In this issue: |
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REVIEW FOCUSED ON THE UNACCEPTABLY HIHG MORTALITY RATES OF PATIENTS WITH CHRONIC RENAL FAILURE |
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CARDIOVASCULAR OUTCOMES IN CKD: PROBLEMS AND SOLUTIONS |
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EURECA-m EVENTS |
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EURECA-m Board Members |
Gérard Michel London (EURECA-m Chairman) |
Alberto Ortiz Arduan (EURECA-m Secretary) |
Gunnar Heine, Germany |
Mehmet Kanbay, Turkey |
Francesca Mallamaci, Italy |
Ziad A. Massy, France |
Patrick Rossignol, France |
Raymond Vanholder, Belgium |
Andrzej Wiecek, Poland (liaison with National Societies of Nephrology)
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EURECA-m Advisor and LUST Study Coordinator
Carmine Zoccali, Italy |
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EURECA-m Registry Clinical Coordinator
Francesca Mallamaci, Italy |
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Epidemiology and Biostatistics Consultants
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Kitty J Jager, The Netherlands
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Friedo W Dekker, The Netherlands
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Giovanni Tripepi, Italy
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Cecile Couchoud, France |
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It is my pleasure to announce you the very upcoming EURECA-m CME Course* to be held during the ERA-EDTA annual congress of Amsterdam (May 31, 2014 from 9:00 until 13:00): to download the program, please click here. We expect you to be numerous!
*CME Courses on May 31, 2014 are reserved to regularly registered congress members and are included in the registration fee. In order to participate in the CME Courses, all regularly registered congress members must go to the session halls and have their badge scanned by the hostesses at the entrance (at participant’s own responsibility). Please note that the seat capacity of the conference rooms is limited, therefore participation in these courses will be on a “first come first served” basis. For all info concerning the registrations, please click here.
In addition, I am also pleased to welcome the two new elected EURECA-m Board Members: Professors Heine Gunnar and Francesca Mallamaci as well as to thank Professors Adrian Covic, David Goldsmith and Danilo Fliser who left the Board after 5 years of fruitful collaboration.
At the end of the above mentioned CME Course of Amsterdam the new Members will be officially welcomed and special Board membership Certificates will be given to the outgoing Board members (2009-2014).
Through our newsletter and blasts, we will continue to keep you updated on all our future initiatives.
Enjoy this newsletter reading! |
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Prof. Gérard Michel London
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LUST UPDATES
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In previous EURECA-m newsletters I illustrated into detail the scope and the design of the LUST study, a randomized trial testing whether a treatment policy guided by systematic monitoring of lung water as measured by chest ultrasound (US) may reduce mortality, heart failure, coronary heart disease and/or heart failure in dialysis patients. I also remarked that lung water assessment by chest US is a quick, reliable, and easy to learn technique that requires just a 2-hours training session.
LUST study is one of the main investments and undertakings of EURECA-m and for this reason I believe that all EURECA-m members need periodical news about the progress of the trial. I am happy to inform you that the trial has already garnered a superb result, i.e. we successfully completed the training and the certification of all nephrologists-sonographers and the vast majority of cardiologists of participating centers by an original, almost cost-less approach consisting in WEB-based training sessions with individual centers . The success of the training-phase is mainly due to the talent and dedication of Luna Gargani , Rosa Sicari and Eugenio Picano, all investigators at the LUST-cardiovascular imaging Unit at CNR-Clinical Physiology Institute in Pisa. Luna has given an outstanding educational performance. The very high degree of agreement between US lung readings by her and by nephrologists-sonographers, the very basis for lung-US certification of LUST centers, stands as a proof that in LUST all sonographers have reached a high level of competence with the technique. To my knowledge this experience is unique and as such it deserves to be described into a specific methodological paper.
The coordinating center in Reggio Cal has already enrolled 27 patients. The study proceeds smoothly at this Unit and all patients have already completed the first echocardiography follow-up study (6 months). Some interesting observations are emerging in the preliminary analysis of data at this Unit. First, the reduction in US-B lines (the experimental manoeuver in LUST) can be achieved with just relatively small changes in dry body weight. Second, we note that when the number of US-B lines re-enters or approaches the normal range the pre-post dialysis difference in US-B lines markedly attenuates. If confirmed across the whole study, this phenomenon may be used as a novel clue for assessing the “dry weight” of dialysis patients. Centers in Iasi (over 30 patients), Wroclaw (31 patients), Maribor (28 patients), Ioannina (19 patients), Homburg (14 patients), Parma (12 patients) have already randomized and actually entered into the study several patients. Centers in France had problems of various kind with their demanding ethical committees but the French coordinator of the study, Patrick Rossignol, has now sorted these problems and I remain positive that these centers may eventually join LUST. After the dropping out of the British center we have now invited an additional center in Viareggio (Vincenzo Panichi) and this center has enthusiastically accepted the invitation to join. Centers in Madrid, Barcelona, Hannover, Kallithea, Jerusalem and Imola are progressing at slow pace but I am sure they will eventually be able to successfully participate into LUST.
I hope to meet all LUST investigators in Amsterdam at the ERA EDTA Congress!
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REVIEW FOCUSED ON THE UNACCEPTABLY HIHG MORTALITY RATES OF PATIENTS WITH CHRONIC RENAL FAILURE |
The EURECA-m working group writing committee has authored a review focused on the unacceptably high mortality rates of patients with chronic renal failure, i.e., those with estimated glomerular filtration rates below 15 ml/min/1.72 m2, which will be published in The Lancet and presented during the 51st ERA-EDTA Congress (May 31st - June 3rd in Amsterdam).
Be prepared to read a carefully researched and crafted update on the global epidemiology, causes, pathophysiology, risk factors and staging of mortality risk. To learn what evidence is available from randomized clinical trials testing interventions to decrease mortality and what additional hypothesis derived from observational studies merit to be formally tested. To join in the brainstorming on what logistical, educational, political, scientific, technical and clinical approaches may best tackle this serious issue.
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Prof. Alberto Ortiz Arduan
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CARDIOVASCULAR OUTCOMES IN CKD: PROBLEMS AND SOLUTIONS |
EURECA-m collaborated in the successful innovative 2 days CME Course held in Antalya last April 4th-5th, 2014: CardiovaScular outcomes in CKD: problems and solutions, organized by Professors Gultekin Suleymanlar and Mahmut Ilker Yilmaz.
The CME discussed cardiovascular outcome in chronic kidney disease (CKD) in all aspects: 11 talks by experts in the field grouped into four sessions were held:
- The challenge of optimizing volume control: an ever ending quest in CKD;
- Progress in mineral-bone disorders as related to cardiovascular disease in CKD:
- Metabolic disorders and the risk for cardiovascular and renal complications;
- Hypertension control and CKD prevention: a priority public health issue.
The discussion about cardio-renal link is very complex: there is a bi-directionality link, loss of kidney function may trigger cardiovascular disease and cardiovascular diseases may also engender kidney damage. The experts also discussed that hyperuricemia should be a target for treatment as well as about the aldosteron and its therapeutic targeting in CKD progression and hypertension; they also provided an update on vascular calcification (including phosphate, FGF-23, klotho and sclerostin) and pointed out the importance of salt restriction and volume control in CKD as well as the importance of controlling and monitoring hypertension in general population and in CKD population.
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EURECA-m EVENTS
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