, fear of dialysis and PCPs' underestimation of CKD severity. There is also no financial incentive for early referral, which hinders the implementation of the guidelines among PCPs (14-16). The practical implementation of early referral also remains questionable as it is unlikely that nephrologists would be able to provide regular follow up of all patients with CKD (15, 17, 18). In addition, there is some doubt on the impact in reducing mortality in patients or decreasing ESRD occurrence in patients with CCl between 45-60 ml/min but without albuminuria. (18, 19). An observational study from East Kent in UK, found a prevalence of patients with moderate to severe CKD as high as 0.55%, using cutoff values: serum creatinine > 180 μmol/l in males and > 135 μmol/l in females (17). In this study, 84.8% of the patients were unknown to local nephrology units and only 8.1% were referred to them during the 31.3 months follow-up. Median survivals of referred and unreferred patients were 29.1 and 27.4 months, respectively (p<0.001). Interestingly, ESRD by itself accounted for only 4.8% of deaths whereas the majority of patients died from CVD, infections and cancer. Male sex, low glomerular filtration rate (GFR) and non-referral were associated with poor prognosis. The authors concluded that the referral of all identified patients would have led to a nonsustainable overload of nephrology care resources. Blood pressure and proteinuria First-line drug: ACEIs or ARBs in patients with proteinuria or diabetic nephropathy. Aim: BP ≤130/80 mmHg or ≤125/75 mmHg if proteinuria >1 g/24h; Proteinuria <500 mg/24h. Diabetes Use of antidiabetic drugs appropriate to renal function.
The Journal of Clinical Endocrinology and Metabolism, Jan 23, 2019
Context: Sex steroid hormones exhibit anabolic effects whereas a deficiency engenders sarcopenia.... more Context: Sex steroid hormones exhibit anabolic effects whereas a deficiency engenders sarcopenia. Moreover, supraphysiological levels of glucocorticoids promote skeletal muscle atrophy, whereas physiologic levels of glucocorticoids may improve muscle performance. Objective: To study the relationship between both groups of steroid hormones at a physiological range with skeletal muscle mass and function in the general population. Design: Cross-sectional analysis of the associations between urinary excreted androgens, estrogens, glucocorticoids, and steroid hormone metabolite ratios with lean mass and handgrip strength in a population-based cohort. Setting: Three centers in Switzerland including 1128 participants. Measures: Urinary steroid hormone metabolite excretion by gas chromatography-mass spectrometry, lean mass by bioimpedance analysis, and isometric handgrip strength by dynamometry. Results: For lean mass a strong positive association was found with 11b-OH-androsterone and with most glucocorticoids. Androsterone showed a positive association in middle-aged and older adults. Estriol showed a positive association only in men. For handgrip strength, strong positive associations with androgens were found in middle-aged and older adults, whereas positive associations were found with cortisol metabolites in young to middle-aged adults.
Journal of the American Society of Nephrology, 2022
Significance Statement The ability to produce glucose from nonhexose precursors is a main metabol... more Significance Statement The ability to produce glucose from nonhexose precursors is a main metabolic function of renal proximal tubule (PT) cells. PT cells adapt metabolically during CKD, but little is known about gluconeogenesis in chronically injured PT cells. Our study demonstrates the progressive loss of gluconeogenesis enzymes in animal models and in CKD patients in parallel to global change in metabolic pathway expression and activation of injury pathways. This alteration is not only due to loss of PT cells but has systemic repercussions on glucose and lactate levels in experimental and human CKD. In retrospective human studies, gluconeogenesis downregulation predicted CKD progression. This work provides new evidence for metabolic regulation during CKD and the functional effect. Introduction CKD is associated with alterations of tubular function. Renal gluconeogenesis is responsible for 40% of systemic gluconeogenesis during fasting, but how and why CKD affects this process and...
Revue Médicale Suisse, 2022
Revue Médicale Suisse, 2021
Néphrologie & Thérapeutique, 2021
Introduction Tandis que l’hyperkalisemie est frequente chez les patients hemodialyses chroniques ... more Introduction Tandis que l’hyperkalisemie est frequente chez les patients hemodialyses chroniques et est associee a une hausse de la mortalite, les evidences concernant les options de traitement restent limitees. Nous avons ainsi compare l’effet du Patiromer et du Sodium Polystyrene Sulfonate (SPS) sur le controle du potassium au sein de cette population. Description Apres evaluation de 180 patients hemodialyses chroniques prevalents, nous avons inclus 52 patients avec des valeurs de potassium pre-dialyse > 5,1 mmol/L sans chelateur dans une etude en crossover comparant le Patiromer 16,8 g 1×/jour au SPS 15 g avant chaque repas, administres les jours de non-dialyse. La duree de traitement etait de 4 semaines avec une periode intermediaire de wash-out de 2 semaines. L’ordre d’attribution des traitements a ete randomisee. Methodes Les taux seriques de potassium ont ete mesures en pre-dialyse avant chaque seance. La tolerance a ete evaluee sur une echelle semi-quantitative allant de 0 a 10. Des modeles de regression lineaires mixte avec effet aleatoire sur l’intercept ont ete utilises. Resultats Quarante-cinq patients ont termine l’etude sans valeur manquantes sur les variables considerees. L’âge moyen etait de 66,3 ± 19,2 ans avec 74 % d’hommes et 44 % de diabetiques. Les taux seriques hebdomadaires moyens de potassium pre-dialyse etaient de 4,5 ± 0,7 mmol/L et 5,0 ± 0,5 mmol/L sous SPS et Patiromer respectivement. Le traitement par SPS etait associe a une diminution de 0,47 mmol/L des taux seriques hebdomadaires moyens de potassium pre-dialyse compare au Patiromer (p Conclusion Chez les patients hemodialyses chroniques, un traitement de SPS 15 g avant chaque repas les jours de non-dialyse resulte en des taux seriques de potassium pre-dialyse inferieurs compare a un traitement de Patiromer 16,8 g 1×/jour, bien que la tolerance soit inferieure.
Uploads
Papers by Pierre-yves Martin