EURECA-m e-Newsletter
Year 7 Issue 3 October 2016
   
In this issue:
 
 
LUST Study
 
Eureca-m Registry
  
Fibromuscular dysplasia (FMD) needs to be revisited
 
 
 
EURECA-m Board Members
Gérard Michel London (EURECA-m Chairman)
Alberto Ortiz Arduan (EURECA-m Secretary)
Charles J. Ferro, United Kingdom
Gunnar Heine, Germany
Mehmet Kanbay, Turkey (Co-Editor in Chief of EURECA-m Newsletter)
Francesca Mallamaci, Italy
Patrick Rossignol, France (Co-Editor in Chief of EURECA-m Newsletter)
Pantelis Sarafidis, Greece
Raymond Vanholder, Belgium
Marianne C. Verhaar, The Netherlands
 
EURECA-m Advisor and LUST Study Coordinator
Carmine Zoccali, Italy
       

EURECA-m Registry Clinical Coordinator
Francesca Mallamaci, Italy

    
EURECA-m External Consultant for Epidemiology in Cardiovascular Diseases in CKD
Ziad A. Massy, France
      
    
Epidemiology and Biostatistics Consultants
Kitty J Jager, The Netherlands
Friedo W Dekker, The Netherlands
Giovanni Tripepi, Italy
Cecile Couchoud, France
      
 

Dear all,

We are pleased to share with you the latest issue of our Eureca-m newsletter. Headlines include breaking news from the LUST trial (Prof. Zoccali), from the Eureca-m registry (Prof. Mallamaci), along with a proposal for a collaborative effort on fibromuscular dysplasia with the European Working Group “Hypertension and the kidney” led by Prof. Persu.

We are looking forward to meeting you during the next EURECA-m CME course, held in Madrid, June 3, 2017.

Sincerely yours,

Mehmet Kanbay & Patrick Rossignol

Mehmet Kanbay
Prof. Mehmet Kanbay
EURECA-m Newsletter co-Editor in Chief
Patrick Rossignol
Prof. Patrick Rossignol
EURECA-m Newsletter co-Editor in Chief
 
 LUST Study

Interest on lung congestion in chronic diseases is on the rise. Publications on this issue in Pub-Med and just during the last 5 years as much as 421 papers on this issue have been published. A major driver of the renovated interest on this issue has been the establishment of lung ultrasound (US) as a simple, cheap and reliable way of measuring lung water in every-day clinical practice. Within the nephrology realm, the potential usefulness of the technique was championed by EURECA-m investigators while in the USA it was initially felt as not directly manageable by nephrologists and as such not of immediate interest for renal physicians. To further raise interest on lung US among nephrologists, within the LUST study it was contemplated the testing of an online, entirely WEB-based learning program for educating nephrologists to the use of lung US. This study corollary to LUST was leaded by dr Luna Gargani, a cardiologist at the CNR Institute of Clinical Physiology and a LUST investigator. This study has been freshly published in Nephrology Dialysis and Transplantation.
Herein, the efficacy of the WEB-based training program has been firmly established. Indeed the degree of agreement between the estimates of lung water (based on the counting of US B lines) made by the trainer and the trainees was of a degree rarely seen in studies of the kind. These observations are remarkable for two reasons, first because the training sessions globally lasted from 2 to 3 hours, second because most nephrologists who undertook the training program were naïve with the use of US machines. Resistance to the use of the use lung US also derives from the fact that evidence of that lung US may capture lung congestion at a pre-clinical stage, well before traditional lung auscultation is still much sparse. To fill this knowledge vacuum, a LUST sub-study investigated into depth the relationship between lung crackles and the degree of lung congestion by US. This study, now published (on line) in the Clinical Journal of the American Society of Nephrology, documents that while lung crackles are observed in less than a quarter of hemodialysis patients before dialysis, evidence of substantial water accumulation in the lung is present in about a half of hemodialysis patients. Furthermore, the degree of association between crackles and US-measured lung water was just slight (shared variance 12%). Overall this study proved that a time-honored clinical sign like auscultation of the thorax to detect crackles at the lung bases is a fairly insensitive instrument to monitor lung congestion in hemodialysis patients. Even though these findings are of obvious interest, the usefulness of lung US for the management of dialysis patients cannot be taken for granted. Indeed, as for all new techniques, the issue remains be tested into a formal clinical trial. The LUST study is ongoing and it will take at least 2 years to complete it. In the meanwhile other corollary LUST projects, like the ones commented in this note, will expand our knowledge on lung congestion in high risk dialysis patients and will further focus into this hitherto neglected research area.

Recent LUST publication commented in this note

1) Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project
  Nephrol Dial Transplant. 2016 Sep 26. pii: gfw329. [Epub ahead of print]
2) The agreement between auscultation and lung ultrasound in hemodialysis patients: the LUST study
  Clin J Am Soc Nephrol. 2016 Sep 22. pii: CJN.03890416. [Epub ahead of print]
Zoccali
Prof. Carmine Zoccali
LUST Study Coordinator
   
  Eureca-m Registry

After five years from the creation of the EURECA-m Registry, Centres which contributed to data collection are five. The first patient was enrolled on the 2nd January 2011. The number of patients enrolled so far by centres, are reported below:

1. Reggio Calabria, Italy (109 pts.)
2. Parma, Italy (72 pts.)
3. Ioannina, Greece (67 pts.)
4. Homburg/Saar, Germany (40 pts.)
5. Iasi, Romania (7 pts.)

The enrolment is still going on in Reggio Calabria, where 11 more patients were enrolled during last year. The total number of patients is now 295, which is an incredible high number for a Registry that collects and fully validates 48hABPM, Pulse Wave Velocity (PWV) and Echocardiography data in dialysis patients. In fact, even though the number of patients enrolled is not the one we initially expected and planned (about 1000 patients) the quality of data, particularly 48h ABPM data, is high.
As we have already stated in the previous newsletter, as a spin-off of the Registry, a new study was proposed with two major aims: 1) to confirm in a large unselected HD population in Europe, the findings previously described in a series of Afro-American dialysis patients by Agarwal and 2) to test ABPM feasibility and tolerability in HD patients and in a well-matched group of essential hypertensives.
From the end of 2015 to date, several Skype meetings took place with many centres which agreed to take part to this new project. The Skype meetings were mainly devoted to discuss the main issues of the study protocol. A kick-off meeting was held on the 28th of September 2016 in Reggio Calabria to further discuss some practical issues of the protocol. It was a great result that 13 European Centres (see the following list) are involved in the study. Among the above Centres: 10 Centres already started the project and 3 are completing the procedures to obtain the approval from their Ethical Committees.
The first patient for this new protocol was enrolled in January 2016 in Maribor, Slovenia.
We expect to be able to enrol about 1000 patients and if we reach this target it will be the largest collection of 48 ABPM in haemodialysis patients ever recorded.

Francesca Mallamaci
Prof. Francesca Mallamaci
EURECA-m Registry Clinical Coordinator
   
Fibromuscular dysplasia (FMD) needs to be revisited
ESH
img1

FMD is not only this rare but curable cause of renal artery stenosis in young women.

Did you know that:
• FMD lesions may be found in up to 5% of apparently healthy adults.
• In current cohorts, the mean age at diagnosis is > 50 years, but FMD may also occur in children and elderly men
• FMD is a systemic disease with frequent involvement of multiple vascular beds, including but not limited to renal and carotid arteries.
• FMD can be associated with spontaneous coronary artery dissection.
• FMD has a hereditary component and the first susceptibility genes are currently being identified.
We are developing a comprehensive research program focusing on epidemiology, clinical aspects, imaging, biomarkers and genetics of FMD.

img2

If you follow a cohort of patients with FMD, and are willing to contribute to the European FMD registry and join a network of specialists interested by the clinical and basic aspects of the disease, please contact us (FMD-saintluc@uclouvain.be).

Thank you very much in advance.

Best regards,

Prof. Alexandre PERSU
Chairman of the ESH Working Group
˝Hypertension and the Kidney˝
Cliniques Universitaires Saint-Luc
Brussels, Belgium
E-mail: alexandre.persu@uclouvain.be
Prof. Michel AZIZI
Vice-President of the European Society of Hypertension
Hypertension Unit
Hôpital Européen Georges Pompidou
Paris, France
E-mail: michel.azizi@aphp.fr
EURECA-m Website: http://www.era-edtaworkinggroups.org/en-US/group/eureca-m