Objective -The short term association between daily mortality and ambient air pollution in the city ofLyon, France (population, 410 000) between 1985 and 1990 was assessed using time series analysis. Design -This study followed the standardised design and statistical analysis (Poisson regression) that characterise the APHEA project. Methods -Four categories of cause of death were studied: total (minus external causes), respiratory, cardiovascular, and digestive causes (as a control condition). Results -No association was found with any cause of death for nitrogen dioxide (NO2) and ozone (03), nor, for any pollutant, for digestive conditions. Sulphur dioxide (SO2) and, to a much lesser degree, suspended particles (PM13), were significantly related to mortality from respiratory and cardiovascular conditions. The relative risk (RR) ofrespiratory deaths associated with a 50 pgIm3 increment of mean daily SO2 over the whole period was 1-22 (95% CI 1-05, 1-40); the RR for cardiovascular deaths was 1-54 (1.22,
Background. The impact of renal transplantation (RT) in the elderly with many comorbid conditions is a matter of concern. The aim of our study was to assess the impact of RT on the survival of patients older than 60 years compared with those remaining on the waiting list (WL) according to their comorbidities. Methods. In this multicentric observational retrospective cohort study, we included all patients older than 60 years old admitted on the WL from 01 January 2006 to 31 December 2016. The Charlson comorbidity index (CCI) score was calculated for each patient at inclusion on the WL. Kidney donor risk index was used to assess donor characteristics. Results. One thousand and thirty-six patients were included on the WL of which 371 (36%) received an RT during a median follow-up period of 2.5 (1.4–4.1) years. Patient survival was higher after RT compared to patients remaining on the WL, 87%, 80%, and 72% versus 87%, 55%, and 30% at 1, 3, and 5 years, respectively. After RT survival at 5 years was 37% higher for patients with CCI ≥ 3, and 46% higher in those with CCI < 3, compared with patients remaining on the WL. On univariate and multivariate analysis, patient survival was independently associated with a CCI of ≥3 (hazard ratio 1.62; confidence interval 1.09-2.41; P < 0.02) and the use of calcineurin-based therapy maintenance therapy (hazard ratio 0.53; confidence interval 0.34-0.82; P < 0.004). Conclusions. Our study showed that RT improved survival in patients older than 60 years even those with high comorbidities. The survival after transplantation was also affected by comorbidities.
Renal transplantation is the best treatment option for patients suffering end-stage renal disease (ESRD). 1 New immunosuppressive agents have improved short-and long-term graft survival. 2 Data from the United States Renal Data System (USRDS) reported an almost invariable 4% annual rate of graft failure among renal transplant recipients. 3 Graft failure represents a growing proportion of incident and prevalent dialysis patients' worldwide. 3 Each year in the USA, around 5000 patients return to dialysis after kidney allograft failure (KAF), representing 4-5% of the incident dialysis population. 4 In our country, approximately 2.5% return to dialysis after graft failure each year. 5 Classically, KAF patients have been considered to have poorer survival than transplant-naïve renal replacement therapy patients. 6-10 A United States Renal Data System (USRDS) database retrospective analysis has shown that mortality in patients returning to dialysis after graft failure was primarily due to cardiac (36%) or infectious complications (17%). 11 A recent retrospective study showed that entering dialysis after a failed renal transplant with any type of catheter or high a comorbidity index was associated with greater
Nonprogrammed VA with a catheter predicted all-cause mortality among patients with transplant failure reentering HD.
Peritoneal hyalinizing vasculopathy (PHV) represents the cornerstone of long-term peritoneal dialysis (PD), and especially characterizes patients associated with encapsulating peritoneal sclerosis. However, the mechanisms of PHV development remain unknown. A cross sectional study was performed in 100 non-selected peritoneal biopsies of PD patients. Clinical data were collected and lesions were evaluated by immunohistochemistry. In selected biopsies a microRNA (miRNA)-sequencing analysis was performed. Only fifteen patients (15%) showed PHV at different degrees. PHV prevalence was significantly lower among patients using PD fluids containing low glucose degradation products (GDP) (5.9% vs. 24.5%), angiotensin converting enzyme inhibitors (ACEIs) (7.5% vs. 23.4%), statins (6.5% vs. 22.6%) or presenting residual renal function, suggesting the existence of several PHV protective factors. Peritoneal biopsies from PHV samples showed loss of endothelial markers and induction of mesenchymal proteins, associated with collagen IV accumulation and wide reduplication of the basement membrane. Moreover, co-expression of endothelial and mesenchymal markers, as well as TGF-β1/Smad3 signaling activation were found in PHV biopsies. These findings suggest that an endothelial-to-mesenchymal transition (EndMT) process was taking place. Additionally, significantly higher levels of miR-7641 were observed in severe PHV compared to non-PHV peritoneal biopsies. Peritoneal damage by GDPs induce miRNA deregulation and an EndMT process in submesothelial vessels, which could contribute to collagen IV accumulation and PHV.
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