Skeletal muscle energetics in patients with moderate to advanced kidney disease

Sarcopenia, defined as decrease in muscle function and mass, is common in patients with moderate to advanced chronic kidney disease (CKD) and is associated with poor clinical outcomes. Muscle mitochondrial dysfunction is proposed as one of the mechanisms underlying sarcopenia. Patients with moderate to advanced CKD have decreased muscle mitochondrial content and oxidative capacity along with suppressed activity of various mitochondrial enzymes such as mitochondrial electron transport chain complexes and pyruvate dehydrogenase, leading to impaired energy production. Other mitochondrial abnormalities found in this population include defective beta-oxidation of fatty acids and mitochondrial DNA mutations. These changes are noticeable from the early stages of CKD and correlate with severity of the disease. Damage induced by uremic toxins, oxidative stress, and systemic inflammation has been implicated in the development of mitochondrial dysfunction in CKD patients. Given that mitochondrial function is an important determinant of physical activity and performance, its modulation is a potential therapeutic target for sarcopenia in patients with kidney disease. Coenzyme Q, nicotinamide, and cardiolipin-targeted peptides have been tested as therapeutic interventions in early studies. Aerobic exercise, a well-established strategy to improve muscle function and mass in healthy adults, is not as effective in patients with advanced kidney disease. This might be due to reduced expression or impaired activation of peroxisome proliferator-activated receptor-gamma coactivator 1α, the master regulator of mitochondrial biogenesis. Further studies are needed to broaden our understanding of the pathogenesis of mitochondrial dysfunction and to develop mitochondrial-targeted therapies for prevention and treatment of sarcopenia in patients with CKD.

Qualidade de vida do idoso institucionalizado: realidade vivida na rede nacional de cuidados continuados integrados do Algarve / Quality of life of institutionalized elderly: reality experienced in the national network of integrated continuous care from Algarve

A Qualidade de Vida do idoso institucionalizado é uma temática cada vez mais debatida na sociedade contemporânea. Se por um lado se constata um acréscimo no recurso às instituições por parte dos idosos, por outro surge a necessidade de avaliar sua Qualidade de Vida. Na presente investigação, os objetivos do estudo passam por caracterizar os idosos institucionalizados e identificar as necessidades dos mesmos quanto à condição de idoso na instituição, fundamentando-nos na sua percepção de Qualidade de Vida. Neste projeto participaram 105 idosos internados nas unidades da Rede de Cuidados Continuados Integrados do Algarve. No estudo descritivo, de caráter transversal e de metodologia quantitativa, os dados foram obtidos através da aplicação de dois questionários: sociodemográfico e de caracterização da instituição; e através da aplicação da escala de Qualidade de Vida WHOQOL-BREF. No estudo original, as variáveis foram agrupadas em três categorias: Idoso, Instituição e Idoso na Instituição. Neste artigo apresentamos apenas os resultados referentes à categoria de Idoso na Instituição. Os resultados obtidos revelam diferenças estatisticamente significativas no que se refere à condição física do idoso, presença de suporte social, qualidade das visitas, participação do suporte social nos cuidados, possibilidade de obter períodos temporários de ausência da instituição e grau de autonomia. A condição física do idoso e o grau de autonomia demonstraram ser aspectos fundamentais na boa percepção de Qualidade de Vida do idoso. De igual modo, o suporte social/familiar é um fator importante para o idoso institucionalizado e deve ser preservado, rumo à adequada reintegração social e familiar.

The quality of life of the institutionalized elderly is an increasingly debated topic in contemporary society. If, on one hand, it turns out an increase in the use of institutions by the elderly, on the other emerges the need to assess the quality of life of this population. In this research study, the objectives are to characterize the institutionalized elderly and identify their needs face to the condition of elderly at the institution, basing ourselves in their perception of quality of life. This project involved 105 elderly patients hospitalized in units of the Integrated Continuous Care Network from Algarve. In the descriptive study, of transversal character and quantitative methodology, the data harvest was done through two questionnaires: sociodemographic and of the institution’s characterization; and also by the application of the Quality of Life scale WHOQOL-BREF. In the original study, the variables were grouped into three categories: Elderly, Institution and Elderly at the Institution. In this paper we present only the results for the category Elderly at the Institution. The results show statistically significant differences regarding to the physical condition of the elderly, presence of social support, quality of visits, participation of social support in the care, ability to obtain temporary periods of absence from the institution and degree of autonomy. The physical condition of the elderly and the degree of autonomy proved to be key issues in the perception of good quality of life for the elderly. Similarly, social/familial support is an important factor for the institutionalized elderly and should be preserved, towards proper social and family reintegration.