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Côté N, Fortier C, Desbiens LC, Nemcsik J, Agharazii M. Individual versus integration of multiple components of central blood pressure and aortic stiffness in predicting cardiovascular mortality in end-stage renal diseases. J Hum Hypertens 2024; 38:430-436. [PMID: 38245628 DOI: 10.1038/s41371-023-00888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024]
Abstract
Aortic stiffness, measured by carotid-femoral pulse wave velocity (PWV), is a predictor of cardiovascular (CV) mortality in patients with end-stage renal disease (ESRD). Aortic stiffness increases aortic systolic and pulse pressures (cSBP, cPP) and augmentation index adjusted for a heart rate of 75 beats per minute (AIx@75). In this study, we examined if the integration of multiple components of central blood pressure and aortic stiffness (ICPS) into risk score categories could improve CV mortality prediction in ESRD. In a prospective cohort of 311 patients with ESRD on dialysis who underwent vascular assessment at baseline, 118 CV deaths occurred after a median follow-up of 3.1 years. The relationship between hemodynamic parameters and CV mortality was analyzed through Kaplan-Meier and Cox survival analysis. ICPS risk score from 0 to 5 points were calculated from points given to tertiles, and were regrouped into three risk categories (Average, High, Very-High). A strong association was found between the ICPS risk categories and CV mortality (High risk HR = 2.20, 95% CI: 1.05-4.62, P = 0.036); Very-High risk (HR = 4.44, 95% CI: 2.21-8.92, P < 0.001) as compared to the Average risk group. The Very-High risk category remained associated with CV mortality (HR = 3.55, 95% CI: 1.37-9.21, P = 0.009) after adjustment for traditional CV risk factors as compared to the Average risk group. While higher C-statistics value of ICPS categories (C: 0.627, 95% CI: 0.578-0.676, P = 0.001) was not statistically superior to PWV, cPP or AIx@75, the use of ICPS categories resulted in a continuous net reclassification index of 0.56 (95% CI: 0.07-0.99). In conclusion, integration of multiple components of central blood pressure and aortic stiffness may potentially be useful for better prediction of CV mortality in this cohort.
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Affiliation(s)
- Nadège Côté
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Catherine Fortier
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | | | - János Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Mohsen Agharazii
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.
- Faculty of Medicine, Université Laval, Québec, QC, Canada.
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2
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d'Hervé Q, Girerd N, Bozec E, Lamiral Z, Panisset V, Frimat L, Huttin O, Girerd S. Factors associated with changes in echocardiographic parameters following kidney transplantation. Clin Res Cardiol 2024; 113:412-424. [PMID: 37084138 DOI: 10.1007/s00392-023-02203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Chronic kidney disease leads to cardiac remodelling of multifactorial origin known as "uraemic cardiomyopathy", the reversibility of which after kidney transplantation (KT) remains controversial. Our objectives were to assess, in the modern era, changes in echocardiographic parameters following KT and identify predictive clinical and biological factors associated with echocardiographic changes. METHODS One hundred six patients (mean age 48 ± 16, 73% male) who underwent KT at the University Hospital of Nancy between 2007 and 2018 were retrospectively investigated. Pre- and post-KT echocardiography findings (8.6 months before and 22 months after KT on average, respectively) were centralised, blind-reviewed and compared. RESULTS A majority of patients (60%) had either a left ventricular (LV) ejection fraction < 50%, at least moderately abnormal LV mass index or left atrial (LA) dilatation at pretransplanted echocardiography. After KT, LV remodelling and diastolic doppler indices did not significantly change whereas LA volume index (LAVI) increased (35.9 mL/m2 post-KT vs. 30.9 mL/m2 pre-KT, p = 0.006). Advancing age, cardiac valvular disease, delayed graft function, lower post-KT haemoglobin, and more severe post-KT hypertension were associated with higher LAVI after KT. Higher post-KT serum creatinine, more severe post-KT hypertension and lower pre-KT blood calcium levels were associated with a deterioration in LAVI after KT. DISCUSSION/CONCLUSION Adverse remodelling of the left atrial volume occurred after KT, predominantly in patients with lower pre-KT blood calcium, poorer graft function and post-KT hypertension. These results suggest that a better management of modifiable factors such as pre-KT hyperparathyroidism or post-KT hypertension could limit post-KT cardiac remodelling.
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Affiliation(s)
- Q d'Hervé
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - N Girerd
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm U1116, University Hospital of Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France
| | - E Bozec
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm U1116, University Hospital of Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France
| | - Z Lamiral
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm U1116, University Hospital of Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France
| | - V Panisset
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - L Frimat
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - O Huttin
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm U1116, University Hospital of Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France
- Cardiology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - S Girerd
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm U1116, University Hospital of Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France.
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3
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Andrian T, Siriteanu L, Covic AS, Ipate CA, Miron A, Morosanu C, Caruntu ID, Covic A. Non-Traditional Non-Immunological Risk Factors for Kidney Allograft Loss-Opinion. J Clin Med 2023; 12:jcm12062364. [PMID: 36983364 PMCID: PMC10051358 DOI: 10.3390/jcm12062364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/16/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Rates of late allograft loss have improved slowly in the last decades. Well described traditional risk factors that influence allograft survival include cardiovascular events, rejection, infections and post-transplant neoplasia. Here, we critically evaluate the influence of several non-immunological, non-traditional risk factors and describe their impact on allograft survival and cardiovascular health of kidney transplant recipients. We assessed the following risk factors: arterial stiffness, persistent arteriovenous access, mineral bone disease, immunosuppressive drugs residual levels variability, hypomagnesemia, glomerular pathological alterations not included in Banff criteria, persistent inflammation and metabolic acidosis.
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Affiliation(s)
- Titus Andrian
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Lucian Siriteanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Andreea Simona Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Cristina Alexandra Ipate
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
| | - Adelina Miron
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Corneliu Morosanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
| | - Irina-Draga Caruntu
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, C. I. Parhon University Hospital, 700503 Iasi, Romania
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine, 700115 Iasi, Romania
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Hobson S, Arefin S, Rahman A, Hernandez L, Ebert T, de Loor H, Evenepoel P, Stenvinkel P, Kublickiene K. Indoxyl Sulphate Retention Is Associated with Microvascular Endothelial Dysfunction after Kidney Transplantation. Int J Mol Sci 2023; 24:ijms24043640. [PMID: 36835051 PMCID: PMC9960432 DOI: 10.3390/ijms24043640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Kidney transplantation (KTx) is the preferred form of renal replacement therapy in chronic kidney disease (CKD) patients, owing to increased quality of life and reduced mortality when compared to chronic dialysis. Risk of cardiovascular disease is reduced after KTx; however, it is still a leading cause of death in this patient population. Thus, we aimed to investigate whether functional properties of the vasculature differed two years post-KTx (postKTx) compared to baseline (time of KTx). Using the EndoPAT device in 27 CKD patients undergoing living-donor KTx, we found that vessel stiffness significantly improved while endothelial function worsened postKTx vs. baseline. Furthermore, baseline serum indoxyl sulphate (IS), but not p-cresyl sulphate, was independently negatively associated with reactive hyperemia index, a marker of endothelial function, and independently positively associated with P-selectin postKTx. Finally, to better understand the functional effects of IS in vessels, we incubated human resistance arteries with IS overnight and performed wire myography experiments ex vivo. IS-incubated arteries showed reduced bradykinin-mediated endothelium-dependent relaxation compared to controls via reduced nitric oxide (NO) contribution. Endothelium-independent relaxation in response to NO donor sodium nitroprusside was similar between IS and control groups. Together, our data suggest that IS promotes worsened endothelial dysfunction postKTx, which may contribute to the sustained CVD risk.
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Affiliation(s)
- Sam Hobson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska, Institutet, 141 52 Stockholm, Sweden
| | - Samsul Arefin
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska, Institutet, 141 52 Stockholm, Sweden
| | - Awahan Rahman
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska, Institutet, 141 52 Stockholm, Sweden
| | - Leah Hernandez
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska, Institutet, 141 52 Stockholm, Sweden
| | - Thomas Ebert
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska, Institutet, 141 52 Stockholm, Sweden
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, D-04103 Leipzig, Germany
| | - Henriette de Loor
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, BE-3000 Leuven, Belgium
| | - Pieter Evenepoel
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, BE-3000 Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, BE-3000 Leuven, Belgium
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska, Institutet, 141 52 Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska, Institutet, 141 52 Stockholm, Sweden
- Correspondence:
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Association between Long-Term Change in Arterial Stiffness and Cardiovascular Outcomes in Kidney Transplant Recipients: Insights from the TRANSARTE Study. J Clin Med 2022; 11:jcm11051410. [PMID: 35268501 PMCID: PMC8911013 DOI: 10.3390/jcm11051410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Increased arterial stiffness is associated with cardiovascular (CV) diseases in end-stage renal disease (ESRD) patients, and CV mortality remains higher in kidney transplantation (KT) recipients compared to in the general population. KT is associated with an improvement in arterial stiffness in the early post-transplant period, followed by a potential re-worsening in the late period. In a cohort of KT patients, we evaluated the associations of pulse-wave velocity (PWV) measured at different time-points (pre-transplant, and early and late post-transplant periods) with CV morbi-mortality, as well as the evolution between these measurements with CV morbi-mortality. (2) Methods: Forty KT recipients with a 10-year follow-up were included. The association of PWV with CV events was assessed with multivariable cox analysis. Backward linear regressions were conducted to identify the determinants of PWV at 1 year and those of the long-term evolution of PWV after KT (delta PWV at 1 year—latest PWV). (3) Results: The absence of arterial stiffening during the long-term follow-up after KT is associated with a lower CV outcome rate (HR for the delta PWV = 0.76 (0.58−0.98), p = 0.036). Age at KT is associated with the worsening of arterial stiffness in the late post-transplantation period (β for the delta PWV = −0.104, p = 0.031). A high PWV at 1 year was associated with a potential for recovery during follow-up (β = 0.744, p < 0.0001). (4) Conclusions: The absence of PWV worsening in the late post-transplantation period was significantly associated with a lower risk of CV events, whereas early changes in PWV were not. Finding an intervention capable of reducing long-term PWV could improve the prognosis of KT recipients.
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6
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Inserra F, Forcada P, Castellaro A, Castellaro C. Chronic Kidney Disease and Arterial Stiffness: A Two-Way Path. Front Med (Lausanne) 2021; 8:765924. [PMID: 34888327 PMCID: PMC8650118 DOI: 10.3389/fmed.2021.765924] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022] Open
Abstract
The kidney-heart relationship has raised interest for the medical population since its vast and complex interaction significantly impacts health. Chronic kidney disease (CKD) generates vascular structure and function changes, with significant hemodynamic effects. The early arterial stiffening in CKD patients is a consequence of the interaction between oxidative stress and chronic vascular inflammation, leading to an accelerated deterioration of left ventricular function and alteration in tissue perfusion. CKD amplifies the inflammatory cascade's activation and is responsible for altering the endothelium function, increasing the vascular tone, wall thickening, and favors calcium deposits in the arterial wall. Simultaneously, the autonomic imbalance, and alteration in other hormonal systems, also favor the overactivation of inflammatory and fibrotic mediators. Thus, hormonal disarrangement also contributes to structural and functional lesions throughout the arterial wall. On the other hand, a rise in arterial stiffening and volume overload generates high left ventricular afterload. It increases the left ventricular burden with consequent myocardial remodeling, development of left ventricular hypertrophy and, in turn, heart failure. It is noteworthy that reduction in glomerular mass of renal diseases generates a compensatory glomerular filtration overdriven associated with large-arteries stiffness and high cardiovascular events. Furthermore, we consider that the consequent alterations of the arterial system's mechanical properties are crucial for altering tissue perfusion, mainly in low resistance. Thus, increasing the knowledge of these processes may help the reader to integrate them from a pathophysiological perspective, providing a comprehensive idea of this two-way path between arterial stiffness and renal dysfunction and their impact at the cardiovascular level.
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Affiliation(s)
- Felipe Inserra
- Advisor of Academic Vice-Rectory Department, Maimonides University, Buenos Aires, Argentina.,Master Vascular Mechanics and Arterial Hypertension, Postgraduate Department, Hypertension, Austral University, Buenos Aires, Argentina
| | - Pedro Forcada
- Master Vascular Mechanics and Arterial Hypertension, Postgraduate Department, Hypertension, Austral University, Buenos Aires, Argentina.,Non-Invasive Vascular Labs, CardioArenales and Diagnóstico Integral Médico (DIM) Prevención Cardiovascular, Buenos Aires, Argentina
| | - Agustina Castellaro
- Pediatric Medicine of Prof. Dr. Juan P Garrahan Hospital, Buenos Aires, Argentina
| | - Carlos Castellaro
- Master Vascular Mechanics and Arterial Hypertension, Postgraduate Department, Hypertension, Austral University, Buenos Aires, Argentina.,Department of Nephrology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC) Hospital, Buenos Aires, Argentina
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7
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Cheddani L, Haymann JP, Liabeuf S, Tabibzadeh N, Boffa JJ, Letavernier E, Essig M, Drüeke TB, Delahousse M, Massy ZA. Less arterial stiffness in kidney transplant recipients than chronic kidney disease patients matched for renal function. Clin Kidney J 2021; 14:1244-1254. [PMID: 34094521 PMCID: PMC8173621 DOI: 10.1093/ckj/sfaa120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Chronic kidney disease is associated with a high cardiovascular risk. Compared with glomerular filtration rate-matched CKD patients (CKDps), we previously reported a 2.7-fold greater risk of global mortality among kidney transplant recipients (KTRs). We then examined aortic stiffness [evaluated by carotid-femoral pulse wave velocity (CF-PWV)] and cardiovascular risk in KTRs compared with CKDps with comparable measured glomerular filtration rate (mGFR). METHODS We analysed CF-PWV in two cohorts: TransplanTest (KTRs) and NephroTest (CKDps). Propensity scores were calculated including six variables: mGFR, age, sex, mean blood pressure (MBP), body mass index (BMI) and heart rate. After propensity score matching, we included 137 KTRs and 226 CKDps. Descriptive data were completed by logistic regression for CF-PWV values higher than the median (>10.6 m/s). RESULTS At 12 months post-transplant, KTRs had significantly lower CF-PWV than CKDps (10.1 versus 11.0 m/s, P = 0.008) despite no difference at 3 months post-transplant (10.5 versus 11.0 m/s, P = 0.242). A lower occurrence of high arterial stiffness was noted among KTRs compared with CKDps (38.0% versus 57.1%, P < 0.001). It was especially associated with lower mGFR, older age, higher BMI, higher MBP, diabetes and higher serum parathyroid hormone levels. After adjustment, the odds ratio for the risk of high arterial stiffness in KTRs was 0.40 (95% confidence interval 0.23-0.68, P < 0.001). CONCLUSIONS Aortic stiffness was significantly less marked in KTRs 1 year post-transplant than in CKDps matched for GFR and other variables. This observation is compatible with the view that the pathogenesis of post-transplant cardiovascular disease differs, at least in part, from that of CKD per se.
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Affiliation(s)
- Lynda Cheddani
- Université Paris Saclay (Paris Sud et Versailles Saint Quentin en Yvelines), INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Jean Philippe Haymann
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, APHP, Hôpital Tenon, Paris, France
| | - Sophie Liabeuf
- Service de Pharmacologie Clinique, Centre Hospitalo Universitaire Amiens, Amiens, France
- Laboratoire MP3CV, EA 7517, Université Jules Vernes de Picardie, CURS, Amiens, France
| | - Nahid Tabibzadeh
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, APHP, Hôpital Tenon, Paris, France
| | - Jean-Jacques Boffa
- Sorbonne Université, INSERM, UMR_S 1155, APHP, Hôpital Tenon, Paris, France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Tenon, Paris, France
| | - Emmanuel Letavernier
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, APHP, Hôpital Tenon, Paris, France
| | - Marie Essig
- Université Paris Saclay (Paris Sud et Versailles Saint Quentin en Yvelines), INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Tilman B Drüeke
- Université Paris Saclay (Paris Sud et Versailles Saint Quentin en Yvelines), INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), France
| | - Michel Delahousse
- Service de Néphrologie et Transplantation Rénale, Hôpital Foch, Suresnes, France
| | - Ziad A Massy
- Université Paris Saclay (Paris Sud et Versailles Saint Quentin en Yvelines), INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Ambroise Paré, Boulogne Billancourt, France
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8
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Abstract
BACKGROUND In chronic kidney disease, the enhanced aortic stiffness increases risk of cardiovascular events. Kidney transplantation (KTx) may improve aortic stiffness; however, it is unclear whether the improvement of aortic stiffness is merely the outcome of the reduction of blood pressure (BP) post-KTx. Furthermore, the long-term trajectory of aortic stiffness remains uncertain, as activation of the immune system may have a negative long-term impact on arterial wall property. METHOD Using aortic stiffness β0 as a BP-independent stiffness parameter, and a statistical adjustment for BP, we aimed to examine the early vs. late changes in aortic stiffness, and to define the characteristics of patients with favourable and unfavourable long-term trajectories of aortic stiffness. In this longitudinal study, aortic stiffness was assessed before, 3, 6 and 24 months after KTx in 79 individuals. Aortic stiffness was determined by carotid-femoral pulse wave velocity (cf-PWV), and aortic stiffness index β0 was obtained by applying the stiffness parameter β0 theory to cf-PWV based on Bramwell-Hill's equation using a reference pressure. RESULTS There was an early reduction of β0 3 months after KTx (29.0 ± 2.0 to 25.8 ± 1.2, P = 0.033) followed by a gradual increase at 6 (28.0 ± 1.4, P = 0.005 vs. 3 months) and 24 months (28.3 ± 1.3, P = 0.003 vs. 3 months). A late increase in β0 was associated with higher levels of the interleukin-6 (P = 0.029) even after adjustment for potential cofounders. Using statistical adjustments for BP showed similar results. CONCLUSION Reduction of aortic stiffness index β0 3 months after KTx suggests that KTx leads to an early de-stiffening of the intrinsic mechanical properties of aorta. However, this improvement is followed by a later stiffening, which is associated with increased interleukin-6, suggesting that activation of the immune system may be involved in arterial wall remodelling in kidney recipients.
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9
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Buus NH, Carlsen RK, Hughes AD, Skov K. Influence of Renal Transplantation and Living Kidney Donation on Large Artery Stiffness and Peripheral Vascular Resistance. Am J Hypertens 2020; 33:234-242. [PMID: 31678997 DOI: 10.1093/ajh/hpz175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/04/2019] [Accepted: 10/28/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Vascular status following renal transplantation (RT) may improve while living kidney donation (LKD) is possibly associated with an increased cardiovascular risk. METHODS We prospectively assessed glomerular filtration rate (mGFR, 51Chrome EDTA clearance) and intermediate vascular risk factors in terms of blood pressure (BP), pulse wave velocity (PWV), central augmentation index (AIx), excess pressure (Pexcess), and forearm vascular resistance in donors (n = 58, 45 ± 13 years) and recipients (n = 51, 50 ± 12 years) before and one year following LKD or RT. RESULTS After kidney donation, mGFR decreased by 33% to 65 ± 11 ml/min/1.73m2, while recipients obtained a mGFR of 55 ± 9 ml/min/1.73m.2 Ambulatory 24-hour mean arterial BP (MAP) remained unchanged in donors but decreased by 5 mm Hg in recipients (P < 0.05). Carotid-femoral PWV increased by 0.3 m/s in donors (P < 0.05) but remained unchanged in recipients. AIx was unaltered after LKD but decreased following RT (P < 0.01), and Pexcess did not change in either group. Resting forearm resistance (Rrest), measured by venous occlusion plethysmography, increased after LKD (P < 0.05) but was unaffected by RT, while no changes were seen in minimum resistance (Rmin). ΔPWV showed a positive linear association to Δ24-hour MAP in both groups. Multiple linear regression analysis (adjusting for age, gender, and the baseline value of the studied parameter) did not detect independent effects of graft function on 24-hour MAP, PWV, AIx, vascular resistance, or Pexcess, whereas low post-donation GFR was related to higher AIx and Rrest. CONCLUSIONS RT reduced BP and AIx without affecting PWV, whereas LKD resulted in increased PWV and Rrest, despite unchanged BP.
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Affiliation(s)
- Niels H Buus
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Institute of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Rasmus K Carlsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Alun D Hughes
- Institute of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Karin Skov
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
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10
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Korogiannou M, Xagas E, Marinaki S, Sarafidis P, Boletis JN. Arterial Stiffness in Patients With Renal Transplantation; Associations With Co-morbid Conditions, Evolution, and Prognostic Importance for Cardiovascular and Renal Outcomes. Front Cardiovasc Med 2019; 6:67. [PMID: 31179288 PMCID: PMC6543273 DOI: 10.3389/fcvm.2019.00067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Patients with chronic kidney disease (CKD), particularly those with end-stage renal disease (ESRD), are at increased risk of cardiovascular events and mortality. The spectrum of arterial remodeling in CKD and ESRD includes atheromatosis of middle-sized conduit arteries and, most importantly, the process of arteriosclerosis, characterized by increased arterial stiffness of aorta and the large arteries. Longitudinal studies showed that arterial stiffness and abnormal wave reflections are independent cardiovascular risk factors in several populations, including patients with CKD and ESRD. Kidney transplantation is the treatment of choice for patients with ESRD, associated with improved survival and better quality of life in relation to hemodialysis or peritoneal dialysis. However, cardiovascular mortality in transplanted patients remains much higher than that in general population, a finding that is at least partly attributed to adverse lesions in the vascular tree of these patients, generated during the progression of CKD, which do not fully reverse after renal transplantation. This article attempts to provide an overview of the field of arterial stiffness in renal transplantation, discussing in detail available studies on the degree and the associations of arterial stiffness with other co-morbidities in renal transplant recipients, the prognostic significance of arterial stiffness for cardiovascular events, renal events and mortality in these individuals, as well as studies examining the changes in arterial stiffness following renal transplantation.
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Affiliation(s)
- Maria Korogiannou
- Department of Nephrology and Renal Transplantation Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Xagas
- Department of Nephrology and Renal Transplantation Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Marinaki
- Department of Nephrology and Renal Transplantation Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John N Boletis
- Department of Nephrology and Renal Transplantation Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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11
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Zanoli L, Lentini P, Briet M, Castellino P, House AA, London GM, Malatino L, McCullough PA, Mikhailidis DP, Boutouyrie P. Arterial Stiffness in the Heart Disease of CKD. J Am Soc Nephrol 2019; 30:918-928. [PMID: 31040188 DOI: 10.1681/asn.2019020117] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
CKD frequently leads to chronic cardiac dysfunction. This complex relationship has been termed as cardiorenal syndrome type 4 or cardio-renal link. Despite numerous studies and reviews focused on the pathophysiology and therapy of this syndrome, the role of arterial stiffness has been frequently overlooked. In this regard, several pathogenic factors, including uremic toxins (i.e., uric acid, phosphates, endothelin-1, advanced glycation end-products, and asymmetric dimethylarginine), can be involved. Their effect on the arterial wall, direct or mediated by chronic inflammation and oxidative stress, results in arterial stiffening and decreased vascular compliance. The increase in aortic stiffness results in increased cardiac workload and reduced coronary artery perfusion pressure that, in turn, may lead to microvascular cardiac ischemia. Conversely, reduced arterial stiffness has been associated with increased survival. Several approaches can be considered to reduce vascular stiffness and improve vascular function in patients with CKD. This review primarily discusses current understanding of the mechanisms concerning uremic toxins, arterial stiffening, and impaired cardiac function, and the therapeutic options to reduce arterial stiffness in patients with CKD.
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Affiliation(s)
| | - Paolo Lentini
- Division of Nephrology and Dialysis, St. Bassiano Hospital, Bassano del Grappa, Italy
| | - Marie Briet
- Institut National de la Santé et de la Recherche Médicale U1083, National Center for Scientific Research Joint Research Unit 6214, Centre Hospitalo-Universitaire d'Angers, Université d'Angers, Angers, France
| | - Pietro Castellino
- Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrew A House
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Gerard M London
- Institut National de la Santé et de la Recherche Médicale U970, Paris, France
| | - Lorenzo Malatino
- Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Peter A McCullough
- Department of Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | | | - Pierre Boutouyrie
- Institut National de la Santé et de la Recherche Médicale U970, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; and.,Department of Pharmacology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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12
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Safar ME, Asmar R, Benetos A, Blacher J, Boutouyrie P, Lacolley P, Laurent S, London G, Pannier B, Protogerou A, Regnault V. Interaction Between Hypertension and Arterial Stiffness. Hypertension 2019; 72:796-805. [PMID: 30354723 DOI: 10.1161/hypertensionaha.118.11212] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Michel E Safar
- From the Diagnosis and Therapeutics Center, Hôtel-Dieu Hospital, Paris, France (M.E.S., J.B.)
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland/Beirut, Lebanon (R.A.)
| | - Athanase Benetos
- Department of Geriatrics, Nancy University Hospital, Université de Lorraine, Inserm U1116, DCAC, France (A.B.)
| | - Jacques Blacher
- From the Diagnosis and Therapeutics Center, Hôtel-Dieu Hospital, Paris, France (M.E.S., J.B.)
| | - Pierre Boutouyrie
- Department of Pharmacology, Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital; Paris-Descartes University; PARCC-Inserm U970, Paris, France (P.B., S.L.)
| | - Patrick Lacolley
- Université de Lorraine, Inserm U1116, DCAC, Nancy, France (P.L., V.R.)
| | - Stéphane Laurent
- Department of Pharmacology, Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital; Paris-Descartes University; PARCC-Inserm U970, Paris, France (P.B., S.L.)
| | - Gérard London
- PARCC-Inserm U970, Paris, France (G.L., B.P.); Department of Nephrology, Manhès Hospital, Fleury-Mérogis, France (G.L., B.P.)
| | - Bruno Pannier
- PARCC-Inserm U970, Paris, France (G.L., B.P.); Department of Nephrology, Manhès Hospital, Fleury-Mérogis, France (G.L., B.P.)
| | - Athanase Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (A.P.)
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13
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[Essential hypertension: Definitions, hemodynamic, clinical and therapeutic review]. Presse Med 2019; 48:19-28. [PMID: 30665781 DOI: 10.1016/j.lpm.2018.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/19/2018] [Accepted: 11/27/2018] [Indexed: 01/31/2023] Open
Abstract
Arterial hypertension is à chronic disease that affects more than 25 % of the French adult population. Increased peripheral resistance combined with normal cardiac output is a special feature of arterial hypertension. The increase in the resistance of arterioles remains an important feature of arterial hypertension while the study of the rigidity of large arterials trunks remains poorly explored. Pulse wave velocity (PWV) measurement has been established as one of the major independent predictors of cardiovascular events in arterial hypertension.
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14
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Jia G, Aroor AR, Hill MA, Sowers JR. Role of Renin-Angiotensin-Aldosterone System Activation in Promoting Cardiovascular Fibrosis and Stiffness. Hypertension 2018; 72:537-548. [PMID: 29987104 PMCID: PMC6202147 DOI: 10.1161/hypertensionaha.118.11065] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Guanghong Jia
- Diabetes and Cardiovascular Research Center, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Research Service, Truman Memorial Veterans Hospital, Columbia, MO, 65201, USA
| | - Annayya R. Aroor
- Diabetes and Cardiovascular Research Center, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Research Service, Truman Memorial Veterans Hospital, Columbia, MO, 65201, USA
| | - Michael A. Hill
- Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, 65211, USA
| | - James R. Sowers
- Diabetes and Cardiovascular Research Center, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, 65211, USA
- Research Service, Truman Memorial Veterans Hospital, Columbia, MO, 65201, USA
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Abstract
PURPOSE OF REVIEW Increased arterial stiffness, an abnormal structural and functional change in the vascular wall, is a precursor for hypertension, coronary heart disease, stroke, and associated cardiovascular disease (CVD). The aim of this paper is to review the etiology of arterial stiffening and potential therapeutic approaches to modulate arterial fibrosis and stiffness. RECENT FINDINGS The Framingham Heart Study demonstrated that arterial stiffness is an independent predictor of CVD and related morbidity and mortality. Dysfunction of endothelial cells, vascular smooth muscle cells, extracellular matrix, and other functional elements of the vessel wall contribute to underlying pathophysiology of increased arterial stiffness. An activated renin-angiotensin-aldosterone system, oxidative stress, abnormal peri-vascular adipose tissue, inflammation, and increased sympathetic nervous system activity are associated with the development and progression of arterial fibrosis, stiffening, and associated CVD. In this review, we will discuss the structural and function changes and mechanisms of the vessel wall in arterial stiffness and provide potential therapeutic strategies.
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Cheddani L, Radulescu C, Chaignon M, Karras A, Neuzillet Y, Duong JP, Tabibzadeh N, Letavernier E, Delahousse M, Haymann JP. From arterial stiffness to kidney graft microvasculature: Mortality and graft survival within a cohort of 220 kidney transplant recipients. PLoS One 2018; 13:e0195928. [PMID: 29723212 PMCID: PMC5933694 DOI: 10.1371/journal.pone.0195928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/02/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Aortic stiffness assessed by carotid-femoral pulse wave velocity (CF-PWV) is a predictor of mortality in several populations. However, little is known in kidney transplant recipients. Our objectives were to evaluate the ability of CF-PWV measured 3 months following transplantation to predict mortality, graft loss and its potential links to measured Glomerular Filtration Rate (mGFR) or kidney graft microvasculature parameters. METHODS The study is based on a monocentric retrospective cohort including 220 adult kidney graft recipients evaluated three months after transplantation. CF-PWV measures, clinical, laboratory and histological data performed at 3 (M3) and 12 months (M12) following transplantation were retrospectively collected. The two primary endpoints were all-cause mortality and occurrence of end stage renal disease (ESRD) defined by initiation of dialysis. RESULTS After a median follow up of 5.5 years [1.9; 8.8], death and graft loss occurred in 10 and 12 patients respectively. M3 CF-PWV was an independent mortality risk factor (HR = 1.29 [1.03; 1.61]; p = 0.03), despite no aortic stiffness variation during the first year of transplantation. Of notice, M3 CF-PWV was not associated with M12 mGFR or ESRD outcome. Graft microcirculation assessed by Banff vascular fibrous intimal thickening score (cv) worsened between M3 and M12 (p = 0.01), but no link was found with CF-PWV, mGFR or ESRD outcome. Surprisingly, acute rejections at M3 were associated after adjustment with mortality (p = 0.03) but not ESRD. CONCLUSION Aortic stiffness measured 3 months after kidney transplantation is a strong predictor of mortality with no obvious influence on kidney graft microvasculature or graft loss.
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Affiliation(s)
- Lynda Cheddani
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
| | | | - Michel Chaignon
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
| | - Alexandre Karras
- Service de Néphrologie, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- Université Paris Descartes, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U970- PARCC, Paris, France
| | | | - Jean-Paul Duong
- Service d’Anatomopathologie, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Necker, Paris, France
| | - Nahid Tabibzadeh
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
| | - Emmanuel Letavernier
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
| | - Michel Delahousse
- Service de Néphrologie et Transplantation rénale, Hôpital Foch, Suresnes, France
- INSERM U-1018; CESP Team 5 (EpReC, Renal and Cardiovascular Epidemiology), Villejuif, France
| | - Jean-Philippe Haymann
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
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