RESUMEN

INTRODUCTION: Brazil ranks second in the absolute number of transplantations in the world. Despite improvements in graft survival, many patients will progress to graft loss and return to dialysis. Concerns exist regarding adverse clinical outcomes in this population when undergone peritoneal dialysis (PD). OBJECTIVE: To compare the occurrence of mortality, technique failure, and peritonitis among incident patients in PD coming from either Tx or pre-dialysis treatment. METHODOLOGY: A retrospective study in which 47 adult patients with Tx failure (Tx group) were matched for age, gender, diabetes mellitus (DM), modality and start year of PD, with 1:1 predialysis patient (nTx group). The Fine-Gray competing risk model was used to analyze mortality and technique failure. RESULTS: Compared to nTx, the Tx group had a lower body mass index, serum potassium, and albumin concentrations. A higher ferritin level, transferrin saturation and the number of patients with positive serology for viral hepatitis were also observed in the Tx group. In the multivariate analysis, patients of the Tx group had 4.4-times higher risk of death (p = 0.007), with infection as the main cause. Technique failure and peritonitis were similar in both groups. CONCLUSION: Previous Tx is a risk factor for mortality but not for technique failure or peritonitis in incident patients on a PD program.

Asunto(s)

Fallo Renal Crónico/epidemiología , Trasplante de Riñón/efectos adversos , Diálisis Peritoneal , Peritonitis/epidemiología , Adulto , Anciano , Índice de Masa Corporal , Brasil/epidemiología , Femenino , Rechazo de Injerto/complicaciones , Rechazo de Injerto/epidemiología , Rechazo de Injerto/patología , Humanos , Estimación de Kaplan-Meier , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Peritonitis/complicaciones , Peritonitis/terapia , Factores de Riesgo , Tasa de Supervivencia

RESUMEN

BACKGROUND: Chronic Kidney Disease (CKD) is a worldwide public health problem. The prevalence of CKD is rising especially in elderly, as consequence of population-ageing related to socioeconomic development and better life expectancy. There are scarce studies evaluating CKD progression and its associated factors in elderly patients. METHODS: This is a retrospective observational study including 340 patients (≥ 65 years old) CKD stages 3a-5 non-dialysis, incidents in an outpatient CKD clinic, followed by 2.1 years. CKD progression was assessed by the slope of eGFR calculated by CKD-EPI and BIS 1 equations. The patients were divided in progressor and non-progressor groups (eGFR slope < or ≥ 0 mL/min/1.73 m2/year, respectively). RESULTS: Kidney function declined in 193 (57%) patients. In this group, the progression rate was -2.83 (-5.1 / -1.1) mL /min /1.73 m2 /year. Compared to non progressor, the progressor patients were younger [72 (69-78) vs. 76 (69-80) years; p = 0.02]; had higher proportion of diabetic nephropathy, higher serum phosphorus [3.8 (3.3-4.1) vs. 3.5 (3.9-4.1) mg/dL; p = 0.04] and proteinuria [0.10 (0-0.9 vs. 0 (0-0.3)] g/L; p = 0.007)] at the admission. In the logistic regression analysis adjusted for gender and eGFR, proteinuria was independently associated with CKD progression [OR (Odds Ratio) (1.83; 95% CI, 1.17-2.86; p < 0.01)]. CONCLUSION: CKD progression was observed in the majority of elderly CKD patients and proteinuria was the most important factor associated to the decline of kidney function in this population.

Asunto(s)

Insuficiencia Renal Crónica/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Nefropatías Diabéticas/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Proteinuria/epidemiología , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/patología

RESUMEN

The authors of this "fast reading" present the data they have considered as more relevant in the KDIGO 2012 as concerned to evaluation and management of chronic kidney disease. The text does not correspond to their opinion, it is a brief presentation of guidelines that could be useful in clinical practice.

Asunto(s)

Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia , Humanos , Guías de Práctica Clínica como Asunto

RESUMEN

Os autores desta "leitura rápida" apresentam os dados que consideraram mais relevantes na versão 2012 do KDIGO referente à avaliação e manuseio da doença renal crônica. Não se trata da opinião dos autores, mas sim de uma apresentação mais concisa das diretrizes, que podem ser úteis na prática clínica.

---

The authors of this "fast reading" present the data they have considered as more relevant in the KDIGO 2012 as concerned to evaluation and management of chronic kidney disease. The text does not correspond to their opinion, it is a brief presentation of guidelines that could be useful in clinical practice.

Asunto(s)

Humanos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia , Guías de Práctica Clínica como Asunto

RESUMEN

OBJETIVO: Investigar a relação entre a transfusão de hemácias e os níveis séricos de Fas solúvel, eritropoietina e citocinas inflamatórias em pacientes gravemente enfermos, com e sem insuficiência renal aguda. MÉTODOS: Os seguintes grupos foram estudados: pacientes gravemente enfermos com insuficiência renal aguda (n=30) e sem insuficiência renal aguda (n=13), pacientes portadores de doença renal crônica terminal em hemodiálise (n=25) e indivíduos saudáveis (n=21). Os níveis séricos de Fas solúvel, eritropoietina, interleucina 6, interleucina 10 e ferro, além da concentração de hemoglobina e de hematócrito, foram analisados em todos os grupos. A associação entre tais variáveis foram estudadas nos pacientes gravemente enfermos. RESULTADOS: Os níveis séricos de eritropoietina mostraram-se mais elevados nos pacientes gravemente enfermos do que nos dos demais grupos. Concentrações mais baixas de hemoglobina foram documentadas nos pacientes com insuficiência renal aguda em relação aos demais. Níveis séricos mais elevados de Fas solúvel foram observados nos pacientes com insuficiência renal aguda e doença renal crônica terminal. Pacientes gravemente enfermos transfundidos apresentaram níveis séricos mais elevados de Fas solúvel (5.906±2.047 e 1.920±1.060; p<0,001), interleucina 6 (518±537 e 255±502; p=0,02), interleucina 10 (35,8±30,7 e 18,5±10,9; p=0,02) e ferro, além de maior mortalidade em 28 dias. Os níveis séricos de Fas solúvel mostraram-se independentemente associados ao número de transfusões (p=0,02). O nível sérico de Fas solúvel foi um preditor independente da necessidade de transfusão de hemácias em pacientes gravemente enfermos (p=0,01). CONCLUSÃO: O nível sérico de Fas solúvel é um preditor independente da necessidade de transfusão de hemácias em pacientes gravemente enfermos, com ou sem insuficiência renal aguda. Mais estudos clínicos e laboratoriais são necessários para confirmar tal resultado.

---

OBJECTIVE: To investigate the relation between the need for red blood cell transfusion and serum levels of soluble-Fas, erythropoietin and inflammatory cytokines in critically ill patients with and without acute kidney injury. METHODS: We studied critically ill patients with acute kidney injury (n=30) and without acute kidney injury (n=13), end-stage renal disease patients on hemodialysis (n=25) and healthy subjects (n=21). Serum levels of soluble-Fas, erythropoietin, interleukin 6, interleukin 10, iron status, hemoglobin and hematocrit concentration were analyzed in all groups. The association between these variables in critically ill patients was investigated. RESULTS: Critically ill patients (acute kidney injury and non-acute kidney injury patients) had higher serum levels of erythropoietin than the other groups. Hemoglobin concentration was lower in the acute kidney injury patients than in other groups. Serum soluble-Fas levels were higher in acute kidney injury and end-stage renal disease patients. Critically ill patients requiring red blood cell transfusions had higher serum levels of soluble-Fas (5,906±2,047 and 1,920±1,060; p<0.001), interleukin 6 (518±537 and 255+502; p=0.02) and interleukin 10 (35.8±30.7 and 18.5±10.9; p=0.02), better iron status and higher mortality rates in the first 28 days in intensive care unit. Serum soluble-Fas levels were independently associated with the number of red blood cell units transfused (p=0.02). Serum soluble-Fas behaved as an independent predictor of the need for red blood cell transfusion in critically ill patients (p=0.01). CONCLUSIONS: Serum soluble-Fas level is an independent predictor of the need for red blood cell transfusion in critically ill patients with or without acute kidney injury. Further studies are warranted to reconfirm this finding.

Asunto(s)

Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , /sangre , Enfermedad Crítica , Transfusión de Eritrocitos , Eritropoyetina/sangre , Interleucinas/sangre , Enfermedad Aguda , Biomarcadores/sangre , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática

RESUMEN

BACKGROUND: Exacerbation of chronic glaucoma or acute glaucoma is occasionally observed in patients undergoing hemodialysis (HD) because of anterior chamber depth changes during this therapy. PURPOSE: To evaluate anterior chamber depth and axial length in patients during HD sessions. METHODS: A total of 67 eyes of 35 patients were prospectively enrolled. Axial length and anterior chamber depth were measured using ultrasonic biometry, and these measures were evaluated at three different times during HD sessions. Body weight and blood pressure pre- and post-HD were also measured. RESULTS: There was no difference in the axial length between the three measurements (P = 0.241). We observed a significantly decreased anterior chamber depth (P = 0.002) during HD sessions. CONCLUSION: Our results support the idea that there is a change in anterior chamber depth in HD sessions.

RESUMEN

OBJECTIVE: To investigate the relation between the need for red blood cell transfusion and serum levels of soluble-Fas, erythropoietin and inflammatory cytokines in critically ill patients with and without acute kidney injury. METHODS: We studied critically ill patients with acute kidney injury (n=30) and without acute kidney injury (n=13), end-stage renal disease patients on hemodialysis (n=25) and healthy subjects (n=21). Serum levels of soluble-Fas, erythropoietin, interleukin 6, interleukin 10, iron status, hemoglobin and hematocrit concentration were analyzed in all groups. The association between these variables in critically ill patients was investigated. RESULTS: Critically ill patients (acute kidney injury and non-acute kidney injury patients) had higher serum levels of erythropoietin than the other groups. Hemoglobin concentration was lower in the acute kidney injury patients than in other groups. Serum soluble-Fas levels were higher in acute kidney injury and end-stage renal disease patients. Critically ill patients requiring red blood cell transfusions had higher serum levels of soluble-Fas (5,906±2,047 and 1,920±1,060; p<0.001), interleukin 6 (518±537 and 255+502; p=0.02) and interleukin 10 (35.8±30.7 and 18.5±10.9; p=0.02), better iron status and higher mortality rates in the first 28 days in intensive care unit. Serum soluble-Fas levels were independently associated with the number of red blood cell units transfused (p=0.02). Serum soluble-Fas behaved as an independent predictor of the need for red blood cell transfusion in critically ill patients (p=0.01). CONCLUSIONS: Serum soluble-Fas level is an independent predictor of the need for red blood cell transfusion in critically ill patients with or without acute kidney injury. Further studies are warranted to reconfirm this finding.

Asunto(s)

Enfermedad Crítica , Transfusión de Eritrocitos , Eritropoyetina/sangre , Interleucinas/sangre , Receptor fas/sangre , Enfermedad Aguda , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

INTRODUCTION: The Nutrition Committee of the Brazilian Society of Nephrology (SBN) held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention. OBJECTIVE: To describe epidemiological and nutritional aspects of hemodialysis patients. METHOD: Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected. RESULTS: 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%), Diabetic Nephropathy (24.6%), unknown/undiagnosed causes (19.9%), Glomerulopathies (13.6%) and others (11.2%). Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years. CONCLUSION: This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.

Asunto(s)

Fallo Renal Crónico/terapia , Estado Nutricional , Diálisis Renal , Adolescente , Adulto , Brasil , Estudios Transversales , Estudios Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven

RESUMEN

BACKGROUND: Cardiovascular complications remain the main cause of mortality in patients with chronic kidney disease (CKD). Adiponectin is an adipose tissue-derived protein that carries important cardioprotective properties. We aimed at investigating the determinants of adiponectin levels in CKD patients. METHODS: This prospective observational study included 98 CKD patients [glomerular filtration rate (GFR) 36.1+-14.4 ml/min, 56.5+-10.4 y, 63% male, 31% diabetics, and body mass index (BMI) 27.1+-5.2 kg/m²]. Evaluation of adiponectin (imunoenzimatic assay), laboratory parameters, nutritional status (subjective global assessment), total body fat (dual x-ray energy absorptiometry), and visceral and subcutaneous abdominal fat (computed tomography) was performed at baseline and after 12 months. RESULTS: Adiponectin correlated with GFR (r = -0.45; p < 0.001), proteinuria (r = 0.21; p = 0.04), BMI (r = -0.33; p < 0.01), and visceral fat (r = -0.49; p < 0.001). In the linear regression analysis, the determinants of adiponectin levels were sex (female ß = 3.8; p < 0.01), age (ß = 0.14; p = 0.03), GFR (ß = -0.15; p < 0.01) and visceral fat (ß = -0.04; p < 0.001) (R² = 0.41). After 12 months, a progression of the disease was evidenced by the reduction of GFR (-1.6+-6.3 ml/min; p = 0.01) and increase of proteinuria (0.3+-0.8 g/d; p < 0.01). An accumulation of visceral fat was observed, from 97+-73 cm² to 111+-82 cm² (p < 0.001), with a concomitant reduction of adiponectin concentration, from 27.6+-7.5 mg/l to 22.2+-11.6 mg/l (p < 0.001). Body weight, BMI, total body fat, and subcutaneous abdominal fat remained unchanged. After adjustments for the baseline determinants of adiponectin, the increase in visceral fat was independently associated with overtime decrease in adiponectin levels (ß = -0.04; p = 0.025; R² = 0.21). CONCLUSION: Age, sex, renal function and visceral fat were independently associated with adiponectin levels in nondialyzed CKD patients. However, variation in visceral fat was the only predictor of variation in adiponectin levels over 12 months.

Asunto(s)

Adiponectina/sangre , Insuficiencia Renal Crónica/sangre , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos

RESUMEN

INTRODUÇÃO: O Comitê de Nutrição da Sociedade Brasileira de Nefrologia (SBN) realizou, em 2010, o primeiro Censo Brasileiro de Nutrição em pacientes em Hemodiálise. Dados multicêntricos contribuem para o desenvolvimento de condutas clínicas e intervenção nutricional. OBJETIVO: Descrever aspectos nutricionais e epidemiológicos de pacientes em hemodiálise. MÉTODO: Estudo transversal em 36 clínicas de diálise, 2.622 participantes selecionados aleatoriamente. Foram coletados: registros sociodemográficos, clínicos, bioquímicos e antropométricos. RESULTADOS: Dos pacientes, 60,45% era da região Sudeste, 13,53% Nordeste, 12,81% Sul, 10,33% Centro-Oeste e 2,86% Norte. Cerca de 58% eram homens e 63,1% tinham menos de 60 anos. Casados ou em união estável, 58,5% deles. Aproximadamente 80% dependia do Sistema Único de Saúde. O tabagismo apresentou diferença entre sexo e idade. As etiologias presuntivas foram nefroesclerose hipertensiva 26,4%, nefropatia diabética 24,6%, causas desconhecidas/não diagnosticadas 19,9%, glomerulopatias 13,6% e outros 11,2%. A hipertensão arterial e o Diabetes Mellitus acometiam aproximadamente 30% dos pacientes, principalmente aqueles acima de 60 anos. O Índice de Massa Corporal não diferiu entre sexos, embora tenha diferido entre grupos etários e quando utilizados critérios de avaliação distintos. A média de circunferência da cintura de homens e mulheres foi, respectivamente, 90,5 cm e 88,0 cm. O perfil lipídico não diferiu entre às faixas etárias, porém, houve diferenças entre sexos. Os valores de albumina estiveram menores nas mulheres e em pacientes com idade superior a 60 anos. CONCLUSÃO: O estudo caracterizou os pacientes em hemodiálise no Brasil em 2010, podendo subsidiar novos estudos para acompanhamento de transições nutricionais e epidemiológicas da população.

---

INTRODUCTION: The Nutrition Committee of the Brazilian Society of Nephrology (SBN) held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention. OBJECTIVE: To describe epidemiological and nutritional aspects of hemodialysis patients. METHOD: Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected. RESULTS: 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%), Diabetic Nephropathy (24.6%), unknown/undiagnosed causes (19.9%), Glomerulopathies (13.6%) and others (11.2%). Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years. CONCLUSION: This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.

Asunto(s)

Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Fallo Renal Crónico/terapia , Estado Nutricional , Diálisis Renal , Brasil , Estudios Transversales , Estudios Epidemiológicos

RESUMEN

INTRODUÇÃO: As complicações cardiovasculares permanecem como a principal causa de mortalidade nos pacientes portadores de doença renal crônica (DRC). A adiponectina é uma proteína produzida pelo tecido adiposo que apresenta importante propriedade cardioprotetora. O nosso objetivo foi investigar os determinantes dos níveis de adiponectina nos pacientes com DRC. MÉTODOS: Este estudo prospectivo observacional incluiu 98 pacientes [taxa de filtração glomerular (TFG) 36,1+-14,4 ml/min; 56,5+-10,4 anos; 63% homens; 31% diabéticos e índice de massa corporal (IMC) 27,1+-5,2 kg/m²]. A avaliação da adiponectina (teste imunoenzimático), dos parâmetros laboratoriais, do estado nutricional (avaliação global subjetiva), da gordura corporal total (absortometria de raios-x de dupla energia) e da gordura abdominal visceral e subcutânea (tomografia computadorizada) foi realizada no início e após 12 meses. RESULTADOS: A adiponectina correlacionou-se com a TFG (r = -0,45; p < 0,001), a proteinúria (r = 0,21; p = 0,04), o IMC (r = -0,33; p < 0,01) e a gordura visceral (r = -0,49; p < 0,001). Na análise de regressão múltipla, os determinantes das concentrações de adiponectina foram o sexo (feminino β = 3,8; p < 0,01), a idade (β = 0,14; p = 0,03), a TFG (β = -0,15; p < 0,01) e a gordura visceral (β = -0,04; p < 0,001) (R² = 0,41). Após 12 meses, a progressão da DRC foi evidenciada pela diminuição da TFG (-1,6+-6,3 ml/min; p = 0,01) e aumento da proteinúria (0,3+-0,8 g/d; p < 0,01). Houve um aumento da gordura visceral de 97+-73 cm² para 111+-82 cm² (p < 0,001) e concomitante redução dos níveis de adiponectina, de 27,6+-7,5 mg/l para 22,2+-11,6 mg/l (p < 0,001). O peso corporal, o IMC, a gordura corporal total e a gordura abdominal subcutânea não se alteraram neste período. Ajustando pelos fatores associados à adiponectina, observamos que somente o acúmulo de gordura visceral ao longo do tempo determinou a redução nos níveis de adiponectina (β = -0,04; p = 0,025; R² = 0,21). CONCLUSÃO: A idade, o sexo, a função renal e a gordura visceral estiveram independentemente associados com os níveis de adiponectina nos pacientes com DRC na fase não dialítica. No entanto, a mudança da gordura visceral foi o único preditor das variações nos níveis de adiponectina ao longo de 12 meses.

---

BACKGROUND: Cardiovascular complications remain the main cause of mortality in patients with chronic kidney disease (CKD). Adiponectin is an adipose tissue-derived protein that carries important cardioprotective properties. We aimed at investigating the determinants of adiponectin levels in CKD patients. METHODS: This prospective observational study included 98 CKD patients [glomerular filtration rate (GFR) 36.1+-14.4 ml/min, 56.5+-10.4 y, 63% male, 31% diabetics, and body mass index (BMI) 27.1+-5.2 kg/m²]. Evaluation of adiponectin (imunoenzimatic assay), laboratory parameters, nutritional status (subjective global assessment), total body fat (dual x-ray energy absorptiometry), and visceral and subcutaneous abdominal fat (computed tomography) was performed at baseline and after 12 months. RESULTS: Adiponectin correlated with GFR (r = -0.45; p < 0.001), proteinuria (r = 0.21; p = 0.04), BMI (r = -0.33; p < 0.01), and visceral fat (r = -0.49; p < 0.001). In the linear regression analysis, the determinants of adiponectin levels were sex (female β = 3.8; p < 0.01), age (β = 0.14; p = 0.03), GFR (β = -0.15; p < 0.01) and visceral fat (β = -0.04; p < 0.001) (R² = 0.41). After 12 months, a progression of the disease was evidenced by the reduction of GFR (-1.6+-6.3 ml/min; p = 0.01) and increase of proteinuria (0.3+-0.8 g/d; p < 0.01). An accumulation of visceral fat was observed, from 97+-73 cm² to 111+-82 cm² (p < 0.001), with a concomitant reduction of adiponectin concentration, from 27.6+-7.5 mg/l to 22.2+-11.6 mg/l (p < 0.001). Body weight, BMI, total body fat, and subcutaneous abdominal fat remained unchanged. After adjustments for the baseline determinants of adiponectin, the increase in visceral fat was independently associated with overtime decrease in adiponectin levels (β = -0.04; p = 0.025; R² = 0.21). CONCLUSION: Age, sex, renal function and visceral fat were independently associated with adiponectin levels in nondialyzed CKD patients. However, variation in visceral fat was the only predictor of variation in adiponectin levels over 12 months.

Asunto(s)

Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adiponectina/sangre , Insuficiencia Renal Crónica/sangre , Estudios Transversales , Estudios Prospectivos

RESUMEN

BACKGROUND: Hypovitaminosis D is highly prevalent among patients with chronic kidney disease and has been associated with worse outcome even in the earlier stages of the disease. OBJECTIVE: This study aimed to investigate the risk factors for hypovitaminosis D in nondialyzed patients with chronic kidney disease. DESIGN: This cross-sectional study included 120 patients with chronic kidney disease at stages 2 to 5 (62% male, age: 55.4 ± 11.3 year, estimated glomerular filtration rate: 35.1 ± 15 mL/minute, body mass index [BMI]: 27.1 ± 5.2 kg/m(2), 31% diabetics). Serum 25-hydroxivitamin D [25(OH)D] was measured by chemiluminescence. Subjective global assessment, total body fat (dual-energy X-ray absorptiometry), visceral and subcutaneous abdominal fat (computed tomography), and several laboratory parameters were assessed. RESULTS: Insufficiency of 25(OH)D (15 to 30 ng/mL) was observed in 55% and deficiency (<15 ng/mL) in 20% of the patients. Patients with diabetes, BMI ≥30 kg/m(2), and who had the blood collection during the winter or spring had lower levels of 25(OH)D. Serum 25(OH)D correlated inversely with parathyroid hormone, proteinuria, insulin resistance, leptin, and subcutaneous abdominal fat. The risk factors for hypovitaminosis D were diabetes (odds ratio: 3.8; 95% CI: 1.2 to 11.7; P = .022) and BMI ≥30 kg/m(2) (odds ratio: 4.3; 95% CI: 1.2 to 15.3; P = .018). In the logistic regression analysis adjusting for gender, skin color, and season of the year, diabetes and BMI ≥30 kg/m(2) were independently associated with hypovitaminosis D. CONCLUSIONS: Diabetes and obesity were the risk factors for hypovitaminosis D in nondialyzed patients with chronic kidney disease. Effective interventional protocols of vitamin D supplementation taking into account these risk factors are warranted for this population.

Asunto(s)

Fallo Renal Crónico/complicaciones , Deficiencia de Vitamina D/etiología , Adulto , Anciano , Distribución de la Grasa Corporal , Índice de Masa Corporal , Estudios Transversales , Complicaciones de la Diabetes , Suplementos Dietéticos , Femenino , Tasa de Filtración Glomerular , Humanos , Resistencia a la Insulina , Fallo Renal Crónico/fisiopatología , Mediciones Luminiscentes , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Hormona Paratiroidea/sangre , Factores de Riesgo , Estaciones del Año , Vitamina D/administración & dosificación , Vitamina D/análogos & derivados , Vitamina D/sangre

RESUMEN

BACKGROUND: Waist circumference (WC) has been well recognized as a surrogate marker of abdominal adiposity. In peritoneal dialysis (PD) patients, however, aspects related to this dialysis modality, such as abdominal distension, presence of catheter and frequent hernia, raise questions regarding the reliability of WC measurements. Herein, we investigated for the first time whether WC is a reliable marker of abdominal adiposity in PD population. METHODS: This study included 107 prevalent PD patients [56% male, age 52 ± 17 years, 35% diabetics, body mass index (BMI) 24.8 ± 3.9 kg/m(2)]. WC measured at umbilicus level was evaluated against the trunk fat assessed by dual-energy x-ray absorptiometry at baseline and after 6 months. All measurements were taken with the empty abdominal cavity. RESULTS: At baseline, a strong correlation of WC with trunk fat (r = 0.81; P < 0.001) was observed. Adjusting for gender, age, dialysis vintage and BMI, WC was independently associated with trunk fat (ß = 0.30; P < 0.001; R(2) = 0.77). The agreement between WC and trunk fat was 0.59 (kappa statistic) and the area under the curve was 0.90. In the prospective evaluation, we observed that changes in WC correlated with changes in trunk fat as well (r = 0.49; P < 0.001). The kappa statistic of 0.48 remained indicative of a moderate agreement between the methods. The receiver operating characteristic curve analysis showed that WC was sensitive to detect changes in trunk fat (area under the curve 0.76). In the logistic regression analysis adjusting for gender, age and BMI, changes in WC were independently associated with changes in trunk fat. CONCLUSION: The simple anthropometric method of WC is a reliable marker of abdominal adiposity in PD patients.

Asunto(s)

Grasa Abdominal/diagnóstico por imagen , Fallo Renal Crónico/terapia , Diálisis Peritoneal/métodos , Circunferencia de la Cintura , Absorciometría de Fotón/métodos , Adulto , Anciano , Biomarcadores/análisis , Análisis Químico de la Sangre , Índice de Masa Corporal , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/diagnóstico , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Diálisis Peritoneal/efectos adversos , Estudios Prospectivos , Curva ROC , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Resultado del Tratamiento

RESUMEN

AIM: To evaluate the intraocular pressure and ocular perfusion pressure during a hemodialysis. METHODS: Sixty-seven eyes from thirty-five patients were evaluated at the beggining of hemodialysis, 2 hours and 4 hours after initiation. Intraocular pressure was evaluated using a Tonopen. Systolic and diastolic arterial pressures were measured with a manual sphygmomanometer. The ocular perfusion pressure was estimated by measuring the difference between 2/3 of the mean arterial pressure and the intraocular pressure values. Generalized estimating equations were used to evaluate the difference between the repeated measurements using the appropriate correction for inter-eye dependency. RESULTS: There was no statistically significant difference in ocular perfusion pressure, in intraocular pressure (p=0.93) and in systolic arterial pressure (p=0.92) at the three time points (p=0.69). But, when analyzing the extreme values, some patients exhibited lower diastolic perfusion pressures at all time points. CONCLUSION: Our results did not support the view that significant changes in ocular perfusion pressure and intraocular pressure occur during hemodialysis session. However, we observed that some patients exhibited lower diastolic perfusion pressures, which could be a poor prognostic factor for glaucoma patients.

Asunto(s)

Ojo/irrigación sanguínea , Presión Intraocular/fisiología , Diálisis Renal , Adulto , Anciano , Análisis de Varianza , Presión Sanguínea/fisiología , Femenino , Glaucoma/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de Tiempo

RESUMEN

AIM: To evaluate the intraocular pressure and ocular perfusion pressure during a hemodialysis. METHODS: Sixty-seven eyes from thirty-five patients were evaluated at the beggining of hemodialysis, 2 hours and 4 hours after initiation. Intraocular pressure was evaluated using a Tonopen. Systolic and diastolic arterial pressures were measured with a manual sphygmomanometer. The ocular perfusion pressure was estimated by mea suring the difference between 2/3 of the mean arterial pressure and the intraocular pressure values. Generalized estimating equations were used to evaluate the difference between the repeated measurements using the appropriate correction for inter-eye dependency. RESULTS: There was no statistically significant difference in ocular perfusion pressure, in intraocular pressure (p=0.93) and in systolic arterial pressure (p=0.92) at the three time points (p=0.69). But, when analyzing the extreme values, some patients exhibited lower diastolic perfusion pressures at all time points. CONCLUSION: Our results did not support the view that significant changes in ocular perfusion pressure and intraocular pressure occur during hemodialysis session. However, we observed that some patients exhibited lower diastolic perfusion pressures, which could be a poor prognostic factor for glaucoma patients.

---

OBJETIVO: Avaliar a pressão intraocular e a pressão de perfusão ocular durante uma sessão de hemodiálise. MÉTODOS: Sessenta e sete olhos de trinta e cinco pacientes foram avaliados no início, após 2 horas e após 4 horas do início de uma sessão de hemodiálise. A pressão intraocular foi avaliada usando o aparelho Tonopen. Pressões arteriais sistólica e diastólica foram aferidas usando esfigmomanômetro manual. A pressão de perfusão ocular foi estimada por meio do cálculo da diferença entre 2/3 da pressão arterial média e valores da pressão intraocular. Equações de estimação generalizada foram usadas para avaliar a diferença entre medidas repetidas usando correção apropriada para dependência entres olhos. RESULTADOS: Não houve diferença estatisticamente significativa na pressão de perfusão ocular, PIO (p=0,93) e na pressão arterial sistólica (p=0,92) nos três períodos medidos da hemodiálise (p=0,69). Mas, quando analisados valores extremos, alguns pacientes exibiram pressões diastólicas menores em todos os períodos aferidos. CONCLUSÃO: Nossos resultados não apontaram mudanças significativas na pressão de perfusão ocular e pressão intraocular durante a hemodiálise. No entanto, foi observado que alguns pacientes exibiram pressões diastólicas menores, o que pode ser um fator de prognóstico ruim para pacientes com glaucoma.

Asunto(s)

Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ojo/irrigación sanguínea , Presión Intraocular/fisiología , Diálisis Renal , Análisis de Varianza , Presión Sanguínea/fisiología , Glaucoma/fisiopatología , Factores de Riesgo , Factores de Tiempo

RESUMEN

OBJECTIVES: The aim of this study was to evaluate the activity-related energy expenditure (AEE) of patients undergoing hemodialysis (HD) and to compare it with that of healthy controls. DESIGN: This was a cross-sectional study. SETTING: This was an in-center study conducted at the Dialysis Unit, Nephrology Division, Federal University of São Paulo-Oswaldo Ramos Foundation, Brazil. PATIENTS AND METHODS: AEE was evaluated in 32 patients undergoing HD (20 men, aged: 46.3 ± 12.2 years). A subgroup consisting of 22 patients was pair-matched by gender and age with 22 sedentary, healthy individuals. AEE was measured over a period of 5 days using a portable physical activity monitor. Body fat and lean body mass were assessed by dual energy X-ray absorptiometry and body cell mass by bioelectrical impedance analysis. RESULTS: AEE correlated positively with lean body mass and body cell mass, and negatively with age, body fat, and body mass index. From the multiple regression analysis, it was found that age and lean body mass (r(2) = 0.32) or body cell mass (r(2) = 0.30) were the best among the variables that explained variations in AEE. AEE of HD patients in comparison with healthy controls was found to be lower on dialysis days (234 [9.5 to 1,145] kcal/day vs. 565 [214 to 1,319] kcal/day, median [range]; P < .01) as well as on nondialysis days (369 [89.5 to 1,242] kcal/day vs. 565 [214 to 1,319] kcal/day; P = .02). Total energy expenditure of the HD patients on dialysis days (2,051 ± 289 kcal/day) as well as nondialysis days (2,202 ± 283 kcal/day) was also found to be lower in comparison with controls (2,514 ± 307 kcal/day; P < .01). The average contribution of the AEE toward total energy expenditure in HD patients was 15%, whereas in controls it was 24% (P = .03). CONCLUSION: As compared with sedentary, healthy individuals, AEE was reported to be considerably lower in HD patients.

Asunto(s)

Metabolismo Energético , Actividad Motora , Diálisis Renal , Absorciometría de Fotón , Tejido Adiposo/metabolismo , Adulto , Composición Corporal , Índice de Masa Corporal , Calorimetría Indirecta , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Análisis de Regresión , Encuestas y Cuestionarios

RESUMEN

OBJECTIVE: Correction of anemia using epoetin decreases morbidity and increases survival and quality of life in end-stage renal disease. Maintaining hemoglobin levels within the range proposed by guidelines has become a major challenge, with hemoglobin cycling affecting more than 90% of patients undergoing hemodialysis. The variability of hemoglobin levels over time was assessed in our patients. METHODS: Data were retrospectively collected on 249 patients undergoing hemodialysis over a 3-year period at seven centers in Brazil. Hemoglobin was measured at least monthly, and target levels were those between 10.5 g/dL and 12.5 g/dL. Patients were grouped into six categories of variability consistently low (<10.5 g/dL), consistently target range (10.5 to 12.5 g/dL), consistently high (>12.5 g/dL), low amplitude fluctuation with low hemoglobin levels, low amplitude fluctuation with high hemoglobin levels and high amplitude fluctuation. None of the patients maintained stable hemoglobin levels for the entire 36-month period. RESULTS: The mean monthly proportion of patients that had hemoglobin levels within the target range was 50% (range, 42% to 61%). Mean levels above the target (30%) were more frequent than those below it (20%). During 6, 12, and 36 months, proportions of patients with consistently low levels of hemoglobin decreased from 3.6% to 0%, from 31.7% to 2.8% for those with consistently high, from 7.6% to 0% for those with low amplitude fluctuation with low hemoglobin levels and from 41.3% to 8.3% for those with low amplitude fluctuation with high hemoglobin levels. However, the proportions of patients with high amplitude fluctuation increased from 21.5% to 88.9%. CONCLUSION: Maintaining hemoglobin levels within the target range is difficult, especially for longer periods of time. Missing the target seems more often due to levels above it, but high-amplitude fluctuations eventually occur in the majority of patients.

Asunto(s)

Anemia/tratamiento farmacológico , Eritropoyetina/uso terapéutico , Hematínicos/uso terapéutico , Hemoglobinas/análisis , Fallo Renal Crónico/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Anemia/diagnóstico , Anemia/etiología , Epoetina alfa , Femenino , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Proteínas Recombinantes , Valores de Referencia , Diálisis Renal , Estudios Retrospectivos , Adulto Joven

RESUMEN

OBJECTIVES: This study aimed to assess the prevalence of underreporting among patients treated by peritoneal dialysis (PD), and to investigate whether the reported energy intake is influenced by overweight status in this population. DESIGN: This was a prospective, observational study. SETTING: This study took place at the Dialysis Unit of the Nephrology Division, Federal University of São Paulo-Oswaldo Ramos Foundation, São Paulo, Brazil. PATIENTS: Forty adult patients were recruited: 24 men and 16 women; age, 53.4+/-16.5 years; body mass index (BMI), 25.1+/-3.8 kg/m(2) (x+/-SD); median duration of dialysis, 19 months (range, 3 to 101 months). Only patients on PD >3 months, free of peritonitis for at least 3 months, without catabolic conditions and with normal thyroid function, were included. METHODS: Energy intake was evaluated using a 3-day food record. Resting energy expenditure (REE) was measured by indirect calorimetry. Body composition was assessed using dual-energy x-ray absorptiometry. The total energy (TE) offered was considered the sum of energy intake plus energy provided by glucose absorption. All measurements were collected at baseline and after 6 months. Underreporting of energy intake was considered to have occurred when the TE/REE ratio was <1.40. RESULTS: The TE/REE ratio was 1.35+/-0.31. Twenty-one patients (52.5%) had a TE/REE ratio <1.40. The TE/REE ratio correlated negatively with BMI (r=-0.52, P < .01), and positively with duration of dialysis (r=0.44, P < .01). No correlation was found between TE/REE ratio and any other variables. Patients were divided into two groups according to BMI <25 kg/m(2) and BMI > or =25 kg/m(2). The majority of patients (83.3%) in the higher BMI group had a TE/REE ratio <1.40. In a logistic regression analysis, using TE/REE ratio <1.40 or > or =1.40 as the dependent variable, BMI> or =25 kg/m2 was the only determinant of energy underreporting. After 6 months of follow-up, no change in either body weight or BMI was evident. CONCLUSIONS: This study showed that a significant number of PD patients underreported the energy intake evaluated by 3-day food diaries. This finding was evidenced particularly in overweight patients.

Asunto(s)

Ingestión de Energía , Metabolismo Energético/fisiología , Sobrepeso/psicología , Autorrevelación , Metabolismo Basal/fisiología , Composición Corporal , Índice de Masa Corporal , Calorimetría Indirecta , Registros de Dieta , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Diálisis Peritoneal , Prevalencia , Estudios Prospectivos

RESUMEN

OBJETIVO: Avaliar a variabilidade dos níveis de hemoglobina (Hb) em pacientes em hemodiálise (HD) tratados com eritropoetina. MÉTODOS: Foram coletados dados retrospectivos de 249 pacientes que estavam em HD e apresentavam, nos três meses anteriores, média de Hb entre 10,5 g/dL e 12,5 g/dL. O período de observação total foi de 36 meses. A cada mês de coleta, classificaram-se os valores de Hb em: < 10,5g/dL, 10,5g/dL< Hb< 12,5g/dL (intervalo alvo), ou Hb >12,5g/dL. Além disto, os pacientes foram divididos em seis categorias de variabilidade da Hb: baixo persistente (<10,5g/dL), alvo persistente (10,5 a 12,5 g/dL), alto persistente (>12,5g/dL), flutuação de baixa amplitude com Hb baixo, flutuações de baixa amplitude com Hb alto e flutuações de alta amplitude. RESULTADOS: Mês a mês, a média da proporção de pacientes com Hb dentro da faixa alvo foi de 50 por cento (variação, 42 por cento a 61 por cento). A proporção de valores de Hb médios acima da faixa alvo (30 por cento) foi mais frequente que a proporção abaixo do alvo (20 por cento). Durante os períodos de seis, 12, e 36 meses, a proporção de pacientes com Hb baixa persistente se reduziu de 3,6 por cento para 0 por cento; de 31,7 por cento para 2,8 por cento naqueles com Hb alta persistente; de 7,6 por cento para 0 por cento naqueles com baixa amplitude com Hb baixo; e de 41,3 por cento para 8,3 por cento nos pacientes com baixa amplitude com Hb alto. Entretanto, houve aumento na proporção de pacientes (de 21,5 por cento a 88,9 por cento) com alta amplitude de Hb. Portanto, à medida que o tempo de observação se alongou observou-se maior variabilidade dos valores de hemoglobina. Nenhum paciente manteve os níveis de Hb dentro do alvo durante todo o período do estudo. CONCLUSÃO: A manutenção da Hb dentro da faixa alvo é difícil, especialmente em períodos longos e a variabilidade ocorre mais frequentemente para valores mais elevados de Hb.

---

OBJECTIVE: Correction of anemia using epoetin decreases morbidity and increases survival and quality of life in end-stage renal disease. Maintaining hemoglobin levels within the range proposed by guidelines has become a major challenge, with hemoglobin cycling affecting more than 90 percent of patients undergoing hemodialysis. The variability of hemoglobin levels over time was assessed in our patients. METHODS: Data were retrospectively collected on 249 patients undergoing hemodialysis over a 3-year period at seven centers in Brazil. Hemoglobin was measured at least monthly, and target levels were those between 10.5 g/dL and 12.5 g/dL. Patients were grouped into six categories of variability consistently low (<10.5g/dL), consistently target range (10.5 to 12.5 g/dL), consistently high (>12.5g/dL), low amplitude fluctuation with low hemoglobin levels, low amplitude fluctuation with high hemoglobin levels and high amplitude fluctuation. None of the patients maintained stable hemoglobin levels for the entire 36-month period. RESULTS: The mean monthly proportion of patients that had hemoglobin levels within the target range was 50 percent (range, 42 percent to 61 percent). Mean levels above the target (30 percent) were more frequent than those below it (20 percent). During 6, 12, and 36 months, proportions of patients with consistently low levels of hemoglobin decreased from 3.6 percent to 0 percent, from 31.7 percent to 2.8 percent for those with consistently high, from 7.6 percent to 0 percent for those with low amplitude fluctuation with low hemoglobin levels and from 41.3 percent to 8.3 percent for those with low amplitude fluctuation with high hemoglobin levels. However, the proportions of patients with high amplitude fluctuation increased from 21.5 percent to 88.9 percent. CONCLUSION: Maintaining hemoglobin levels within the target range is difficult, especially for longer periods of time. Missing the target seems more often due to ...

Asunto(s)

Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Anemia/tratamiento farmacológico , Epoetina alfa/uso terapéutico , Hematínicos/uso terapéutico , Hemoglobinas/análisis , Fallo Renal Crónico/complicaciones , Anemia/diagnóstico , Anemia/etiología , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Valores de Referencia , Diálisis Renal , Estudios Retrospectivos

RESUMEN

BACKGROUND AND AIMS: Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients. This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histology. METHODS: 101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months. RESULTS: The 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hormone (498 +/- 352 vs. 326 +/- 236 pg/ml, p = 0.017), bone alkaline phosphatase (38 +/- 24 vs. 28 +/- 15 U/l, p = 0.03) and deoxypyridinoline (135 +/- 107 vs. 89 +/- 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 +/- 21 vs. 91 +/- 28 mg/dl, p = 0.015). Phosphorus (5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl, p = 0.47) and calcium (1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 +/- 5.9 vs. 13.1 +/- 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078, p = 0.003 for calcium and 0.017 +/- 0.016 vs. 0.071 +/- 0.084 microm(3)/microm(2)/day, p = 0.010 for sevelamer). CONCLUSIONS: There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups.

Asunto(s)

Acetatos/administración & dosificación , Remodelación Ósea/efectos de los fármacos , Calcinosis/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Poliaminas/administración & dosificación , Diálisis Renal/estadística & datos numéricos , Brasil/epidemiología , Compuestos de Calcio/administración & dosificación , Quelantes/administración & dosificación , Comorbilidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Sevelamer , Resultado del Tratamiento