RESUMEN

Abstract tHistory of chronic periodontitis (CP) is a risk factor for oseointegration failure. The osteoclastogenesis system (RANK, RANKL and OPG) is critical for bone homeostatic control. We investigated the levels of OPG and RANKL in peri-implant tissues from volunteers with and without a history of CP and their association with mucosae inflammation. This is a single-blind case-contro study. Diagnosis of a history of CP and peri-implant examination was performed on 46 volunteers, divided into control (without history of CP, n=26) and CP group (with history of CP, n=20). Gingival biopsies were harvested during implant exposure. Quantitative PCR evaluated OPG/RANKL mRNA expressions. OPG and RANKL proteins were analyzed by western blot and immunohistochemistry assay. The chi-square test analyzed the significance of nominal variables between groups while continuous variables were analyzed by T-test or Mann-Whitney test, after Shapiro-Wilk test evaluation. The 2-ΔΔCT Livak method calculation evaluated the gene expression. Values of p<0.05 were considered statistically significant. Volunteers with CP history had 23 times higher chance of developing mucosae inflammation. High mucosae levels of RANKL (p=0.04) and RANKL/OPG (p=0.001) mRNA expressions were observed in CP group. CP volunteers showed increased RANKL protein levels in opposition to decreased OPG expression. Even without active periodontitis, volunteers with a history of CP had elevated gingival levels of RANKL/OPG and higher correlation with peri-implant mucosae inflammation and implant loss.

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Resumo A história de periodontite crônica (CP) é um fator de risco para falhas na osseointegração. O sistema de osteoclastogênese (RANK, RANKL e OPG) é crucial para o controle da homeostase óssea. O objetivo deste estudo foi investigar os níveis de OPG e RANKL no tecido peri-implantar de voluntários com e sem histórico de CP e sua associação com inflamação da mucosa. Este é um estudo tipo caso-controle. O exame para diagnóstico de CP e na região peri-implantar foi realizado em 46 voluntários, divididos em controle (sem história CP, n=26) e grupo CP (com histórico de CP, n=20). Descartes gengivais foram obtidos durante a exposição do implante. PCR quantitativo avaliou a expressão do RNAm de OPG/RANKL. As proteínas OPG e RANKL foram analisadas por western blot e imunohistoquímica. O teste do qui-quadrado analisou a significância entre as variáveis nominais enquanto as variáveis contínuas foram analisadas pelo teste-t e Mann-Whitney, após o teste de Shapiro-wilk. O método do Livak 2--ΔΔCT avaliou a expressão gênica. Os voluntários com CP apresentaram 23 vezes mais chances de desenvolver inflamação da mucosa. Expressão elevada no RNAm de RANKL (p=0.04) e RANKL/OPG (p=0.001) foram observadas no grupo CP. Voluntários com CP mostraram aumento dos níveis da proteína RANKL em contraste com diminuída expressão de OPG. Mesmo sem periodontite ativa, voluntários com histórico de CP apresentaram elevado nível gengival de RANKL/OPG e alta correlação com inflamação peri-implantar e perda do implante.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Periodontitis Crónica/metabolismo , Implantes Dentales , Mucosa Bucal/patología , Osteoprotegerina/metabolismo , Ligando RANK/metabolismo , Western Blotting , Periodontitis Crónica/patología , Inmunohistoquímica , Osteoprotegerina/genética , Reacción en Cadena de la Polimerasa , Ligando RANK/genética , ARN Mensajero/genética

RESUMEN

tHistory of chronic periodontitis (CP) is a risk factor for oseointegration failure. The osteoclastogenesis system (RANK, RANKL and OPG) is critical for bone homeostatic control. We investigated the levels of OPG and RANKL in peri-implant tissues from volunteers with and without a history of CP and their association with mucosae inflammation. This is a single-blind case-contro study. Diagnosis of a history of CP and peri-implant examination was performed on 46 volunteers, divided into control (without history of CP, n=26) and CP group (with history of CP, n=20). Gingival biopsies were harvested during implant exposure. Quantitative PCR evaluated OPG/RANKL mRNA expressions. OPG and RANKL proteins were analyzed by western blot and immunohistochemistry assay. The chi-square test analyzed the significance of nominal variables between groups while continuous variables were analyzed by T-test or Mann-Whitney test, after Shapiro-Wilk test evaluation. The 2-ΔΔCT Livak method calculation evaluated the gene expression. Values of p<0.05 were considered statistically significant. Volunteers with CP history had 23 times higher chance of developing mucosae inflammation. High mucosae levels of RANKL (p=0.04) and RANKL/OPG (p=0.001) mRNA expressions were observed in CP group. CP volunteers showed increased RANKL protein levels in opposition to decreased OPG expression. Even without active periodontitis, volunteers with a history of CP had elevated gingival levels of RANKL/OPG and higher correlation with peri-implant mucosae inflammation and implant loss.

Asunto(s)

Periodontitis Crónica/metabolismo , Implantes Dentales , Mucosa Bucal/patología , Osteoprotegerina/metabolismo , Ligando RANK/metabolismo , Anciano , Western Blotting , Periodontitis Crónica/patología , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Osteoprotegerina/genética , Reacción en Cadena de la Polimerasa , Ligando RANK/genética , ARN Mensajero/genética

RESUMEN

Subjects susceptible to chronic periodontitis (CP) show a high risk for the development of periimplantitis (PI). Both diseases are multifactorial, presenting similarities in their pathophysiology and polygenic profile. MMP-13 (matrix metalloproteinases 13/ collagenase 3) is a collagenolytic enzyme, which expression is induced by TGF beta 3 (transforming growth factor type 3) in human gingival fibroblasts and inhibited by TIMP-2 (tissue inhibitor of metalloproteinase type 2). The aim of this study was to investigate the occurrence of periimplantitis (PI) in subjects with history of chronic periodontitis (CP) and polymorphisms frequency in MMP13, TIMP2 and TGFB3 genes. One hundred and sixty-three volunteers received dental implant placement were submitted to oral and radiographic examination in order to identify past history of CP or presence of PI. Volunteers were divided into 4 groups: Control (without PI and CP, n=72), CP (with CP and without PI, n=28), PI (with PI and without CP, n=28) and diseased (with CP and PI, n=35). The chi-square test correlated genotypes in specific regions of MMP13 (rs2252070), TIMP2 (rs7501477) and TGFB3 (rs2268626) genes, considering the interaction between CP and PI. The results showed that volunteers with CP had 3.2 times more susceptibility to develop PI (p=0.0004) compared to those without CP. No significant association was observed in MMP13, TIMP2 and TGFB3 genes with CP or PI. CP is a risk factor to develop PI, however, there is no association of both diseases with polymorphisms in the MMP13, TIMP2 and TGFB3 genes.

Asunto(s)

Periimplantitis/genética , Periodontitis/genética , Polimorfismo de Nucleótido Simple , Anciano , Brasil , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Humanos , Masculino , Metaloproteinasa 13 de la Matriz , Persona de Mediana Edad , Inhibidor Tisular de Metaloproteinasa-2 , Factor de Crecimiento Transformador beta3

RESUMEN

Abstract Subjects susceptible to chronic periodontitis (CP) show a high risk for the development of peiimplantitis (PI). Both diseases are multifactorial, presenting similarities in their pathophysiology and polygenic profile. MMP-13 (matrix metalloproteinases 13/ collagenase 3) is a collagenolytic enzyme, which expression is induced by TGF beta 3 (transforming growth factor type 3) in human gingival fibroblasts and inhibited by TIMP-2 (tissue inhibitor of metalloproteinase type 2). The aim of this study was to investigate the occurrence of peiimplantitis (PI) in subjects with history of chronic periodontitis (CP) and polymorphisms frequency in MMP13, TIMP2 and TGFB3 genes. One hundred and sixty-three volunteers received dental implant placement were submitted to oral and radiographic examination in order to identify past history of CP or presence of PI. Volunteers were divided into 4 groups: Control (without PI and CP, n=72), CP (with CP and without PI, n=28), PI (with PI and without CP, n=28) and diseased (with CP and PI, n=35). The chi-square test correlated genotypes in specific regions of MMP13 (rs2252070), TIMP2 (rs7501477) and TGFB3 (rs2268626) genes, considering the interaction between CP and PI. The results showed that volunteers with CP had 3.2 times more susceptibility to develop PI (p=0.0004) compared to those without CP. No significant association was observed in MMP13, TIMP2 and TGFB3 genes with CP or PI. CP is a risk factor to develop PI, however, there is no association of both diseases with polymorphisms in the MMP13, TIMP2 and TGFB3 genes.

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Resumo Indivíduos susceptíveis à periodontite crônica (CP) apresentam alto risco para o desenvolvimento de periimplantite (PI). Ambas doenças são multifatoriais e apresentam similaridades na patofisiologia e perfil poligênico. A MMP-13 (metaloproteinase da matriz tipo 13) é uma enzima colagenolítica cuja expressão é induzida por TGF beta 3 (fator transformador do crescimento tipo 3) nos fibroblastos gengivais humanos e inibida por TIMP-2 (inibidor tecidual de metaloproteinase tipo 2). O objetivo deste estudo foi investigar a ocorrência de periimplantite em sujeitos com periodontite crônica e a frequência dos polimorfismos nos genes MMP13, TIMP2 e TGFB3. Cento e sessenta e três voluntários submetidos à instalação de implantes endósseos foram analisados clínica e radiograficamente quanto à presença de histórico de CP e PI, sendo divididos em 4 grupos: Controle (sem história de CP e PI, n=72), CP (com CP e sem PI, n=28), PI (com PI e sem CP, n=28) e Doentes (com CP e PI, n=35). O teste do qui-quadrado correlacionou os genótipos nas regiões dos genes MMP13 (rs2252070), TIMP2 (rs7501477) e TGFB3 (rs2268626), considerando a interação entre CP e PI. Os resultados mostraram que voluntários com CP possuem 3.2 vezes mais chances de desenvolver PI (p=0.0004) comparados aos sem CP. Nenhuma associação significativa foi observada entre os genes MMP13, TIMP2 e TGFB3 e CP ou PI. A CP é um fator de risco ao desenvolvimento de PI, no entanto, não há associação entre ambas as doenças com polimorfismos nos genes MMP13, TIMP2 e TGFB3.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Periimplantitis/genética , Periodontitis/genética , Polimorfismo de Nucleótido Simple , Brasil , Estudios de Casos y Controles , Enfermedad Crónica , Metaloproteinasa 13 de la Matriz , Inhibidor Tisular de Metaloproteinasa-2 , Factor de Crecimiento Transformador beta3

RESUMEN

OBJECTIVE: Scoliosis surgery involves major blood loss and frequently requires blood transfusion. The cost and risks involved in using allogeneic blood have motivated investigation of methods capable of reducing patients' bleeding during operations. One of these methods is to use antifibrinolytic drugs, and tranexamic acid is among these. The aim of this study was to assess the use of this drug for controlling bleeding in surgery to treat idiopathic scoliosis. METHODS: This was a retrospective study in which the medical files of 40 patients who underwent thoracolumbar arthrodesis by means of a posterior route were analyzed. Of these cases, 21 used tranexamic acid and were placed in the test group. The others were placed in the control group. The mean volumes of bleeding during and after the operation and the need for blood transfusion were compared between the two groups. RESULTS: The group that used tranexamic acid had significantly less bleeding during the operation than the control group. There was no significant difference between the groups regarding postoperative bleeding and the need for blood transfusion. CONCLUSIONS: Tranexamic acid was effective in reducing bleeding during the operation, as demonstrated in other studies. The correlation between its use and the reduction in the need for blood transfusion is multifactorial and could not be established in this study. We believe that tranexamic acid may be a useful resource and that it deserves greater attention in randomized double-blind prospective series, with proper control over variables that directly influence blood loss.

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OBJETIVO: A cirurgia de escoliose envolve elevada perda sanguínea e necessita frequentemente de hemotransfusão. O custo e os riscos envolvidos no uso do sangue alogênico têm motivado pesquisas de métodos capazes de reduzir o sangramento operatório nos pacientes. Um desses métodos é o uso de drogas antifibrinolíticas, entre as quais está o ácido tranexâmico (ATX). O objetivo deste estudo foi verificar o uso dessa droga no controle do sangramento em cirurgias de escoliose idiopática. MÉTODOS: Estudo retrospectivo no qual foram analisados os prontuários de 40 pacientes submetidos à artrodese toracolombar por via posterior. Desses, apenas 21 usaram o ATX e foram relacionados no grupo teste. Os demais foram relacionados no grupo controle. Foram comparadas as médias de sangramento per e pós-operatório e a necessidade de hemotransfusão entre os dois grupos. RESULTADOS: O grupo que usou o ATX teve sangramento peroperatório significativamente menor do que o grupo controle. Não houve diferença significativa entre os grupos para o sangramento pós-operatório e a necessidade de hemotransfusão. CONCLUSÕES: O ATX foi eficaz na redução do sangramento peroperatório, conforme demostrado em outros estudos. A correlação entre o seu uso e a redução da necessidade de hemotransfusão é multifatorial e não pôde ser estabelecida neste trabalho. Acreditamos que o ácido tranexâmico possa ser um recurso útil e merece maior atenção em séries prospectivas, duplo-cegas, randomizadas, com o devido controle das variáveis que interferem diretamente na perda sanguínea.

RESUMEN

BACKGROUND: Patients undergoing hemodialysis (HD) present altered levels of appetite hormones such as acyl-ghrelin (orexigenic) and obestatin (anorexigenic), which may contribute to anorexia. Physical exercise may affect these hormones and improve appetite in these patients. OBJECTIVES: The objective of this study is to evaluate the effects of a resistance exercise program in appetite hormones, body composition, and nutritional status in HD patients. DESIGN: Intervention study with the control group. SUBJECTS: Fifty-two patients on regular HD program were enrolled into two groups: 37 patients performed exercises (56.7% male, 45 ± 12.8 years, 57 (9-192) months on HD) and 15 patients comprised the control group (66.7% men, 50 ± 10.6 years, 57 (11-153) months on HD). MEASUREMENTS: Exercise program (performed with elastic bands and ankle cuffs in both lower limbs) was supervised three times a week during 6 months (72 sessions). Patients had their blood drawn in a regular HD day after overnight fasting, before and after 6 months of exercise program. Obestatin, acyl-ghrelin, routine biochemical parameters, quality of life, and anthropometric data were collected and analyzed before and after 6 months. RESULTS: After 6 months of exercise, obestatin levels reduced [from 3.0 ng/mL (2.3-3.4) to 1.9 ng/mL (0.6-3.4)] and acyl-ghrelin levels increased [from 21.5 pg/mL (1.3-77.7) to 37.2 pg/mL (16.7-94.1)] and the control group presented no significant differences in both plasma levels of hormones. Body composition and physical functional assessed by SF-36 and albumin levels (3.7 ± 0.3 to 3.9 ± 0.2, p < 0.05) improved after exercises. CONCLUSION: Six months of resistance exercises contributed to changes in plasma appetite hormones, body composition, and nutritional status in hemodialysis patients.

Asunto(s)

Composición Corporal/fisiología , Ghrelina/sangre , Estado Nutricional/fisiología , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/sangre , Entrenamiento de Fuerza/métodos , Adulto , Índice de Masa Corporal , Femenino , Humanos , Modelos Lineales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos

RESUMEN

OBJECTIVE: Scoliosis surgery involves major blood loss and frequently requires blood transfusion. The cost and risks involved in using allogeneic blood have motivated investigation of methods capable of reducing patients' bleeding during operations. One of these methods is to use antifibrinolytic drugs, and tranexamic acid is among these. The aim of this study was to assess the use of this drug for controlling bleeding in surgery to treat idiopathic scoliosis. METHODS: This was a retrospective study in which the medical files of 40 patients who underwent thoracolumbar arthrodesis by means of a posterior route were analyzed. Of these cases, 21 used tranexamic acid and were placed in the test group. The others were placed in the control group. The mean volumes of bleeding during and after the operation and the need for blood transfusion were compared between the two groups. RESULTS: The group that used tranexamic acid had significantly less bleeding during the operation than the control group. There was no significant difference between the groups regarding postoperative bleeding and the need for blood transfusion. CONCLUSIONS: Tranexamic acid was effective in reducing bleeding during the operation, as demonstrated in other studies. The correlation between its use and the reduction in the need for blood transfusion is multifactorial and could not be established in this study. We believe that tranexamic acid may be a useful resource and that it deserves greater attention in randomized double-blind prospective series, with proper control over variables that directly influence blood loss. .

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OBJETIVO: A cirurgia de escoliose envolve elevada perda sanguínea e necessita frequentemente de hemotransfusão. O custo e os riscos envolvidos no uso do sangue alogênico têm motivado pesquisas de métodos capazes de reduzir o sangramento operatório nos pacientes. Um desses métodos é o uso de drogas antifibrinolíticas, entre as quais está o ácido tranexâmico (ATX). O objetivo deste estudo foi verificar o uso dessa droga no controle do sangramento em cirurgias de escoliose idiopática. MÉTODOS: Estudo retrospectivo no qual foram analisados os prontuários de 40 pacientes submetidos à artrodese toracolombar por via posterior. Desses, apenas 21 usaram o ATX e foram relacionados no grupo teste. Os demais foram relacionados no grupo controle. Foram comparadas as médias de sangramento per e pós-operatório e a necessidade de hemotransfusão entre os dois grupos. RESULTADOS: O grupo que usou o ATX teve sangramento peroperatório significativamente menor do que o grupo controle. Não houve diferença significativa entre os grupos para o sangramento pós-operatório e a necessidade de hemotransfusão. CONCLUSÕES: O ATX foi eficaz na redução do sangramento peroperatório, conforme demostrado em outros estudos. A correlação entre o seu uso e a redução da necessidade de hemotransfusão é multifatorial e não pôde ser estabelecida neste trabalho. Acreditamos que o ácido tranexâmico possa ser um recurso útil e merece maior atenção em séries prospectivas, duplo-cegas, randomizadas, com o devido controle das variáveis que interferem diretamente na perda sanguínea. .

Asunto(s)

Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Tiempo de Sangría , Transfusión Sanguínea , Escoliosis/cirugía , Ácido Tranexámico

RESUMEN

Connective tissue growth factor (CTGF)/CCN family member 2 (CCN2) is a CCN family member of matricellular signaling modulators. It has been shown that CCN2/CTGF mediates cell adhesion, aggregation and migration in a large variety of cell types, including vascular endothelial cells, fibroblasts, epithelial cells, aortic smooth muscle and also pluripotent stem cells. Others matricellular proteins are capable of interacting with CCN2/CTGF to mediate its function. Cell migration is a key feature for tumor cell invasion and metastasis. CCN2/CTGF seems to be a prognostic marker for cancer. In addition, here we intend to discuss recent discoveries and a new strategy to develop therapies against CCN2/CTGF, in order to treat cancer metastasis.

RESUMEN

The normal intestinal microbiota plays a major role in the maintenance of health and disease prevention. In fact, the alteration of the intestinal microbiota has been shown to contribute to the pathogenesis of several pathological conditions, including obesity and insulin resistance, among others. Recent studies have revealed profound alterations of the gut microbial flora in patients and animals with chronic kidney disease (CKD). Alterations in the composition of the microbiome in CKD may contribute to the systemic inflammation and accumulation of gut-derived uremic toxins, which play a central role in the pathogenesis of accelerated cardiovascular disease and numerous other CKD-associated complications. This review is intended to provide a concise description of the potential role of the CKD-associated changes in the gut microbiome and its potential role the pathogenesis of inflammation and uremic toxicity. In addition, the potential efficacy of pre- and pro-biotics in the restoration of the microbiome is briefly described.

Asunto(s)

Enfermedades Cardiovasculares/etiología , Inflamación/etiología , Intestinos/microbiología , Microbiota , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/microbiología , Animales , Metabolismo de los Hidratos de Carbono , Grasas/metabolismo , Femenino , Humanos , Mucosa Intestinal/metabolismo , Lipopolisacáridos/metabolismo , Masculino , Prebióticos , Embarazo , Probióticos , Proteínas/metabolismo , Insuficiencia Renal Crónica/metabolismo

RESUMEN

Cumulative evidence indicates that oxidative stress and inflammation frequently occurs in patients undergoing maintenance hemodialysis (HD) and as a result of overproduction of reactive oxygen species (ROS) and a decrease of antioxidant defenses such as selenium (Se). Previous studies in our laboratory showed that the supplementation of 1 unit of Brazil nut (the richest known food source of Se) a day during 3 months is effective to improve Se status and increase glutathione peroxidase (GPx) levels in HD patients. The aim of this study was to evaluate the effect of Brazil nut supplementation on oxidative stress and inflammation markers in HD patients. Forty HD patients from Rio de Janeiro, Brazil were studied. All patients received one nut per day for 3 months. The Se plasma levels and GPx, 8-isoprostane, 8-hydroxy-2-deoxyguanosine (8-OHdG), and cytokine (TNF-α and IL-6) levels and lipid profile were determined before and after 3 months of supplementation. The plasma Se and GPx activity increased, while cytokines, 8-OHdG, and 8-isoprostane plasma levels decreased significantly after 3 months supplementation. HDL-c levels increased and LDL-c levels decreased significantly. These data suggest that the consumption of only one Brazil nut per day during 3 months was effective to reduce the inflammation, oxidative stress markers, and the atherogenic risk, thereby increasing the antioxidant defenses in HD patients. Our results indicate that Brazil nut as Se source plays an important role as an anti-inflammatory and antioxidant agent in HD patients.

Asunto(s)

Bertholletia/química , Biomarcadores/sangre , Inflamación/sangre , Estrés Oxidativo/efectos de los fármacos , Diálisis Renal , Selenio/uso terapéutico , 8-Hidroxi-2'-Desoxicoguanosina , Adulto , Anciano , Citocinas/sangre , Desoxiguanosina/análogos & derivados , Desoxiguanosina/sangre , Suplementos Dietéticos , Dinoprost/análogos & derivados , Dinoprost/sangre , Glutatión Peroxidasa/sangre , Humanos , Lípidos/sangre , Persona de Mediana Edad , Nueces/química , Selenio/administración & dosificación , Selenio/sangre , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

INTRODUCTION AND OBJECTIVES: Patients with chronic kidney disease (CKD) present anorexia, which may be related with the chronic inflammatory process. Thus the objective of this study was to evaluate if there is association between inflammation and the orexigenic hormone, acyl-ghrelin, in CKD patients undergoing hemodialysis (HD). METHODS: Thirty-six patients were studied (61.1% men, 46.7 ± 14.9 years, BMI 22.9 ± 3.9 kg/m²) in regular HD program (65.0 ± 46.8 months). Plasma levels of acyl-ghrelin and inflammatory markers TNF-α, IL-6 and CRP were measured by enzyme immunoassay (ELI-SA, Enzyme Linked Immunosorbent Assay). Anthropometric parameters were collected for assessment of nutritional status and dietary intake was assessed by food recall. RESULTS: The patients presented elevated plasma levels of IL-6 (83 ± 10 pg/mL), TNF-α (21.06 pg/mL [20.6-40.0]) and CRP (2.7 pg/mL [1.73.4]) compared to normal values. Acylghrelin plasma levels were (18.0 [1.3 to 77.7 pg/mL]) low when compared to healthy individuals. However, patients with high BMI (> 25 kg/m²) presented lower acyl-ghrelin plasma levels (13.6 [1.3 to 30.5] pg/mL) when compared to patients with BMI < 25 kg/m² (21.7 [7.4 to 77.7] pg/mL) (p < 0.05). Acylghrelin and BMI were negatively correlated (r = -0.38, p = 0.02) and there was no significant correlation between acyl-ghrelin and inflammatory markers. CONCLUSIONS: Hemodialysis patients showed low acyl-ghrelin levels and seem to present an acyl-ghrelin resistance and there was no correlation between inflammation and this orexigenic hormone.

Asunto(s)

Proteína C-Reactiva/análisis , Ghrelina/sangre , Inflamación/sangre , Inflamación/etiología , Interleucina-6/sangre , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Diálisis Renal , Factor de Necrosis Tumoral alfa/sangre , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

INTRODUÇÃO E OBJETIVOS: Pacientes com doença renal crônica (DRC) apresentam um quadro de anorexia que pode estar relacionado com o processo inflamatório crônico, característico desta população. Assim, o presente estudo teve como objetivo avaliar se há associação entre inflamação e o hormônio orexígeno, acyl-grelina, em pacientes com DRC em hemodiálise (HD). MÉTODOS: Foram estudados 36 pacientes (61,1% homens; 46,7 ± 14,9 anos; IMC 22,9 ± 3,9 kg/m²) em programa regular de HD (65,0 ± 46,8 meses em HD). Os níveis plasmáticos de acyl-grelina e dos marcadores inflamatórios (TNF-α, IL-6 e PCR) foram medidos com o uso do método imunoenzimático (ELISA, Enzyme Linked Immunosorbent Assay). Dados antropométricos foram coletados para avaliação do estado nutricional e a ingestão alimentar foi analisada por meio de recordatório alimentar de 24h de 2 dias. RESULTADOS: Os pacientes apresentaram elevados níveis de IL-6 (83 ± 10 pg/mL), TNF-α (21,06 pg/mL [20,6-40,0]) e PCR (2,7 pg/mL [1,7-3,4]) quando comparados a valores normais. Os níveis plasmáticos de acyl-grelina (18,0 pg/mL [1,3-77,7 pg/mL]) foram baixos comparados com valores de indivíduos saudáveis. Porém, pacientes com elevado IMC (> 25 kg/m²) apresentaram menores concentrações plasmáticas de acyl-grelina (13,6 [1,3-30,5] pg/mL) em relação aos pacientes com IMC < 25 kg/m² (21,7 [7,4-77,7] pg/mL (p < 0,05). Houve correlação negativa entre o IMC e acyl-grelina (r = -0,38; p = 0,02), porém, não houve correlação significativa entre acyl-grelina e os marcadores inflamatórios. CONCLUSÃO: Apesar dos pacientes em HD apresentarem baixas concentrações de acyl-grelina e uma provável resistência a este hormônio, não houve associação entre inflamação e acyl-grelina.

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INTRODUCTION AND OBJECTIVES: Patients with chronic kidney disease (CKD) present anorexia, which may be related with the chronic inflammatory process. Thus the objective of this study was to evaluate if there is association between inflammation and the orexigenic hormone, acyl-ghrelin, in CKD patients undergoing hemodialysis (HD). METHODS: Thirty-six patients were studied (61.1% men, 46.7 ± 14.9 years, BMI 22.9 ± 3.9 kg/m²) in regular HD program (65.0 ± 46.8 months). Plasma levels of acyl-ghrelin and inflammatory markers TNF-α, IL-6 and CRP were measured by enzyme immunoassay (ELI-SA, Enzyme Linked Immunosorbent Assay). Anthropometric parameters were collected for assessment of nutritional status and dietary intake was assessed by food recall. RESULTS: The patients presented elevated plasma levels of IL-6 (83 ± 10 pg/mL), TNF-α (21.06 pg/mL [20.6-40.0]) and CRP (2.7 pg/mL [1.73.4]) compared to normal values. Acylghrelin plasma levels were (18.0 [1.3 to 77.7 pg/mL]) low when compared to healthy individuals. However, patients with high BMI (> 25 kg/m²) presented lower acyl-ghrelin plasma levels (13.6 [1.3 to 30.5] pg/mL) when compared to patients with BMI < 25 kg/m² (21.7 [7.4 to 77.7] pg/mL) (p < 0.05). Acylghrelin and BMI were negatively correlated (r = -0.38, p = 0.02) and there was no significant correlation between acyl-ghrelin and inflammatory markers. CONCLUSIONS: Hemodialysis patients showed low acyl-ghrelin levels and seem to present an acyl-ghrelin resistance and there was no correlation between inflammation and this orexigenic hormone.

Asunto(s)

Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteína C-Reactiva/análisis , Ghrelina/sangre , Inflamación/sangre , Inflamación/etiología , /sangre , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Diálisis Renal , Factor de Necrosis Tumoral alfa/sangre , Estudios Transversales

RESUMEN

Despite the fact that low plasma zinc (Zn) levels play important roles in the oxidative stress, the relationships between lipid peroxidation and inflammation biomarkers with low plasma Zn levels have not been investigated in chronic kidney disease (CKD) patients. The aim of this study was to evaluate the Zn plasma levels, electronegative LDL [LDL(-)] levels, and inflammation markers as predictors of cardiovascular (CV) mortality in hemodialysis (HD) patients. Forty-five HD patients (28 men, 54.2 ± 12.7 years, 62.2 ± 51.4 months on dialysis and BMI 24.3 ± 4.1 kg/m(2)) were studied and compared to 20 healthy individuals (9 men, 51.6 ± 15.6 years, BMI 25.2 ± 3.9 kg/m(2)) and followed for 24 months to investigate the risks for CV mortality. LDL(-) levels were measured by ELISA, plasma Zn levels by atomic absorption spectrophotometry, C-reactive protein (CRP) level by immunoturbidimetric method, and tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), and plasminogen activator inhibitor-1 (PAI-1) levels by a multiplex assay kit. HD patients presented low plasma Zn levels (54.9 ± 16.1 µg/dL) and high-LDL(-) (0.18 ± 0.12 U/L) and TNF-α (5.5 ± 2.2 pg/mL) levels when compared to healthy subjects (78.8 ± 9.4µ g/dL, 0.10 ± 0.08U/L, 2.4 ± 1.1 pg/mL, respectively, p < 0.05). Zn plasma levels were negatively correlated to TNF-α (r = -0.49; p = 0.0001) and LDL(-) (r = -0.33; p = 0.008). During the 2 years, 24.4% of the patients died, all due to CV disease. Analysis by the Cox model showed that high CRP, TNF-α, IL-6 levels, and long duration of HD were significant predictors of mortality. In conclusion, reduced Zn levels were associated with lipid peroxidation and inflammation, and we confirm here in a Brazilian cohort of HD patients that inflammation markers are strong predictors of CV death.

Asunto(s)

Enfermedades Cardiovasculares/sangre , Fallo Renal Crónico/sangre , Peroxidación de Lípido , Lipoproteínas LDL/sangre , Zinc/sangre , Adulto , Anciano , Brasil/epidemiología , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/mortalidad , Estudios de Casos y Controles , Femenino , Voluntarios Sanos , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Masculino , Persona de Mediana Edad , Diálisis Renal , Factores de Riesgo

RESUMEN

BACKGROUND: Elevated serum uric acid has been associated with a variety of cardiovascular disease and with inflammation, but these have been little explored in chronic kidney disease (CKD). Elevated uric acid levels are common in CKD patients and could be involved in inflammatory milieu; our aim was to analyze the association between uric acid and inflammatory markers in hemodialysis (HD) patients. DESIGN: This was a cross-sectional study. SETTING: This study was conducted from private clinic, Rio de Janeiro, Brazil. PATIENTS: This study included 50 HD patients and 21 healthy subjects. METHODS AND PROCEDURES: This study included 50 HD patients [62% men, 54.3 ± 12.6 years, 57.5 ± 50.1 months on dialysis, and body mass index (BMI), 24.4 ± 4.1 kg/m2] and 21 healthy individuals (45% men, 50.7 ± 15.7 years and BMI, 25.5 ± 4 kg/m2). Uric acid was measured using uricase-PAP method; inflammatory [tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP)] and atherosclerosis markers [intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), monocyte chemoattractant protein-1 (MCP-1), plasminogen activator inhibitor-1 (PAI-1)] were measured by a multiplexed assay. RESULTS: PATIENTS presented high levels of TNF-α, IL-6, CRP, VCAM-1, ICAM-1 (5.5 ± 2.1 pg/mL, 4.1 ± 1.6 pg/mL, 0.32 ± 0.30 mg/mL, 48.5 ± 8.5 ng/mL, 20.5 ± 15.9 ng/mL, respectively), compared with healthy individuals (2.4 ± 1.1 pg/mL, 2.7 ± 0.4 pg/mL, 0.11 ± 0.12 mg/mL, 23.8 ± 5.5 ng/mL, 7.2 ± 1.2 ng/mL, respectively) ( p < 0.04). Uric acid levels were also higher in HD patients (5.4 ± 1.3 mg/dL) than in healthy individuals (3.9 ± 0.9 mg/dL) ( p < 0.02). There was a positive correlation between uric acid and inflammatory markers, IL-6 (r = 0.30, p = 0.01), CRP (r = 0.37, p = 0.003), TNF-α (r = 0.40, p = 0.001), ICAM-1 (r = 0.53, p = 0.0001), and VCAM-1 (r = 0.45, p = 0.0001). CONCLUSION: These original data suggest that uric acid may have a role in inflammation and atherosclerosis in HD patients. However, further prospective studies involving intervention trials should be conducted in order to search for actual causality relationship between these markers.

Asunto(s)

Inflamación/sangre , Fallo Renal Crónico/sangre , Ácido Úrico/sangre , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Diálisis Renal

RESUMEN

Peptides involved in the regulation of body composition are of interest in hemodialysis (HD) patients because protein wasting associated with high fat mass (FM) is present in these patients. Zinc-α2-glycoprotein (ZAG), a new adipokine, is involved in the regulation of lipid metabolism, adiposity, and energy balance. The purpose of this study was to evaluate ZAG levels and its relationship with body composition and dietary intake in HD patients. Forty-nine HD patients (28 men, 53.1 ± 12.5 years, and BMI 24.0 ± 4.3 kg/m2) were studied and compared with 20 healthy subjects (9 men, 49.5 ± 15.2 years, and BMI 25.6 ± 4.1 kg/m(2)). Plasma ZAG levels were measured using the ELISA methods and body composition was evaluated through anthropometric data. Dietary intake was assessed 3 days by 24-hour food recall. Although most of the HD patients (59.2%) were eutrophic according to BMI, 92.3% presented high percentage of body fat (BF), and 43.5%, reduced fat-free mass according to midarm muscle circumference values. ZAG levels were ∼2.5-fold higher in HD patients (135.9 ± 40.9 mg/L) compared with healthy individuals (54.6 ± 23.0 mg/L) (p < 0.0001). Circulating ZAG was not associated with dietary intake; however, this peptide was negatively correlated with %BF and, for each 1% reduction in BF, ZAG levels increased by 2.4 mg/L (p = 0.02). In summary, circulating ZAG is increased and inversely correlated with adiposity in HD patients; however, in spite of its higher plasma levels, the majority of HD patients did not show low BF.

Asunto(s)

Adiposidad/fisiología , Metabolismo Energético , Obesidad/sangre , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Proteínas de Plasma Seminal/sangre , Adolescente , Adulto , Anciano , Composición Corporal , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Insuficiencia Renal Crónica/sangre , Adulto Joven , Zn-alfa-2-Glicoproteína

RESUMEN

Both apelin and parathyroid hormone (PTH) are endogenous ligands for G-protein-coupled receptors. Apelin acts as a mitogenic agent for osteoblasts, and metabolic bone abnormalities are frequently seen in hemodialysis (HD) patients because of hyperparathyroidism. The aim of this study was to analyze plasma apelin levels in HD patients and to determine whether they are related to PTH concentrations. A total of 23 HD patients [15 men and 8 women, with a mean (SD) age of 54.2 (4.4) years and a mean body mass index (BMI) of 25.0 (4.1) kg/m(2)] were studied and compared with 15 healthy subjects [6 men and 9 women, with a mean (SD) age of 51.3 (13.6) years and a BMI of 27.0 (4.3) kg/m(2)]. Plasma apelin-36 was measured using an enzyme immunometric assay method and PTH was measured by ELISA. There was no significant difference in apelin levels between the patients [0.80 (0.6) ng/mL] and the healthy subjects [0.83 (0.23) ng/mL]. There was a positive correlation between apelin and PTH (r = 0.66, p = 0.0001). The patients with PTH >300 pg/mL had significantly higher plasma apelin levels [1.17 (0.7) ng/mL] compared with the patients with PTH <300 pg/mL [0.50 (0.15) ng/mL] (p = 0.003). In conclusion, HD patients with secondary hyperparathyroidism have high plasma apelin levels, which suggest that apelin may protect bone in HD patients by acting as an osteoblastic factor.

Asunto(s)

Densidad Ósea/fisiología , Hiperparatiroidismo Secundario/sangre , Péptidos y Proteínas de Señalización Intercelular/sangre , Hormona Paratiroidea/sangre , Insuficiencia Renal Crónica/sangre , Apelina , Estudios de Casos y Controles , Femenino , Humanos , Hiperparatiroidismo Secundario/etiología , Masculino , Persona de Mediana Edad , Valores de Referencia , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia

RESUMEN

UNLABELLED: Recent evidences suggested a possible relationship between zinc deficiency and leptin levels in pathogenesis of anorexia in chronic kidney disease. The present study addressed the relationship between zinc and leptin in hemodialysis (HD) patients. METHODS: Fifty HD patients (54.3±12.7years old, 62% men) were studied and compared to 21 healthy volunteers (50.7±15.7years old, 43% men). Biochemical data, serum zinc, plasma leptin, IL-6, TNF-α and C-Reactive Protein levels were determined. Anthropometric parameters, food intake and appetite score were also assessed. RESULTS: The leptin levels were higher in HD patients (16.1µg/mL (0.21-118.25) vs 6.0µg/mL (0.50-23.10)) in healthy volunteers (p=0.04), whereas serum zinc levels were lower (54.5±16.3µg/dL) compared to healthy volunteers (78.4±9.4µg/dL) (p=0.0001). The plasma leptin was correlated negatively with plasma zinc (r=-0.33; p=0.007), energy (r=-0.38; p=0.002) and protein intake (r=-0.34; p=0.006) and, positively correlated with BMI (r=0.54; p=0.0001), % body fat (r=0.70; p=0.0001) and conicity index (r=0.46; p=0.001). Plasma zinc was associated with hemoglobin (r=0.30; p=0.04) and negatively associated with TNF-α (r=-0.37; p=0.002) and C-Reactive Protein (r=-0.37; p=0.004). There was no correlation among Zn, leptin and appetite score in these patients. CONCLUSION: This study showed that low plasma zinc levels are negatively associated with high leptin levels in HD patients.

Asunto(s)

Leptina/sangre , Diálisis Renal , Zinc/sangre , Adulto , Anciano , Proteína C-Reactiva/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factor de Necrosis Tumoral alfa/metabolismo

RESUMEN

OBJECTIVE: To evaluate the body composition and inflammatory status in patients on hemodialysis (HD) according to the cutoff of 23 kg/m² for the body mass index (BMI). METHODS: Forty-seven patients (30 men, 11 diabetics, 53.8 ± 12.2 y of age, 58.2 ± 50.9 mo on HD) were studied. Anthropometric data and handgrip strength were evaluated. C-reactive protein, tumor necrosis factor-α, leptin, and interleukin-6 were measured. Mortality was assessed after 24 mo of follow-up. RESULTS: Nineteen patients (40.4%) presented BMI values lower than 23 kg/m² and leptin levels, midarm muscle area, and free-fat mass were significantly lower in these patients. The prevalence of functional muscle loss according to handgrip strength was not different between the BMI groups. The sum of skinfold thicknesses, the percentage of body fat, fat mass, the fat mass/free-fat mass ratio, and waist circumference were significantly lower in patients with a BMI lower than 23 kg/m², but the mean values did not indicate energy wasting. Patients with a BMI higher than 23 kg/m² presented a higher prevalence of inflammation and higher waist circumference and body fat values. The adiposity parameters were correlated with C-reactive protein and leptin. A Cox multivariate regression analysis demonstrated that C-reactive protein, tumor necrosis factor-α, and interleukin-6 predict cardiovascular mortality. CONCLUSION: Patients on HD with a BMI lower than 23 kg/m² did not present signs of energy wasting, whereas those with a BMI higher than 23 kg/m² had more inflammation, probably because of a greater adiposity. Thus, the BMI value of 23 kg/m² does not seem to be a reliable marker of protein-energy wasting in patients on HD.

Asunto(s)

Composición Corporal , Índice de Masa Corporal , Inflamación , Fallo Renal Crónico , Desnutrición Proteico-Calórica , Síndrome Debilitante , Adulto , Anciano , Biomarcadores , Compartimentos de Líquidos Corporales/metabolismo , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/mortalidad , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/terapia , Femenino , Humanos , Inflamación/sangre , Mediadores de Inflamación/metabolismo , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Leptina/sangre , Masculino , Persona de Mediana Edad , Músculo Esquelético , Obesidad/sangre , Obesidad/complicaciones , Modelos de Riesgos Proporcionales , Desnutrición Proteico-Calórica/sangre , Desnutrición Proteico-Calórica/etiología , Valores de Referencia , Diálisis Renal , Reproducibilidad de los Resultados , Síndrome Debilitante/sangre , Síndrome Debilitante/etiología

RESUMEN

Anemia is a frequent comorbidity in patients undergoing hemodialysis and is associated with reduced functional capacity. Thus, it possible to assume that anemia can also impair muscle strength in these patients. The aim of this study was to assess whether there is an association between handgrip strength and anemia in patients undergoing hemodialysis. Fifty five patients on regular hemodialysis program (aged 49.0±14.0, 38 men) were studied. Handgrip strength, assessed by manual dynamometry, was measured in the arm without vascular access functioning after the dialysis session, being considered impaired when values were lower than the 10th percentile of age and gender specific values btained from an urban population in Rio de Janeiro. Biochemical data and body composition were also evaluated. Sixty-two percent of patients presented anemia and 34.5% showed handgrip strength compromised. The handgrip strength was positively correlated with height, body weight, body mass index, waist circumference, corrected arm muscle area and fat-free mass; and negatively correlated with age and dialysis efficiency. Hemoglobin and hematocrit were not correlated with handgrip strength and they did not differ between patients with preserved handgrip strength and those with handgrip strength compromised. Thus, anemia did not exert influence on the handgrip strength in patients undergoing hemodialysis, which reinforces the use of manual dynamometry as a reliable method for the assessment of nutritional status in this population.

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La anemia es una comorbilidad frecuente en pacientes sometidos a hemodiálisis y se asocia con una capacidad funcional reducida. Por lo tanto, podemos suponer que la anemia también puede comprometer la fuerza muscular en esos pacientes. El objetivo de este estudio fue evaluar si existe una asociación entre la fuerza de prensión manual y el estado de anemia en pacientes sometidos a hemodiálisis. Se estudiaron 55 pacientes en tratamiento regular de hemodiálisis (49,0±14,0 años de edad, 38 hombres). Se midió, por dinamometría, la fuerza prensil manual en un brazo sin acceso vascular funcional después de la sesión de hemodiálisis. Se consideró que la fuerza prensil se encontraba perjudicada cuando los valores fueron inferiores al 10% del valor correspondiente a sexo y edad, tomando como valores de referencia los obtenidos para la población urbana de Río de Janeiro. Se evaluaron, asimismo, los datos bioquímicos y de composición corporal. El sesenta y dos por ciento de los pacientes tenía anemia y 34,5% presentó fuerza prensil comprometida. La fuerza de prensión manual se correlacionó positivamente con la altura, el peso corporal, el índice de masa corporal, la circunferencia de la cintura, el área muscular del brazo corregida y la masa libre de grasa. Se observó correlación negativa entre la fuerza de prensil manual, la edad y la eficacia de la diálisis. La cantidad de hemoglobina y el hematocrito fueron semejantes entre los pacientes con fuerza prensil normal y comprometida pero no se correlacionaron con la misma Se concluye que la anemia no tuvo ninguna influencia en la fuerza de pensión manual en los pacientes sometidos a hemodiálisis, lo que refuerza el uso de la dinamometría manual como método confiable para la evaluación del estado nutricional de esa población.

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A anemia é uma comorbidade frequente em pacientes submetidos à hemodiálise e está associada à redução da capacidade funcional. Desta forma, podemos supor que a anemia é capaz também de comprometer a força muscular destes pacientes. O objetivo deste estudo foi avaliar se há associação entre força de preensão manual e o estado de anemia em pacientes submetidos à hemodiálise. Foram estudados 55 pacientes em programa regular de hemodiálise (49,0±14,0 anos de idade, 38 homens). A força de preensão manual, avaliada através de dinamometria manual, foi aferida no braço sem acesso vascular funcionante após a sessão de hemodiálise, sendo considerada comprometida quando os valores foram inferiores ao percentil 10 correspondente, segundo gênero e idade, aos valores de referência obtidos para população urbana do RJ. Dados bioquímicos e de composição corporal também foram avaliados. Sessenta e dois por cento dos pacientes apresentaram anemia e 34,5% exibiram força de preensão manual comprometida. A força de preensão manual apresentou correlação positiva com a estatura, peso corporal, índice de massa corporal, circunferência da cintura, área muscular do braço corrigida e massa livre de gordura e correlação negativa com idade e eficiência dialítica. A hemoglobina e hematócrito não se correlacionaram com força de preensão manual e não diferiram entre os pacientes com força de preensão manual preservada e comprometida. Conclui-se que a anemia não exerceu influência sobre a força de preensão manual de pacientes submetidos à hemodiálise, o que reforça o uso da dinamometria manual como método confiável para avaliação do estado nutricional nesta população.

Asunto(s)

Humanos , Dinamómetro de Fuerza Muscular/clasificación , Diálisis Renal/clasificación , Anemia/patología

RESUMEN

Inflammation, oxidative stress, and obesity are important features associated with pathogenesis of cardiovascular disease, a major contributor to the mortality of hemodialysis (HD) patients. Apelin is an adipokine involved in a variety of physiological functions; however, little is known about apelin in chronic kidney disease (CKD). Thus, the purpose of this study was to analyze apelin plasma levels in HD patients and verify whether there is any relationship with inflammation, oxidative markers, and obesity. Twenty-four HD patients [53.6 ± 14.4 years, 14 men, and body mass index (BMI) of 25.0 ± 4.2 kg/m(2)] were studied and compared with 15 healthy subjects (51.3 ± 13.5 years, 7 men, and BMI of 26.3 ± 3.7 kg/m(2)). Plasma apelin-12 and -36 were measured using the enzyme immunometric assay method. Plasma electronegative low-density lipoprotein [LDL(-)] levels were measured using ELISA method, and tumor necrosis factor-α, interleukin-6, leptin, and plasminogen activator inhibitor-1 levels were measured by a multiplex assay kit. C-Reactive protein (CRP) was determined by immunoturbidimetry. Anthropometric data were also evaluated. There was no difference between apelin-36 levels in HD patients (0.82 ± 0.60 ng/mL) and healthy subjects (0.83 ± 0.23 ng/mL). In contrast, apelin-12 levels were significantly higher in patients (0.34 ± 0.15 ng/mL vs. 0.24 ± 0.13 ng/mL in healthy subjects). TNF-α, CRP, and LDL(-) levels were higher in patients; however, there was no correlation among apelin-12 or -36 and inflammatory or oxidative markers. The adiposity parameters were also not associated with apelin-12 or -36. In conclusion, plasma apelin seems to be not associated with cardiovascular risk in HD patients.

Asunto(s)

Enfermedades Cardiovasculares/sangre , Péptidos y Proteínas de Señalización Intercelular/sangre , Fallo Renal Crónico/terapia , Diálisis Renal/mortalidad , Medición de Riesgo/métodos , Adolescente , Adulto , Anciano , Apelina , Biomarcadores/sangre , Brasil/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Femenino , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Incidencia , Fallo Renal Crónico/sangre , Fallo Renal Crónico/mortalidad , Masculino , Persona de Mediana Edad , Estrés Oxidativo , Pronóstico , Factores de Riesgo , Tasa de Supervivencia/tendencias , Adulto Joven