ABSTRACT
La enfermedad renal diabética (ERD) es una comorbilidad con alta prevalencia a nivel mundial, siendo una de las complicaciones más frecuentes de la diabetes mellitus (DM). La ERD se relaciona con complicaciones cardiovasculares y progresión de la enfermedad renal crónica (ERC), por ello la identificación de factores modificables, como el control de la presión arterial, es uno de los pilares más importantes en el manejo integral. En esta revisión hacemos un recorrido sobre el papel de la hipertensión y el bloqueo del eje renina angiotensina aldosterona (RAAS) en el curso de la ERD y las estrategias terapéuticas orientadas a la reducción de la presión arterial (PA), el bloqueo RAAS y el impacto en resultados renales y cardiovasculares. El objetivo de este artículo es hacer una revisión de las intervenciones más importantes que actúan bloqueando el eje renina angiotensina aldosterona (RAAS) y determinar si estas medidas en los pacientes con ERD, solo tienen impacto en el control de la presión arterial o si también son estrategias de nefro y cardio-protección. Conclusión: La ERD es una de las complicaciones más frecuentes de la diabetes mellitus (DM). El control de la PA sigue siendo un pilar fundamental para lograr estos objetivos. Los bloqueadores del RAAS (iECAS y BRAs) son los antihipertensivos de elección con efecto terapéutico por el bloqueo RAAS y esto les permite tener además del control de la PA, efectos nefroprotectores y cardioprotectores importantes en pacientes con ERD, sobre todo cuando hay la presencia de albuminuria. Evaluamos que además de los inhibidores de la enzima convertidora de angiotensina (iECAs) y los bloqueadores del receptor de angiotensina (BRAs), vienen tomando importancia los antagonistas selectivos del receptor mineralocorticoide (ARM) como Finerenona.
Diabetic kidney disease (DKD) is a comorbidity with a high worldwide prevalence, and one of the most frequent complications of diabetes mellitus (DM). CKD is related to cardiovascular complications and the progression of chronic kidney disease (CKD), therefore the identification of modifiable factors, such as blood pressure control, is one of the most important pillars in comprehensive management. In this review, we will analyze the role of hypertension and the renin-angiotensin-aldosterone system (RAAS) and its suppression in the course of CKD, and therapeutic strategies aimed at reducing blood pressure (BP), RAAS blockade, and the impact on renal and cardiovascular outcomes. The objective of this article is to review the most important interventions that act by blocking the renin-angiotensin-aldosterone system (RAAS) and to determine if these measures in patients with CKD only have an impact on blood pressure control or if they are also nephron and cardio-protective strategies. Conclusion: DKD is one of the most frequent complications of diabetes mellitus (DM). BP control continues to be a fundamental pillar to achieve these objectives. RAAS blockers (iECAS and ARBs) are the first-line antihypertensive with a therapeutic effect due to RAAS blockade and this allows them to have, in addition to BP control, important nephroprotective and cardioprotective effects in patients with CKD, especially when there is albuminuria. We evaluated that in addition to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), selective mineralocorticoid receptor antagonists (MRA) such as Finerenone are gaining importance.
Subject(s)
Diabetes Mellitus , Renal Insufficiency, Chronic , Hypertension , Angiotensins , Receptors, Angiotensin , Renin , Angiotensin Receptor Antagonists , Kidney DiseasesABSTRACT
Introducción: La diabetes mellitus (DM) es una enfermedad crónica inflamatoria muy frecuente y por ende una de las emergencias sanitarias mundiales de más rápido crecimiento en las últimas décadas. Hay tres ejes que impactan en la progresión del compromiso renal del paciente diabético. El eje hemodinámico, metabólico e inflamatorio. Resaltamos la importancia del componente inflamatorio como actor protagónico en el desarrollo de la Enfermedad renal diabética (ERD). El manejo del paciente con ERD debe ser holístico, con tres objetivos claros: buen control metabólico, disminuir progresión de la enfermedad renal y disminuir los desenlaces cardiovasculares adversos. Actualmente además de las intervenciones no farmacológicas, el control de los factores de riesgo, el uso de los IECAS/ARA II hay nuevos pilares en el tratamiento de la ERD. Objetivos: El objetivo de esta comunicación es revisar los nuevos pilares en el manejo de la ERD. En la revisión bibliográfica que se hizo, encontramos que hay tres nuevos pilares en el tratamiento. Los inhibidores SGLT-2, los agonistas del receptor GLP-1 y por último finerenona, que es un antagonista selectivo no esteroideo del receptor mineralocorticoide (ARM), no es un antidiabético. Con estas nuevas terapias el manejo actual de estos pacientes ha cambiado considerablemente. Conclusión: Hay nuevos pilares en el tratamiento de la ERD. Los inhibidores SGLT-2, los Agonistas del receptor GLP-1 y el uso de ARM como finerenona, que nos brindan beneficios cardiorenales y que hacen que hoy en día el tratamiento de la ERD tenga un mejor panorama.
Introduction: Diabetes mellitus (DM) is a very common chronic inflammatory disease and finally one of the fastest-growing global health emergencies in recent decades. Three axes impact the progression of renal compromise in diabetic patients. The hemodynamic, metabolic, and inflammatory axis. We highlight the importance of the inflammatory component as a leading actor in developing Diabetic Kidney Disease (DKD). The management of the patient with CKD must be holistic, with three clear objectives: reasonable metabolic control, slowing the progression of kidney disease, and reducing adverse cardiovascular outcomes. Currently, in addition to non-pharmacological interventions, the control of risk factors, and the use of ACE inhibitors/ARA II, there are new pillars in the treatment of CKD. Objectives: The objective of this communication is to review the new pillars in the management of DKD. In the bibliographic review that was carried out, we found that there are three new pillars in the treatment. SGLT-2 inhibitors, GLP-1 receptor agonists, and finally finerenone, which is a selective non-steroidal antagonist of the mineralocorticoid receptor (MRA), not an antidiabetic. With these new therapies, the current management of these patients has changed considerably. Conclusion: There are new pillars in the treatment of DKD. The SGLT-2 inhibitors, the GLP-1 receptor agonists, and the use of MRAs such as finerenone provide us with cardio-renal benefits and which today make the treatment of CKD have a better outlook.
Subject(s)
Diabetes Mellitus , Therapeutics , Kidney DiseasesABSTRACT
Introduction: Dialysis still remains the most common modality for the treatment of end stage kidney disease and it could be maneuvered to augment its dose, minimize complications and improve outcome. Dialysis prescription is a brief of how dialysis is to be given and involves adjustments in patients' characteristics, disease or dialytic procedure. This study aimed to assess the determinants of the prescribed dialysis and its relationship with intradialytic complications and the dialysis dose. Methods: A prospective study in which 1248 sessions for 232 consented participants with end stage kidney disease on maintenance hemodialysis were studied from 2017-2020. Biodata was taken, participants were examined and blood samples were taken to determine electrolytes, urea/creatinine and hematocrit. Pearson's correlation was used to determine the strength of association between dialysis dose and some variables. Results: Determinants of the prescribed dose were dialysis frequency (P<0.001), and predialysis systolic blood pressure (P<0.001) and packed cell volume (P<0.001). Dialysis sessions without significant intradialytic blood pressure changes were most likely to be completed, as sessions with intra-dialysis hypotension were most likely to be terminated. Participants dialyzed with high flux dialyzers, via an arterovenous fistula, higher blood flow and ultrafiltration rates had higher dialysis doses (P<0.001 in all instances). Conclusion: Higher dialysis doses were achieved with higher blood flow and ultrafiltration rates. Intradialytic hypotension was common with dialysis termination, higher blood flow and ultrafiltration rates. Intradialytic hypertension was common with low flux dialyzers. An optimized dialysis prescription is needed to deliver an adequate dialysis dose and minimize complications
Subject(s)
Humans , Male , Female , Blood Circulation , Renal Dialysis , Dialysis , Prescriptions , Kidney Diseases , TherapeuticsABSTRACT
Los ensayos y escritos relacionados con el cuidado del paciente renal a través de los años se han enfocado a la calidad de vida, estilos de afrontamiento, satisfacción o percepciones que experimentan los pacientes durante su enfermedad. El presente articulo pretende reconocer que el cuidado de enfermería para con el paciente renal es un aspecto fundamental que proporciona al profesional la comprensión de la realidad del paciente y contribuye de manera positiva a comprender la realidad de enfermería como disciplina; enmarcadas en algunas posiciones que permiten garantizar su significado. Estas posiciones son la ética, la ontología y la epistemología. La ética se logra cuando el profesional de enfermería consigue proteger y respetar la dignidad humana del paciente renal que reciben atención de salud, la ontología se ocupa de reflexionar acerca de las concepciones de la realidad y sus relaciones centrando su finalidad en la búsqueda de la salud, del bienestar, la independencia y la trascendencia del paciente renal y la epistemología consiste en mostrar, de manera holística, la evolución del conocimiento de la enfermería para brindar un cuidado de excelencia al paciente renal.
Abstract Over the years, essays and writings related to kidney patient care have focused on quality of life, coping styles, satisfaction, or perceptions experienced by patients during their illness. This article aims to recognize that nursing care for kidney patients is a fundamental aspect that provides the professional with an understanding of the patient's reality and contributes positively to understanding the reality of nursing as a discipline framed in some positions that guarantee their meaning. These positions are ethics, ontology, and epistemology. Ethics is achieved when the nursing professional manages to protect and respect the human dignity of kidney patients who receive health care. Ontology deals with reflecting on the conceptions of reality and their relationships, focusing its purpose on the search for health, well-being, independence, and transcendence of kidney patients. And epistemology consists of showing, in a holistic way, the evolution of nursing knowledge to provide excellent care to kidney patients.
Resumo: Ensaios e escritos relacionados com os cuidados aos pacientes renais ao longo dos anos têmse focado na qualidade de vida, estilos de enfrentamento, satisfação ou percepções que os pacientes experimentam durante a sua doença. Este artigo tem como objetivo reconhecer que o cuidado de enfermagem para o doente renal é um aspecto fundamental que proporciona ao profissional uma compreensão da realidade do doente e contribui positivamente para a compreensão da realidade da enfermagem como disciplina; emoldurado em algumas posições que permitem garantir seu significado. Estas posições são ética, ontologia e epistemología. A ética é alcançada quando o profissional de enfermagem consegue proteger e respeitar a dignidade humana do paciente renal que recebe cuidados de saúde, a ontologia se preocupa em refletir sobre as concepções da realidade e as suas relações centrando o seu propósito na procura de saúde, bem-estar, independência e transcendência do paciente renal e epistemologia consiste em mostrar, holisticamente, a evolução do conhecimento de enfermagem para prestar um excelente cuidado ao paciente renal.
Subject(s)
Humans , Male , Female , Aged , Knowledge , Ethics , Kidney Diseases/nursing , Nursing Care , Quality of Life , Nursing Diagnosis , Patient ComfortABSTRACT
Introducción: La Diabetes Mellitus (DM) es una enfermedad inflamatoria sistémica de alta prevalencia e incidencia a nivel mundial. Dentro de las complicaciones crónicas, la enfermedad renal diabética es una de las más frecuentes y que marca el pronóstico. Objetivos: El objetivo de este artículo es hacer una revisión actualizada de la enfermedad renal diabética, a la luz de los cambios en los paradigmas que se han generado en los últimos años con respecto a sus nuevas definiciones, el papel de la inflamación en su desarrollo, la gestión del riesgo cardiovascular y los nuevos tratamientos. La enfermedad renal diabética puede presentarse en aproximadamente el 30-50% de la población con diabetes mellitus tipo 1 o 2 alrededor del mundo. En la patogénesis y progresión de esta condición se distinguen tres ejes fundamentales el hemodinámico, metabólico e inflamatorio. Es importante siempre hacer gestión del riesgo cardiovascular. El diagnóstico se debe hacer con el cálculo de la tasa de filtrado glomerular y la relación albuminuria / creatinuria en muestra ocasional. Los objetivos en el tratamiento deben ser: el control metabólico, reducir o enlentecer la progresión de la enfermedad renal y disminuir los desenlaces cardiovasculares. Conclusión: El tratamiento de la ERD debe ser holístico, desde intervenciones no farmacológicas, como la modificación de los estilos de vida, hasta los nuevos medicamentos como el uso de inhibidores SGLT-2, Agonistas del receptor GLP-1 y el uso antagonistas selectivos del receptor mineralocorticoide como finerenona. El futuro es promisorio.
Introduction: Diabetes mellitus (DM) is a systemic inflammatory disease of high prevalence and incidence worldwide. Among the chronic complications, diabetic kidney disease is one of the most frequent and determines the prognosis. Objectives: The objective of this article is to make an updated review of diabetic kidney disease, in light of the changes in the paradigms that have been generated in recent years concerning to the new definitions, the role of inflammation-causing disease, cardiovascular risk management, and the new treatments. Diabetic kidney disease can present in approximately 30-50% of the population with diabetes mellitus type 1 or 2 around the world. In the pathogenesis and progression of this condition, three fundamental axes are distinguished: the hemodynamic, the metabolic, and the inflammatory. It is important to manage cardiovascular risk. The diagnosis must be made by calculating the glomerular filtration rate and the albuminuria/creatinuria ratio in a random urine sample. The objectives of the treatment should be: metabolic control, reduce or slow the progression of kidney disease and improve cardiovascular outcomes. Conclusion: The treatment of diabetic kidney disease should be holistic, from non-pharmacological interventions, such as lifestyle changes, to new medications such as the use of SGLT-2 inhibitors, GLP-1 receptor agonists, and the use of selective mineralocorticoid receptor antagonists such as finerenone. The future is promising.
Subject(s)
Diabetes Mellitus , Kidney DiseasesABSTRACT
En el paciente con diabetes mellitus (DM) y enfermedad renal crónica (ERC), las alteraciones electrolíticas y metabólicas constituyen un verdadero desafío. En noviembre de 2021, el Comité de Nefropatía de la Sociedad Argentina de Diabetes realizó una jornada científica con el objetivo de actualizar las alteraciones hidroelectrolíticas y del metabolismo óseo mineral, y las consideraciones dietarias en ERC y DM.
In patients with diabetes mellitus (DM) and chronic kidney disease (CKD), electrolyte and metabolic alterations constitute a real challenge. In November 2021, the Nephropathy Committee of the Argentine Diabetes Society held a scientific conference with the aim of updating hydroelectrolytic and mineral bone metabolism disorders, and dietary considerations in CKD and DM.
Subject(s)
Diabetes Mellitus , Electrolytes , Renal Insufficiency, Chronic , Kidney Diseases , MineralsABSTRACT
Diagnosticar, clasificar y estadificar la enfermedad renal en pacientes con diabetes mellitus (DM) es un desafío tanto para los médicos de atención primaria como para los especialistas, porque no existe método en la práctica clínica que evalúe la tasa de filtrado glomerular (TFG) en forma precisa. Para evaluar la función renal en enfermedad renal crónica (ERC) con menos de 60 ml/min/1.73m2 , correspondiente a los estadios 3, 4 y 5 de la clasificación actual, los métodos disponibles en los laboratorios clínicos son de limitada exactitud. En este trabajo se desarrollarán las condiciones que debería cumplir un marcador ideal, las dificultades que ofrece la evaluación de la creatinina, la medición de la TFG, así como las ventajas y limitaciones de las recomendaciones del uso de fórmulas para su determinación, y el algoritmo actual para estimar función renal. Conclusiones: actualmente, a pesar de las limitaciones, se recomienda el empleo de fórmulas para la estimación de la TFG, sobre todo en TFG menor a 60 ml/min/1.73 m2. Es un desafío, para un futuro mediato, desarrollar mejores recursos para su evaluación.
To diagnose,classify and stage diabetic kidney disease in patients with diabetes mellitus is a challenge in clinical practice for both primary care physicians and specialists because there is no method in clinical practice that evaluates accurately the glomerular filtration rate (GFR). This challenge is due to difficulties in evaluating kidney function in stages of chronic kidney disease (CKD) below 60 ml/min/1.73m2 corresponding to stages 3, 4 and 5 of the classification, because the available tools in clinical laboratories are of limited accuracy. This work explores the conditions that an ideal marker should meet, the difficulties offered by the evaluation of serum creatinine, the measurement of the glomerular filtration rate (GFR) as well as the advantages and limitations of the recommendations of the use of formulas for its determination and the current algorithm to estimate renal function. Conclusions: currently, despite the limitations, the use of formulas for the diagnosis of renal function is recommended, especially in GFR below 60 ml/min/1.73 m2. It is a challenge for the near future to develop better tools for the evaluation of TGF.
Subject(s)
Kidney Diseases , Diabetes Mellitus , Diabetic Nephropathies , Renal Insufficiency, ChronicABSTRACT
La nefronoptisis es una enfermedad renal quística, de herencia autosómica recesiva, causada por mutaciones en genes que codifican proteínas involucradas en la función de cilios primarios, lo que resulta en enfermedad renal y manifestaciones extrarrenales como degeneración retiniana y fibrosis hepática. Según la edad de desarrollo de enfermedad renal crónica terminal, se describen tres formas clínicas de presentación: infantil, juvenil y adolescente. El diagnóstico se realiza por una prueba genética positiva o una biopsia de riñón que demuestre cambios tubulointersticiales crónicos con un engrosamiento de las membranas basales tubulares. No existe hasta la actualidad una terapia curativa, por lo que el trasplante renal oportuno es determinante en cuanto al pronóstico. Se presenta un paciente de 13 meses de edad con poliuria de 3 meses de evolución, insuficiencia renal, anemia y elevación de transaminasas. Con hallazgos histológicos compatibles en la biopsia renal, se arribó al diagnóstico de nefronoptisis infantil, con afectación hepática
Nephronophthisis is an autosomal recessive cystic kidney disease caused by mutations in genes that encode proteins involved in the primary cilia function, resulting in kidney disease and extrarenal manifestations such as retinal degeneration and liver fibrosis. According to the age of development of end-stage chronic kidney disease, three clinical forms of presentation are described: infantile, juvenile and adolescent. Diagnosis is made by a positive genetic test, or a kidney biopsy demonstrating chronic tubulointerstitial changes with thickening of the tubular basement membranes. At the moment there is no healing therapy, so early kidney transplant is a fundamental tool to improve prognosis.We present a 13-month old male patient with polyuria, kidney failure, anemia and elevated aminotransferases over three months. With compatible histological kidney biopsy, the diagnosis of infantile nephronophthisis with liver involvement was reached.
Subject(s)
Humans , Male , Infant , Kidney Diseases, Cystic/diagnosis , Kidney Diseases, Cystic/genetics , Kidney Diseases, Cystic/pathology , Kidney Diseases , Kidney Failure, Chronic/genetics , Proteins , Genetic TestingABSTRACT
La insuficiencia renal crónica (IRC) provoca cambios bruscos en la vida del individuo, como el desarrollo de trastornos emocionales que pueden conllevar a cuadros de ansiedad, depresión y estrés; afectando su estado emocional. Objetivo: Validar los instrumentos para analizar la influencia de la hemodiálisis en el estado emocional. Materiales y métodos: La investigación fue de diseño transversal con análisis descriptivo no experimental, modalidad cuali-cuantitativo. Los instrumentos utilizados fueron diseñados y validados por juicio de expertos y analizados estadísticamente con alfa de Cronbach, se empleó una prueba piloto compuesta por 15 personas con insuficiencia renal crónica para la validación de los instrumentos. Resultados: El instrumento cuantitativo presentó un coeficiente de fiabilidad de 0.75 en alfa de Cronbach y el instrumento cualitativo de acuerdo a la rúbrica de los expertos obtuvo un promedio de confiabilidad de 96; por lo que los instrumentos son aprobados y pueden aplicarse con resultados confiables. Conclusión: Los instrumentos tienen una validez, pertinencia y coherencia, adecuados para trabajar en la recolección de datos para determinar el estado emocional de los pacientes sometidos a hemodiálisis. El estudio estableció las asociaciones entre las variables de acuerdo a las etapas de la enfermedad será la predisposición a trastornos del estado de ánimo. Los resultados obtenidos validan la utilidad científica y la efectividad de los instrumentos diseñado(AU)
Chronic renal failure (CRF) causes sudden changes in the individual's life, such as the development of emotional disorders that can lead to anxiety, depression and stress; affecting your emotional state. Objective: To validate the instruments to analyze the influence of hemodialysis on the emotional state. Materials and methods: The research was of a cross-sectional design with non-experimental descriptive analysis, qualitative-quantitative modality. The instruments used were designed and validated by expert judgment and statistically analyzed with Cronbach's alpha. A pilot test consisting of 15 people with chronic renal failure was used to validate the instruments. Results: The quantitative instrument presented a reliability coefficient of 0.75 in Cronbach's alpha and the qualitative instrument, according to the experts' rubric, obtained a reliability average of 96; so the instruments are approved and can be applied with reliable results. Conclusion: The instruments have validity, relevance and coherence, adequate to work on data collection to determine the emotional state of patients undergoing hemodialysis. The study established the associations between the variables according to the stages of the disease will be the predisposition to mood disorders. The results obtained validate the scientific usefulness and effectiveness of the instruments designed(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Anxiety , Nursing Diagnosis , Affective Symptoms , Renal Insufficiency, Chronic , Mood Disorders , Kidney DiseasesABSTRACT
La hipertensión arterial (HTA) es una de las causas de muertes a nivel mundial, esta enfermedad incrementa significativamente los riesgos de sufrir cardiopatías, encefalopatías, nefropatías y otras enfermedades. Su prevalencia está asociada a países de bajos y medianos ingresos, y se consideran factores de riesgos al estrés, alcoholismo, obesidad, tabaquismo, drogas, alimentación, genética, raza, y ciertas patologías como diabetes mellitus, algunas de ellas consideradas como factores de riesgo modificables y que pueden ser medidas de prevención y control en su tratamiento. Objetivo: Recopilar información sobre los transcriptores riesgos modificables relacionados a la hipertensión arterial. Materiales y Métodos: El estudio es del tipo descriptivo, La metodología es una revisión narrativa, con recopilación de literatura referente al tema y disponible en la web, se emplearon los descriptores: hipertensión, factores de riesgo. Resultados: Aporte de información relevante sobre los factores de riesgos modificables entre ellos el consumo de tabaco y alcohol, reducción de peso, alimentación, actividades físicas, reducción del consumo de sal, aumento del consumo de hortalizas y frutas, además de la disminución en el consumo de alimentos grasos, sales, y un control periódico de la tensión arterial, bajo la supervisión médica que son considerados para la prevención y control de la HTA, como métodos alternativos para control y prevención de esta enfermedad. Conclusiones: Los factores de riesgo modificables que predominan son el consumo de grasas, ausencia del control del índice de masa corporal y de la presión arterial, así como el consumo excesivo de sal y presencia de estrés. Los factores de riesgo no modificables que predisponen a hipertensión arterial prevalentemente son los antecedentes familiares de HTA y de obesidad. Se ha determinado que los cambios en el estilo de vida, así como una conducta sana para la prevención y control de riesgos que son modificables atenúan la prevalencia de la misma(AU)
Arterial hypertension (AHT) is one of the causes of death at the Worldwide, this disease significantly increases the risk of heart disease, encephalopathies, nephropathies and other diseases. Its prevalence is associated with countries of low and medium income, and are considered risk factors for stress, alcoholism, obesity, smoking, drugs, food, genetics, race, and certain pathologies such as diabetes mellitus, some of them considered as modifiable risk factors and that can be prevention and control measures in their treatment. Objective: Collect information on transcriptionists modifiable risks related to hypertension arterial. Materials and methods: The study is of the descriptive type, the methodology is a narrative review, with a compilation of literature on the subject and available on the web, used the descriptors: hypertension, risk factors. Results: Contribution of relevant information on modifiable risk factors, including the consumption of tobacco and alcohol, weight reduction, nutrition, physical activities, reduction of salt intake, increased consumption of vegetables and fruits, in addition to the decrease in the consumption of fatty foods, salts, and periodic control of blood pressure, under the medical supervision that are considered for the prevention and control of hypertension, such as alternative methods for control and prevention of this disease. Conclusions: The modifiable risk factors that predominate are the consumption of fats, absence of control of body mass index and blood pressure, as well as excessive consumption of salt and presence of stress. Non-modifiable risk factors that predispose to high blood pressure are predominantly a family history of hypertension and obesity. It has been determined that changes in lifestyle, as well as behavior healthy for the prevention and control of risks that are modifiable attenuate the prevalence ofthe same(AU)
Subject(s)
Risk Factors , Hypertension/diagnosis , Life Style , Tobacco Use Disorder , Brain Diseases , Prevalence , Alcoholism , Heart Diseases , Kidney Diseases , ObesityABSTRACT
INTRODUCCIÓN. La incorporación de nuevas tecnologías como la hemodiafiltración en línea, han mejorado parámetros metabólicos/nutricionales en los pacientes que se encontraban en hemodiálisis convencional; en la actualidad no existen datos registrados en la población ecuatoriana que se encuentra sometida a esta clase de tecnologías. OBJETIVO. Comparar la evolución clínico-metabólica de pacientes que estaban en hemodiálisis convencional y cambiaron a hemodiafiltración en línea, determinar si es favorable la migración de la terapia hemodialítica difusiva a convectiva y establecer si el cambio de terapia dialítica ocasionó resultados favorables. MATERIALES Y MÉTODOS. Estudio analítico retrospectivo. Población y muestra de 38 pacientes enfermos renales crónicos en terapia de sustitución renal modalidad hemodiálisis convencional que cambiaron a hemodiafiltración en línea, independientemente del tiempo de diagnóstico y tratamiento en la unidad de hemodiálisis del Hospital de Especialidades Carlos Andrade Marín, Quito-Ecuador, durante el periodo marzo 2016 a marzo 2017. RESULTADOS. Los efectos nutricionales y metabólicos pudieron denotar mayor ponderación de resultados favorables en la modalidad de hemodiafiltración. En la estabilidad hemodinámica y la dosis de diálisis se evidenció una leve superioridad en la modalidad de hemodiafiltración en comparación a la Hemodiálisis. En las dosis administradas de Calcio, Hierro, Eritropoyetina y Calcitriol no existieron diferencias significativas entre las dos modalidades de tratamientos. CONCLUSIÓN. El cambio de modalidad de Hemodiálisis convencional a Hemodiafiltración en línea fue favorable, y mejoró los parámetros clínicos/metabólicos de los pacientes que requieren terapia de sustitución renal.
INTRODUCTION. The incorporation of new technologies such as online haemodiafiltration have improved metabolic/nutritional parameters in patients who were on conventional haemodialysis; At present, there are no registered data on the Ecuadorian population that is subjected to this kind of technology. OBJECTIVE. To compare the clinical-metabolic evolution of patients who were on conventional hemodialysis and changed to online hemodiafiltration, to determine if the migration from diffusive to convective hemodialysis therapy is favorable and to establish if the change in dialysis therapy caused favorable results. MATERIALS AND METHODS. Retrospective analytical study. Population and sample of 38 patients with chronic kidney disease in conventional hemodialysis modality renal replacement therapy who changed to online hemodiafiltration, regardless of the time of diagnosis and treatment in the hemodialysis unit of the Hospital de Especialidades Carlos Andrade Marín, Quito-Ecuador, during the period March 2016 to March 2017. RESULTS. The nutritional and metabolic effects could denote a greater weighting of favorable results in the hemodiafiltration modality. In hemodynamic stability and dialysis dose, a slight superiority was evidenced in the hemodiafiltration modality compared to hemodialysis. In the administered doses of Calcium, Iron, Erythropoietin and Calcitriol there were no significant differences between the two treatment modalities. CONCLUSION. The change of modality from conventional hemodialysis to online hemodiafiltration was favorable, and improved the clinical/metabolic parameters of patients requiring renal replacement therapy.
Subject(s)
Humans , Male , Female , Ultrafiltration , Renal Dialysis , Hemodiafiltration , Continuous Renal Replacement Therapy , Hemodialysis Units, Hospital , Kidney DiseasesABSTRACT
Abstract Background: Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardiovascular impairment, increasing the rates of atherosclerotic and non-atherosclerotic events. Additionally, adverse kidney events are directly linked with T2DM and cardiovascular diseases. In this context, the sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated both cardioprotective and renoprotective effects in patients with or without T2DM. Therefore, the present meta-analysis aims to evaluate cardiovascular outcomes involving SGLT2i as monotherapy or other add-on antidiabetic agents (ADA) in patients with or without T2DM. Objetive: The present meta-analysis aims to evaluate cardiovascular outcomes involving SGLT2i as monotherapy or add-on other ADA in patients with or without T2DM. Methods: The entrance criteria to SGLT2i studies were: describing any data regarding cardiovascular effects; enrolling more than 1,000 participants; being approved by either the FDA or the EU, and having available access to the supplementary data. The trial had to exhibit at least one of the following results: major adverse cardiovascular events (MACE), cardiovascular death or hospitalization for heart failure, cardiovascular death, hospitalization for heart failure, renal or cardiovascular adverse events, or non-cardiovascular death. The significance level of 0.05 was adopted in the statistical analysis. Results: Nine trials with a total of 76,285 participants were included in the meta-analysis. SGLT2i reduced MACE (RR 0.75, 95% CI [0.55-1.01]), cardiovascular death or hospitalization for heart failure (RR 0.72, 95% CI [0.55-0.93]), cardiovascular death (RR 0.66, 95% CI [0.48-0.91]), hospitalization for heart failure (RR 0.58, 95% CI [0.46-0.73]), renal or cardiovascular adverse events (RR 0.55, 95% CI [0.39-0.78]), and non-cardiovascular death (RR 0.88, 95% CI [0.60-1.00]). Conclusions: Conjunction overall data suggests that these drugs can minimize the risk of cardiovascular events, thus decreasing mortality in patients, regardless of the presence of T2DM.
Subject(s)
Humans , Cardiotonic Agents , Cardiovascular Diseases/mortality , Cardiovascular Diseases/drug therapy , Diabetes Mellitus, Type 2 , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Reproducibility of Results , Outcome Assessment, Health Care , Sodium-Glucose Transporter 2 , Hospitalization , Kidney Diseases/drug therapyABSTRACT
ABSTRACT Objective: To analyze the incidence, risk factors, and associations of clinical outcomes for contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) after coronary angioplasty. Method: Prospective cohort of 182 patients followed for three months after undergoing angioplasty, from July 2020 to June 2021. The analyzed variables were sociodemographic, clinical, and those related to the procedure. Results: The incidence of CI-AKI was 35.7% (n = 65) and was associated with old age, diabetes mellitus, and chronic kidney disease (p = 0.004, p < 0.001, and p = 0.009, respectively). Out of the 17 patients who died within 90 days, 76.5% had CI-AKI (n = 13), the odds ratio between death and CI-AKI was approximately 7.2 times (95% confidence interval (CI), [2.41;26.36]; p = 0.001). The decrease of one unit in the patient's baseline hemoglobin showed a 6.5% increase for CI-AKI (95% CI, [−0.089; −0.040]; p < 0.0001). Conclusion: CI-AKI is prevalent in patients with ACS after angioplasty and is related to diabetes mellitus and chronic kidney disease, showing high mortality rates.
RESUMEN Objetivo: Analizar la incidencia, los factores de riesgo y las asociaciones de resultados clínicos para Lesión Renal Aguda Inducida por Contraste (LRA-IC) en pacientes con Síndrome Coronario Agudo (SCA) después de angioplastia coronaria. Método: Cohorte prospectiva de 182 pacientes monitorizados durante tres meses tras realizada la angioplastia, en el periodo entre julio de 2020 y junio de 2021. Se evaluaron las variables sociodemográficas, clínicas y relacionadas con el procedimiento. Resultados: La incidencia de LRA-IC fue del 35,7% (n = 65) y se asoció con la edad avanzada, la diabetes mellitus y la enfermedad renal crónica (p = 0,004, p < 0,001 y p = 0,009, respectivamente). De los 17 pacientes que fallecieron dentro de los 90 días, el 76,5% tenía LRA-IC (n = 13), la razón de probabilidad entre muerte y LRA-IC fue aproximadamente 7,2 veces (intervalo de confianza, IC del 95%, [2,41;26,36]; p = 0,001). La disminución de una unidad en la hemoglobina basal del paciente demostró un aumento del 6,5% para LRA-IC (IC del 95%, [-0,089; -0,040]; p < 0,0001). Conclusión: En los pacientes con SCA después de angioplastia, la LRA-IC tiene una alta incidencia y está relacionada con la diabetes mellitus y la enfermedad renal crónica, presentando altas tasas de mortalidad.
RESUMO Objetivo: Analisar a incidência, os fatores de risco e as associações dos desfechos clínicos para Lesão Renal Aguda Induzida Por Contraste (LRA-IC) em pacientes com Síndrome Coronariana Aguda (SCA) após angioplastia coronariana. Método: Coorte prospectivo de 182 pacientes seguidos por três meses após angioplastia, entre julho de 2020 e junho de 2021. As variáveis foram sociodemográficas, clínicas e relacionadas ao procedimento. Resultados: A incidência de LRA-IC foi de 35,7% (n = 65) e esteve associada à idade avançada, diabetes mellitus e doença renal crônica (respectivamente p = 0,004, p < 0,001 e p = 0,009). Dos 17 pacientes que faleceram em até 90 dias, 76,5% tiveram LRA-IC (n = 13), a razão de chances entre óbito e LRA-IC foi de aproximadamente 7,2 vezes (intervalo de confiança (IC) 95%, [2,41;26,36]; p = 0.001). A diminuição de uma unidade na hemoglobina basal do paciente demonstrou um aumento de 6,5% para LRA-IC (IC 95%, [-0,089; -0,040]; p < 0,0001). Conclusão: Em pacientes com SCA após angioplastia, a LRA-IC tem alta incidência e está relacionada com diabetes mellitus e doença renal crônica, apresentando altos índices de mortalidade.
Subject(s)
Percutaneous Coronary Intervention , Kidney Diseases , Contrast Media , Acute Coronary Syndrome , Acute Kidney InjuryABSTRACT
Introdução: A análise da ingestão alimentar de pacientes com doença renal crônica (DRC) em tratamento dialítico é eficaz para fornecer informações a fim de auxiliar no diagnóstico nutricional e nortear as condutas dietéticas necessárias. Objetivo: Analisar a adequação do consumo alimentar de acordo com as recomendações publicadas pelo Kidney Disease Outcome Quality Initiative (KDOQI) para macro e micronutrientes, além de avaliar a capacidade antioxidante total da dieta (CATd), de portadores de DRC. Materiais e Métodos: Estudo transversal, com 60 voluntários portadores de DRC em tratamento hemodialítico de um Hospital Universitário de Juiz de Fora MG. A caracterização da amostra foi feita no período de junho de 2019 a fevereiro de 2020, através da aplicação de um Questionário Quantitativo de Frequência Alimentar (QQFA) e de coleta de dados pessoais, clínicos e comorbidades. As análises estatísticas foram conduzidas utilizando-se o software SPSS, versão 20.0. As variáveis numéricas foram apresentadas na forma de média (± desvio-padrão), mediana, mínimo e máximo, enquanto as categóricas em frequência absoluta e relativa. Resultados: Observou-se que 43% e 55% dos pacientes apresentaram um consumo calórico e proteico acima do preconizado pela KDOQI, respectivamente. Para os micronutrientes, foi observado que 77% dos pacientes apresentaram consumo de cálcio abaixo do recomendado e de fósforo 65% maior do que a recomendação atual. Percebeu-se que 67% e 40% dos pacientes apresentaram adequado consumo de sódio e potássio. O perfil lipídico da dieta dos pacientes, demonstrou uma desproporção da razão ômega 6/ômega 3, além de um CATd de 4,05 mmol/dia. Conclusão: Através do presente estudo podemos concluir que o consumo alimentar dos pacientes em hemodiálise avaliados apresenta algumas inadequações em relação às recomendações propostas pela literatura.
Introduction: The analysis of food intake in patients with chronic kidney disease (CKD) undergoing dialysis is effective to provide information to assist in nutritional diagnosis and guide the necessary dietary behaviors. Objective: To analyze the adequacy of food consumption according to the recommendations published by the Kidney Disease Outcome Quality Initiative (KDOQI) for macro and micronutrients, in addition to evaluating the total antioxidant capacity of the diet (CATd) of patients with CKD. Materials and Methods: Cross-sectional study with 60 volunteers with CKD undergoing hemodialysis treatment at a University Hospital in Juiz de Fora MG. The characterization of the sample was carried out from June 2019 to February 2020, through the application of a Quantitative Food Frequency Questionnaire (QQFA) and the collection of personal, clinical and comorbid data. Statistical analyzes were conducted using SPSS software, version 20.0. Numerical variables were presented as mean (± standard deviation), median, minimum and maximum, while categorical variables in absolute and relative frequency. Results: It was observed that 43% and 55% of the patients had a caloric and protein consumption above that recommended by the KDOQI, respectively. For micronutrients, it was observed that 77% of the patients had calcium intake below the recommended level and phosphorus consumption 65% higher than the current recommendation. It was noticed that 67% and 40% of the patients had adequate consumption of sodium and potassium. The lipid profile of the patients' diet showed a disproportion of the omega 6/omega 3 ratio, in addition to a CATd of 4.05 mmol/day. Conclusion: Through the present study we can conclude that the food consumption of the evaluated hemodialysis patients presents some inadequacies in relation to the recommendations proposed by the literature
Subject(s)
Renal Dialysis , Recommended Dietary Allowances , Dialysis , Diet , Eating , Diet, Food, and Nutrition , Food , Kidney DiseasesABSTRACT
ABSTRACT Objective: to analyze the influence of early hemodialysis on the outcome of acute septic kidney injury. Method: this is an observational, analytical, prospective study with patients diagnosed with acute septic kidney injury on hemodialysis. A questionnaire for data collection was used as an instrument. We used the Shapiro-Wilk, nonparametric Kruskal-Wallis, Mann-Whitney U, Student t and chi-square tests for analysis. Results: of the 40 patients analyzed, 60% were male, with a mean age of 55 (±16.8) years, and length of hospital stay of 43 (±26.2) days. When separating patients undergoing early and late hemodialysis into two groups, an increase in serum creatinine (p = 0.001) was observed in those who underwent late hemodialysis, however, creatinine ≥ 4mg/dl is one of the characteristics of this group. In both groups, there was a high mortality: 62.5% (10) in the early hemodialysis group and 41.7% (10) in the late hemodialysis group, with vasopressor use (p = 0.001) being the main risk factor. Conclusion: early onset of hemodialysis in acute septic kidney injury based on KDIGO definitions did not influence the outcome. However, vasopressor use associated with hemodialysis in septic patients was a predictor of death.
RESUMEN Objetivo: analizar la influencia de la hemodiálisis precoz en el desenlace del daño renal agudo séptico. Método: estudio observacional, analítico, prospectivo con pacientes diagnosticados de insuficiencia renal aguda séptica en hemodiálisis. Se utilizó un cuestionario como instrumento para la recolección de datos. Para el análisis se utilizaron las pruebas de Shapiro-Wilk, Kruskal-Wallis no paramétrica, U de Mann-Whitney, t de Student y Chi-Cuadrado. Resultados: de los 40 pacientes analizados, el 60% eran del sexo masculino, con una edad media de 55 (±16,8) años y una estancia hospitalaria de 43 (±26,2) días. Al separar a los pacientes en hemodiálisis temprana y tardía en dos grupos, se observó un aumento de la creatinina sérica (p = 0,001) en los que realizaron hemodiálisis tardía, sin embargo, la creatinina ≥ 4 mg/dl es una de las características de este grupo. En ambos grupos hubo una alta mortalidad: 62,5% (10) en el grupo de hemodiálisis precoz y 41,7% (10) en el grupo de hemodiálisis tardía, siendo el uso de vasopresor (p = 0,001) el principal factor de riesgo. Conclusión: el inicio temprano de la hemodiálisis en la insuficiencia renal aguda séptica basada en las definiciones de KDIGO no influyó en el resultado. Sin embargo, el uso de vasopresor asociado a hemodiálisis en pacientes sépticos fue predictor de muerte.
RESUMO Objetivo: analisar a influência da hemodiálise precoce no desfecho da lesão renal aguda séptica. Método: estudo observacional, analítico, prospectivo, com pacientes diagnosticados com lesão renal aguda séptica em hemodiálise. Foi utilizado como instrumento um questionário para coleta de dados. Utilizaram-se para análise os testes Shapiro-Wilk, o não paramétrico de Kruskal-Wallis, U de Mann-Whitney, t de Student e do Qui-Quadrado. Resultados: dos 40 pacientes analisados, 60% eram do sexo masculino, com média de 55 (±16,8) anos, e tempo de internação hospitalar de 43 (±26,2) dias. Ao separar em dois grupos, pacientes submetidos à hemodiálise precoce e à hemodiálise tardia, observou-se naqueles que realizaram tardiamente a hemodiálise um aumento de creatinina sérica (p = 0,001), entretanto a creatinina ≥ 4mg/dl é umas das características desse grupo. Em ambos os grupos, houve uma alta mortalidade: 62,5% (10) no grupo de hemodiálise precoce e 41,7% (10) no grupo de hemodiálise tardia, sendo o uso de vasopressor (p = 0,001) o principal fator de risco. Conclusão o início precoce da hemodiálise na lesão renal aguda séptica com base nas definições do KDIGO não influenciou no desfecho. Contudo, o uso do vasopressor associado à hemodiálise em pacientes sépticos foi um fator preditor ao óbito.
Subject(s)
Renal Dialysis , Kidney Diseases , SepsisABSTRACT
Objetivo: Determinar a razão oferta/necessidade de procedimentos relacionados com o diagnóstico e assistência à doença renal crônica no Sistema Único de Saúde (SUS), no estado de São Paulo, Brasil, 2019. Métodos: Estudo descritivo, utilizando dados dos sistemas de informações ambulatoriais e hospitalares do SUS. Os números de consultas médicas e exames diagnósticos e de acompanhamento da doença renal realizados no período foram comparados com as estimativas de necessidade obtidas por diretrizes ministeriais. Resultados: Usuários exclusivos do SUS eram 28.791.244, e indivíduos com hipertensão e/ou diabetes mellitus, 5.176.188. O número de procedimentos realizados e a razão entre esse número e a necessidade da população foram de 389.414 consultas com nefrologista (85%); 11.540.371 dosagens de creatinina sérica (223%); 705.709 dosagens de proteinúria (14%); 438.123 ultrassonografias renais (190%); e 1.045 biópsias renais (36%). Conclusão: Na assistência à doença renal crônica no SUS existem, simultaneamente, falta de oferta, desperdício e rastreamento deficiente de procedimentos importantes.
Objetivo: Determinar la relación oferta/necesidad de procedimientos relacionados con el diagnóstico y atención de la enfermedad renal crónica en Sistema Único de Salud (SUS) del Estado de São Paulo, Brasil, en 2019. Métodos: Estudio descriptivo utilizando datos de los sistemas de información ambulatoria y hospitalaria del SUS. Se comparó el número de consultas médicas, pruebas de diagnóstico y seguimiento de la enfermedad renal realizados con las estimaciones de necesidad recomendadas por directrices ministeriales. Resultados: Los usuarios exclusivos de SUS fueron 28.791.244 e hipertensos y/o diabéticos, 5.176.188. El número de procedimientos realizados y la relación entre este número y la necesidad de la población fueran de 389.414 consultas con nefrólogo (85%); 11.540.371 determinaciones de creatinina sérica (223%); 705.709 determinaciones de proteinuria (14%); 438.123 ecografías renales (190%); y 1.045 biopsias renales (36%). Conclusión: En la atención de enfermedad renal en SUS existe, simultáneamente, falta de oferta, desperdicio y seguimiento deficiente de procedimientos importantes.
Objective: To determine the supply/demand ratio for procedures related to diagnosis and treatment for chronic kidney disease in the Brazilian National Health System (SUS), in the state of São Paulo, Brazil, 2019. Methods: This was a descriptive study, using data from the SUS outpatient and hospital information systems. The numbers of medical consultations, diagnostic and chronic kidney disease monitoring tests, performed in the period, were compared with the demand estimation, obtained through ministerial guidelines. Results: Exclusive SUS users were 28,791,244, and individuals with arterial hypertension and/or diabetes mellitus, 5,176,188. The number of procedures performed and the ratio between this number and the needs of the population were 389,414 consultations with nephrologists (85%); 11,540,371 serum creatinine tests (223%); 705,709 proteinuria tests (14%); 438,123 kidney ultrasounds (190%); and 1,045 kidney biopsies (36%). Conclusion: In the chronic kidney disease care in the SUS it could be seen simultaneous existence of lack of supply, waste and inadequate screening of important procedures.
Subject(s)
Humans , Primary Health Care , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Referral and Consultation/statistics & numerical data , Unified Health System , Brazil , Utilization Review , Diagnostic Tests, Routine/statistics & numerical data , Health Services Research , Kidney Diseases/epidemiologyABSTRACT
Introduction: Low birth weight (LBW), a proxy for hostile intrauterine environment, has been associated with these diseases in adulthood. In Brazil, there is scarce literature on the association of LBW with blood pressure (BP) or kidney and pancreatic functions in adults. The big ELSA-Brasil database allowed to explore whether: 1) pre-diabetic individuals could have kidney function impairment, detectable by renal biomarkers; 2) LBW is associated with less favorable BP levels and kidney and pancreatic function in adulthood compared to normal birth weight. Objectives: To analyze the association of LBW with BP and biomarkers of kidney and endocrine-pancreatic function in adults without DM or nephropathy. The specific objectives were: Paper 1: to review the literature on the prevalence of diabetic kidney disease (DKD) in pre-diabetic individuals. Paper 2: to assess serum Cystatin C (sCys C) as an early marker of kidney dysfunction in individuals without DM. Paper 3: to compare BP levels and kidney function biomarkers (estimated glomerular filtration rate - eGFR, albumin-creatinine ratio - ACR and sCys C) according to the presence of LBW and to analyze their associations with BP and kidney function biomarkers in individuals without DM or nephropathy. Paper 4: to compare markers of ß-cell function and insulin sensitivity (HOMA-ß, HOMA-IR, HOMA-AD, QUICKI, TyG and TG/HDL) according to the presence of LBW and to analyze LBW associations with markers of ß-cell function and insulin sensitivity. Methods: Cross-sectional analysis of ELSA-Brasil data includes 2 fronts: assessment of the LBW associations with BP and kidney function and with endocrine-pancreatic function. Individuals aged > 60 years, BMI < 18.5 kg/m², DM, kidney, thyroid and liver dysfunction were excluded. Sociodemographic data, lifestyle, birth weight and previous diseases were collected by questionnaires, and clinical and laboratory data in the HU/USP. Dependent variables were BP, biomarkers of kidney and pancreatic functions, and independent variable was LBW. Categorical variables were compared using the chi-squared test and continuous variables by Student t test or the Wilcoxon test. Multiple linear regression models were employed to analyze associations between LBW and the outcome variables. Directed acyclic graph (DAG) was used to make the minimum necessary adjustment to the models. The propensity score method was applied to homogenize differences in sample size. Results: Paper 1: Prevalence of DKD ranged from 4.5 to 26.0% in pre-diabetic individuals. Considering eGFR in isolation, the prevalence rates varied from 4.5 to 21.3%, based only on ACR from 7.0 to 26.0% and based on combined criteria the prevalence was between 12.3 and 17.7%. Paper 2: Pre-diabetic individuals had higher sCys C levels than normoglycemic ones [0.67 (0.41-0.95) vs 0.48 (0.31-0.81) mg/L, p<0.001] and lower eGFR (96.3±17.4 vs 100.6±17.1 mL/min/1.73m², p<0.001). Normoglycemic hyperfiltrating individuals had lower sCys C than normofiltrating ones (p=0.035). Comparing eGFR levels between groups, this gradually decreased as the sCys C and ACR parameters worsened (p-trend=0.06). Paper 3: The LBW group had higher systolic (p=0.015) and diastolic BP (p=0.014) and ACR values (p=0.031), and lower eGFR (p=0.015) than normal birth weight. The preterm group had higher mean BP levels, but no difference in kidney function was detected. In a regression model, BP levels were associated with LBW, but this association disappeared after adding prematurity, which remained associated with BP (p=0.017). Having applied propensity score matching, LBW was associated with ACR (p=0.003), but not with eGFR or BP levels. Paper 4: Individuals with LBW or normal birth weight reported similar BMI at the age 20 years and current BMI was slightly lower in the LBW group. Cardiometabolic and endocrine-pancreatic function parameters were within normal ranges. In regression analysis, log-transformed HOMA-ß, but not the other indexes, was associated with LBW (p=0.014) independent of sex, skin color, prematurity, and family history of DM. After applying propensity score matching LBW was associated with HOMA-AD and TG/HDL indexes. Discussion: Our findings suggest that individuals with near-normal glucose metabolism disturbance could have some impaired kidney function. Looking at early-life risk factors is relevant since their associations with BP and renal and pancreatic function biomarkers could already be identified even in healthy individuals, without DM and nephropathy. Prospective studies are needed to assess the predictive value aiming at proposing prevention measures.
Introdução: O baixo peso ao nascer (BPN), proxy de ambiente intrauterino hostil, tem sido associado a estas doenças no adulto. Em nosso meio, é escassa a literatura sobre associações de BPN com pressão arterial (PA) e função renal e endócrino-pancreática em adultos. O extenso banco de dados ELSA-Brasil permitiu explorar se: 1) indivíduos pré-diabéticos já poderiam apresentar acometimento renal, detectado de forma precoce por biomarcadores; 2) o BPN associar-se-ia no adulto à PA e marcadores de função renal e endócrino-pancreática mais desfavoráveis que nascidos de peso adequado. Objetivos: Analisar a associação do BPN com PA e marcadores de função renal e endócrino-pancreática em adultos sem DM e sem nefropatia. Os objetivos específicos foram: no Artigo 1, rever a literatura sobre a prevalência de doença renal diabética em indivíduos pré-diabéticos; Artigo 2, analisar a cistatina C sérica (sCys C) como marcador precoce de disfunção renal em indivíduos sem DM do ELSA-São Paulo; Artigo 3, comparar os valores de PA e de marcadores de função renal (taxa de filtração glomerular estimada - TFGe, razão albumina-creatinina - ACR e sCys C) segundo a presença de BPN e analisar sua associação com PA e marcadores de função renal, em indivíduios sem DM e nefropatia; Artigo 4, comparar os valores de marcadores de função de células ß e sensibilidade à insulina (HOMA-ß, HOMA-IR, HOMA-AD, QUICKI, TyG e TG/HDL), segundo a presença de BPN e analisar sua associação com marcadores de função de células ß e sensibilidade à insulina. Métodos: Análises transversais de dados do ELSA-Brasil contemplaram 2 frentes, associação do BPN com PA e função renal e com função pancreática. Foram excluídos indivíduos com >60 anos, IMC <18,5 kg/m², DM, disfunção renal, tireoidiana e hepática. Dados sociodemográficos e de saúde foram coletados por questionários e os clínico-laboratoriais no HU/USP. As variáveis dependentes foram PA, marcadores de função renal e pancreática e a independente o BPN. Variáveis categóricas foram comparadas pelo qui-quadrado e contínuas por teste t de Student ou Wilcoxon. Usou-se regressão linear múltipla para testar associações do peso ao nascer com desfechos e DAG para obter os mínimos ajustes necessários nos modelos. Aplicou-se o escore de propensão para homogeneizar diferenças nos tamanhos amostrais. Resultados: Artigo 1: Verificou-se prevalência de 4,5 a 26,0% de nefropatia diabética no pré-DM. Com base na TFGe, esta taxa variou de 4,5 a 21,3%, na albuminúria de 7,0 a 26,0% e quando combinadas de 12,3 a 17,7%. Artigo 2: Indivíduos com pré-DM tiveram maiores valores de sCys C que os normoglicêmicos [0,67 (0,41-0,95) vs 0,48 (0,31-0,81) mg/L, p<0,001] e menores de TFGe (96,3±17,4 vs 100,6±17,1 mL/min/1,73m², p<0,001). Normoglicêmicos hiperfiltrantes apresentaram valores menores de sCys C que os normofiltrantes (p=0,035). Comparando a TFGe entre os grupos, observou-se queda gradual à medida que pioravam a sCys C e ACR (p-trend=0,06). Artigo 3: O grupo com BPN apresentou níveis mais altos de PA sistólica (p=0,015), diastólica (p=0,014) e de ACR (p=0,031), e menores de TFGe (p=0,015) que o grupo nascido com peso normal. Os prematuros apresentaram níveis médios de PA mais altos que os nascidos com peso normal, mas não houve diferença em marcadores de função renal. À análise de regressão, níveis de PA sistólica e diastólica associaram-se com BPN, mas tal associação não se manteve após incluir prematuridade no modelo, a qual permaneceu associada com PA (p=0,017). Após aplicar escore de propensão, o BPN associou-se com ACR (p = 0.003) mas não com TFGe. Artigo 4: Indivíduos com BPN ou peso normal relataram valores similares de IMC aos 20 anos e o atual foi ligeiramente menor no grupo BPN. Seus dados cardiometabólicos e função endócrino-pancreática foram normais. Em análise de regressão, o HOMA-ß mas não outros índices associou-se ao BPN (p=0,014) independente do sexo, cor, prematuridade e história familiar de DM. Após aplicar o escore de propensão, BPN manteve associação com HOMA-AD e TG/HDL. Conclusão: Nossos achados sugerem que indivíduos com alterações iniciais do metabolismo da glicose já podem apresentar biomarcadores de função renal comprometidos. Atentar-se a eventos precoces da vida como o BPN e prematuridade é relevante, uma vez que associações com PA e biomarcadores de função renal e endócrino-pancreática já podem ser identificadas mesmo em indivíduos saudáveis sem DM e nefropatia. Estudos prospectivos são necessários para avaliar o valor preditivo vislumbrando propor medidas de prevenção.
Subject(s)
Infant, Low Birth Weight , Insulin Resistance , Diabetic Nephropathies , Glomerular Filtration Rate , Infant, Premature , Biomarkers , Creatinine , Albumins , Kidney DiseasesABSTRACT
OBJECTIVES@#Nephrotic syndrome is a common disease of the urinary system. The aim of this study is to explore the effect of astragalus polysaccharides (APS) on multidrug resistance gene 1 (MDR1) and P-glycoprotein 170 (P-gp170) in adriamycin nephropathy rats and the underlying mechanisms.@*METHODS@#A total of 72 male Wistar rats were divided into a control group, a model group, an APS low-dose group, an APS high-dose group, an APS+micro RNA (miR)-16 antagomir group and an APS+miR-16 antagomir control group, with 12 rats in each group. Urine protein (UP) was detected by urine analyzer, and serum cholesterol (CHOL), albumin (ALB), blood urea nitrogen (BUN), and creatinine (SCr) were detected by automatic biochemical analyzer; serum interleukin-6 (IL-6), IL-1β, tumor necrosis factor α (TNF-α) levels were detected by ELISA kit; the morphological changes of kidney tissues were observed by HE staining; the levels of miR-16 and MDR1 mRNA in kidney tissues were detected by real-time RT-PCR; the expression levels of NF-κB p65, p-NF-κB p65, and P-gp170 protein in kidney tissues were detected by Western blotting; and dual luciferase was used to verify the relationship between miR-16 and NF-κB.@*RESULTS@#The renal tissue structure of rats in the control group was normal without inflammatory cell infiltration. The renal glomeruli of rats in the model group were mildly congested, capillary stenosis or occlusion, and inflammatory cell infiltration was obvious. The rats in the low-dose and high-dose APS groups had no obvious glomerular congestion, the proliferation of mesangial cells was significantly reduced, and the inflammatory cells were reduced. Compared with the high-dose APS group and the APS+miR-16 antagomir control group, there were more severe renal tissue structure damages in the APS + miR-16 antagomir group. Compared with the control group, the levels of UP, CHOL, BUN, SCr, IL-6, IL-1β, TNF-α, and MDR1 mRNA, and the protein levels of p-NF-κB p65 and P-gp170 in the model group were significantly increased (all P<0.05); the levels of ALB and miR-16 were significantly decreased (both P<0.05). Compared with the model group, the levels of UP, CHOL, BUN, SCr, IL-6, IL-1β, TNF-α, and MDR1 mRNA, and the protein levels of pNF-κB p65 and P-gp170 in the low-dose and high-dose APS groups were significant decreased (all P<0.05); and the levels of ALB and miR-16 were significantly increased (both P<0.05). Compared with APS+miR-16 antagomir control group, the UP, CHOL, BUN, SCr, IL-6, IL-1β, and TNF-α levels, MDR1 mRNA, and the protein levels of p-NF-κB p65 and P-gp170 were significantly increased (all P<0.05). The levels of ALB and miR-16 were significantly decreased in the APS+miR-16 antagomir group compared with the APS+miR-16 antagomir control group (both P<0.05).@*CONCLUSIONS@#APS can regulate the miR-16/NF-κB signaling pathway, thereby affecting the levels of MDR1 and P-gp170, and reducing the inflammation in the kidney tissues in the adriamycin nephropathy rats.