Publications by authors named "Frank Le Roy"

9 Publications

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Prescribing the dose of dialysis

Nephrol Ther 2019 04;15 Suppl 1:S101-S107

Service de néphrologie hémodialyse, centre hospitalier universitaire de Rouen, 147, avenue du Maréchal-Juin, 76230 Rouen cedex, France.

The concept of dose of dialysis is relatively recent. It evaluates the adequacy of extrarenal clearance, in order to provide the best chances of survival to chronic dialysis patients. Although it presents drawbacks, urea Kt/V is recognized as the most clinically relevant indicator. It can be easily calculated online thanks to the equipment of the dialysis monitors with ionic dialysance. The target of balanced Kt/V is greater than 1.2, provided the minimal Kt dialysis dose is received. To reach these targets, it is necessary to use dialysers of large surface, with high urea mass transfer coefficient. The blood pump flow must be high and dialysate flow rate sufficient. With the advent of online hemodiafiltration, a dose of convective dialysis was imposed. To achieve these convective targets, large surface dialysers with high hydraulic permeability must be used, with a high beta 2 microglobulin screening coefficient and low albumin loss. Prescribing the dose of dialysis is essential in an optimal quality-of-care based approach.
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http://dx.doi.org/10.1016/j.nephro.2019.03.001DOI Listing
April 2019

Clinical Value of Natriuretic Peptides in Predicting Time to Dialysis in Stage 4 and 5 Chronic Kidney Disease Patients.

PLoS One 2016 22;11(8):e0159914. Epub 2016 Aug 22.

Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France.

Background: Anticipating the time to renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is an important but challenging issue. Natriuretic peptides are biomarkers of ventricular dysfunction related to poor outcome in CKD. We comparatively investigated the value of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as prognostic markers for the risk of RRT in stage 4 and 5 CKD patients, and in foretelling all-cause mortality and major cardiovascular events within a 5-year follow-up period.

Methods: Baseline plasma BNP (Triage, Biosite) and NT-proBNP (Elecsys, Roche) were measured at inclusion. Forty-three patients were followed-up during 5 years. Kaplan-Meier analysis, with log-rank testing and hazard ratios (HR), were calculated to evaluate survival without RRT, cardiovascular events or mortality. The independent prognostic value of the biomarkers was estimated in separate Cox multivariate analysis, including estimated glomerular filtration rate (eGFR), creatininemia and comorbidities.

Results: During the first 12-month follow-up period, 16 patients started RRT. NT-proBNP concentration was higher in patients who reached endpoint (3221 ng/L vs 777 ng/L, p = 0.02). NT-proBNP concentration > 1345 ng/L proved significant predictive value on survival analysis for cardiovascular events (p = 0.04) and dialysis within 60 months follow-up (p = 0.008). BNP concentration > 140 ng/L was an independent predictor of RRT after 12 months follow-up (p<0.005), and of significant predictive value for initiation of dialysis within 60 months follow-up.

Conclusions: Our results indicate a prognostic value for BNP and NT-proBNP in predicting RRT in stage 4 and 5 CKD patients, regarding both short- and long-term periods. NT-proBNP also proved a value in predicting cardiovascular events. Natriuretic peptides could be useful predictive biomarkers for therapeutic guidance in CKD.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159914PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993513PMC
July 2017

[Travel memories].

Nephrol Ther 2015 Jul 4;11(4):250-1. Epub 2015 May 4.

Service de néphrologie, hémodialyse, transplantation rénale, CHU de Rouen, 76031 Rouen, France.

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http://dx.doi.org/10.1016/j.nephro.2015.02.002DOI Listing
July 2015

[Extracellular hydration status and residual urinary sodium excretion in chronic hemodialysis patients: a cross-sectional multicenter study].

Nephrol Ther 2014 Apr 4;10(2):94-100. Epub 2014 Feb 4.

Service de néphrologie, centre hospitalier universitaire de Caen, hôpital Clémenceau, boulevard Georges-Clémenceau, CS 30001, 14033 Caen cedex 9, France. Electronic address:

Background: In dialysis patients, a misevaluation of dry weight may lead to an increased morbidity and mortality. The aim of this cross-sectional multicenter study was to evaluate the association between residual urinary sodium excretion and extracellular volume status in chronically treated hemodialysis patients.

Patients And Methods: Dry weight was determined clinically and by whole-body bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care) prior to a mid-week session in 40 chronic hemodialysis patients with significant residual diuresis (more than 250 mL per day) and receiving treatment in four dialysis centers. Regarding their hydration status assessed by the Body Composition Monitor and in comparison to a healthy reference population, patients were assigned to 1 of the 3 categories: overhydrated, normohydrated and dehydrated. Urine output, urinary sodium excretion and residual renal function were measured for all patients within 30 days before dry weight assessment.

Results: The median post-HD session FO was of-0.40 L (IQR: from-1.95 to+0.90) and the median residual urinary sodium excretion was of 64 mmol/L (IQR: 46-79). Among these patients, 16 were normohydated, 16 were dehydrated and 8 were overhydrated. There was a linear relationship between the hydration status after HD session and the urinary sodium excretion (estimate: 5.6±1.5; p<0.001). Compared with normohydrated patients, overhydrated patients had a higher residual urinary sodium excretion (estimate: 26±10; p<0.01).

Conclusion: In this study, urinary sodium excretion is associated with the hydration status evaluated by whole-body bioimpedance spectroscopy.
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http://dx.doi.org/10.1016/j.nephro.2013.11.004DOI Listing
April 2014

High-efficiency on-line haemodiafiltration improves conduit artery endothelial function compared with high-flux haemodialysis in end-stage renal disease patients.

Nephrol Dial Transplant 2014 Feb 13;29(2):414-22. Epub 2013 Nov 13.

Department of Pharmacology, Rouen University Hospital, Rouen, France.

Background: Middle molecular weight uraemic toxins are considered to play an important role in vascular dysfunction and cardiovascular outcomes in end-stage renal disease (ESRD) patients. Recent dialysis techniques based on convection, specifically high-efficiency on-line haemodiafiltration (HDF), enhance the removal of middle molecular weight toxins and reduce all-cause mortality in haemodialysis (HD) patients. However, the mechanisms of these improved outcomes remain to be established.

Methods: This prospective study randomly assigned 42 ESRD patients to switch from high-flux HD to high-efficiency on-line HDF (n=22) or to continue HD (n=20). Brachial artery endothelium-dependent flow-mediated dilatation, central pulse pressure, carotid artery intima-media thickness (IMT), internal diastolic diameter and distensibility and circulating markers of uraemia, inflammation and oxidative stress were blindly assessed before and after a 4-month follow-up.

Results: Brachial flow-mediated dilatation and carotid artery distensibility increased significantly in the HDF group compared with HD, while carotid IMT and diameter remained similar. HDF decreased predialysis levels of the uraemic toxins β2-microglobulin, phosphate and blood TNFα mRNA expression. Oxidative stress markers were not different between the HD and HDF groups. Blood mRNA expression of protein kinase C β2, an endothelial NO-synthase (eNOS) inhibitor, decreased significantly with HDF.

Conclusions: High-efficiency on-line HDF prevents the endothelial dysfunction and stiffening of the conduit arteries in ESRD patients compared with high-flux HD. HDF decreases uraemic toxins, vascular inflammation, and is associated with subsequent improvement in eNOS functionality. These results suggest that reduced endothelial dysfunction may be an intermediate mechanism explaining the beneficial outcomes associated with HDF.
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http://dx.doi.org/10.1093/ndt/gft448DOI Listing
February 2014

Elevated removal of middle molecules without significant albumin loss with mixed-dilution hemodiafiltration for patients unable to provide sufficient blood flow rates.

Blood Purif 2013 29;36(2):78-83. Epub 2013 Aug 29.

Dialysis Unit, Centre Hospitalier, Cherbourg, France.

Background: We examined the hypothesis that mixed-dilution online hemodiafiltration (MIXED) rather than predilution online hemodiafiltration (PRE) could enable patients with low blood flow rate (Qb) to benefit from advantages of convective therapies.

Methods: Thirty-eight patients were included in a prospective, randomized, crossover and multicenter study conducted with a view to comparing the equilibrated Kt/V, reduction ratio (RR) of phosphates, β2-microglobulin (β2-M) and myoglobin (myo) between PRE and MIXED, each at two Qb values of 250 and 300 ml/min during 4 h sessions with a FX1000HDF dialyzer. Albumin losses (Alb) were also measured in 12 patients.

Results: MIXED was always found to be more efficient compared to PRE notably for middle molecules (MM). RRβ2-M: MIX250: 81.3 ± 3.6 vs. PRE250: 75.2 ± 5.9; MIX300: 82.7 ± 3.6 vs. PRE300: 78.1 ± 5.4; RRmyo: MIX250: 70.2 ± 3.6 vs. PRE250: 42.6 ± 2.6; MIX300: 70.6 ± 3.6 vs. PRE300: 45.7 ± 3.6 and with Alb <3.0 g/session.

Conclusion: MIXED allows patients unable to provide sufficiently high Qb to achieve high levels of MM removal.
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http://dx.doi.org/10.1159/000351527DOI Listing
July 2014

Monitoring of hemodialysis quality-of-care indicators: why is it important?

BMC Nephrol 2013 May 24;14:109. Epub 2013 May 24.

Nephrology department, Rouen University Hospital, 1 Avenue de Germont, 76031 Rouen Cedex, Rouen, France.

Background: Meeting specific guideline targets is associated with improved survival rates and reduced hospitalizations in the dialysis population. This prospective work evaluated the adequacy of hemodialysis quality indicators in an in-center hemodialysis population with severe comorbidities, and assessed whether clinical practice could impact intermediate outcomes.

Methods: All the chronic hemodialysis patients treated in Rouen University Hospital hemodialysis Unit between January 2009 and April 2010 were included in this observational study. Every quarter, mean levels and prevalence of conformity were collected for the following indicators: anemia, dialysis dose, serum calcium and phosphorus, PTH, 25OH-vitamin D, albumin, serum bicarbonate, LDL-cholesterol, serum β2-microglobulin, systolic and diastolic blood pressure, intradialytic hypotension and vascular access. Conformity of quality-of-care indicators was determined according to targets defined by international guidelines, whenever available.

Results: Altogether, 124 patients were included in the study. Thirty-three patients were evaluated during the entire follow-up period. An improvement in the percentage of conformity was observed for hemoglobin, dialysis dose, phosphates, PTH, serum bicarbonate and β2-microglobulin in the global population. Failure to improve conformity rates for several indicators, including serum albumin, was found, possibly depending on patients' comorbidities rather than on quality of care.

Conclusion: Overall, this study shows that following quality-of-care indicators can improve clinical practice by identifying center-specific weaknesses, prompting the establishment of corrective measures. Finally, we suggest that the definition and targets of some indicators, especially hypertension and LDL-cholesterol, be reviewed, since evidence of their association with mortality is not demonstrated.
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http://dx.doi.org/10.1186/1471-2369-14-109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701507PMC
May 2013

[Acetate-free hemodialysis: what does it mean?].

Nephrol Ther 2011 Apr 3;7(2):92-8. Epub 2010 Dec 3.

Département de biophysique, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, 75013 Paris, France.

Substituting bicarbonate by acetate in dialysis fluids has been proposed for avoiding precipitation of calcium and magnesium carbonates. However, acetate hemodialysis has been abandoned because of deleterious effects of acetate. Conventional bicarbonate hemodialysis is not totally acetate-free, because 3 to 7 mEq/l of acetic acid are added to the dialysate. Acetate-free hemodialysis is possible with another acid (chlorhydric acid or citric acid) or without acid by using some techniques of low-efficiency hemodiafiltration, as acetate-free biofiltration, which avoids the deleterious effect of blood acidification into the dialyzer. In this paper, advantages and disadvantages of different techniques of acetate-free hemodialysis are discussed.
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http://dx.doi.org/10.1016/j.nephro.2010.10.008DOI Listing
April 2011