Aplicação de exercício isotônico durante a hemodiálise melhora a eficiência dialítica / Isotonic exercise during hemodialysis improves dialysis efficiency

INTRODUÇÃO: A doença renal crônica (DRC) é decorrente de uma lesão renal e perda progressiva e irreversível da função dos rins. A hemodiálise substitui parcialmente essa função, com o objetivo de corrigir as alterações metabólicas na DRC. Para acompanhar a adequação da diálise, é determinado o Kt/V - índice de depuração da ureia por sessão de hemodiálise. O exercício físico de moderada intensidade tem se mostrado de fundamental importância para melhorar os efeitos adversos ao tratamento dialítico. OBJETIVOS: Avaliar o Kt/V em indivíduos com DRC submetidos ao exercício físico isotônico de baixa intensidade durante a hemodiálise. MATERIAIS E MÉTODOS: Analisados dados de 15 voluntários de ambos os sexos, submetidos à hemodiálise três vezes por semana. Após duas horas do início da diálise, foi aplicado um protocolo de exercícios isotônicos de baixa intensidade de membros superiores e inferiores com duração de 30 minutos, por um período de três meses. Os valores do Kt/V foram comparados no período de três meses anteriores sem exercício e após três meses de exercício. RESULTADOS: A média dos valores do Kt/V nos três meses sem exercício foi de 1,13 ± 0,11 e após aplicação do programa de exercícios foi de 1,29 ± 0,12 (p < 0,05). CONCLUSÃO: O programa de exercício físico isotônico de baixa intensidade em pacientes com DRC, aplicados durante a sessão de diálise mostrou a melhora da eficiência dialítica.

INTRODUCTION: The chronic kidney disease (CKD) is due to a renal injury and progressive and irreversible loss of kidney function. Hemodialysis replace partially this function with the objective of correcting the metabolic changes in the DRC. To monitor the adequacy of dialysis is determined the Kt/V - rate of clearance of urea per session of dialysis. The exercise of moderate intensity has been of fundamental importance for improving the adverse effects of dialysis treatment. OBJECTIVES: To evaluate Kt/V in persons with CKD submitted the isotonic exercise of low intensity during hemodialysis. MATERIALS AND METHODS: It was analyzed data from 15 volunteers with CKD, both sexes, submitted to dialysis three times a week. After two hours of the start of dialysis, was applied a protocol of isotonic exercises with low intensity of upper and lower limbs lasting 30 minutes, for a period of three months. The values of Kt/V were compared in the period of three months without exercise and after three months (monthly average). The paired Student t test was used for statistical analysis (p < 0.05). RESULTS: The average values of Kt/V within three months without exercise was 1.13 ± 0.11 and after implementation of the program of exercises was 1.29 ± 0.12 (p < 0.05). CONCLUSION: The program of isotonic exercises of low intensity in patients with CKD applied during the session of dialysis improved the efficiency dialysis.

Rastreamento de nefropatas diabéticos propensos a fatores desencadeantes do pé diabético / Screening of diabetic nephropathy patients prone to triggering factors of diabetic foot

Objetivo: Determinar a prevalência de diabéticos em setor de hemodiálise e o rastreamento daqueles propensos à manifestação de neuropatia e sinais e sintomas do pé diabético. Métodos: Realizou-se um levantamento do número de diabéticos em um setor de hemodiálise para a aplicação do Michigan Neuropathy Screening Instrument Questionnaire, visando triar os sujeitos com sinais de perda sensitiva. Também observaram-se variáveis relacionadas com a magnitude da doença. Os indivíduos foram divididos em dois grupos: Grupo A, sem déficit sensitivo com escore inferior a cinco e o Grupo B, com déficit sensitivo com escore igual ou superior a seis. O grupo B foi submetido à inspeção, teste de força muscular, palpação nervosa e teste de sensibilidade dos pés. Aplicou-se o Teste Mann-Whitney para verificar diferença entre os grupos (p<0,05). Resultados: Dos 168 participantes da diálise, 37(22,02%) eram diabéticos, e destes, 34(20,24%) participaram da pesquisa. Para caracterização do grupoB (N=20), realizou-se uma distribuição de frequência e 4(20%) apresentaram alterações à palpação nervosa, 11(55%) à força muscular, 17(85%) ao teste de sensibilidade, 11(55%) com neuropatia, 6(30%) úlceras plantares, 4(20%) amputações e 100% desconheciam a síndrome do pé diabético. Conclusões: Verificou-se um percentual considerável de diabéticos no setor de hemodiálise, e mais da metade deles apresentaram sinais de neuropatia, diminuição de força muscular e pelo menos um dos sinais e sintomas característicos do pé diabético.

Objective: To survey the prevalence of diabetic paients in the hemodialysis unit, screening those prone to outbreak of neuropathy and signs and symptoms of diabetic foot. Methods: We conducted a survey of the number of diabetics in a hemodialysis unit to apply the Michigan Neuropathy Screening Instrument Questionnaire in order to screen subjects with signs of sensory loss. Also, we observed variables related to the magnitude of the disease. The subjects were divided into two groups: Group A, no sensory deficit with a score of less than five and Group B with sensitive deficit with a score greater than or equal to six. Group B was submitted to examination, muscle strength testing, nerve palpation, and sensitivity testing of the feet. We applied the Mann-Whitney test to verify differences between groups (p <0.05). Results: Of the 168 participants of dialysis, 37 (22.02%) were diabetic and of these 34 (20.24%) joined in the study. To characterize the group B (n = 20), we did a frequency distribution and 4 (20%) presented alterations related to nerve palpation, 11 (55%) regarding muscle strength, 17 (85%) to sensitivity testing, 11 (55%) had neuropathy, 6 (30%) had plantar ulcers, 4 (20%) amputations and 100% were unaware of the diabetic foot syndrome. Conclusions: There was considerable percentage of diabetics in the hemodialysis unit, and more than half of them showed signs of neuropathy, decreased muscle strength and at least one of the signs and symptoms of diabetic foot.

Impact of the Training Program on Lipid Profile and Cardiac Health

The aim of this study was to investigate the effects of training programs on serum lipid profile and myocardial oxidative stress. Male Wistar rats (2 mo-old) were divided into three groups (n = 8): sedentary (S), loadless trained (T) and trained-overload 2% body weight (TL). T and TL were trained through swimming for 9 weeks. T and TL rats had increased myocardial lipoperoxide (TBA) and lipid hydroperoxide (HP), whereas HP was higher in TL than in T animals. Superoxide dismutase (SOD) activities were lowest in TL. Myocardial glutathione peroxidase (GSH-Px) was lower in TL than in T and S rats. TL decreased HDL-cholesterol and increased LDL-cholesterol. The serum lactate dehydrogenase and TBA were increased, while SOD and GSH-Px activities were decreased in TL rats. Loadless training was able to improve HDL-cholesterol and to reduce LDL-cholesterol. In conclusion, the loadless training program induced beneficial effects on lipid profile, while overload training induced dyslipidemic profile that was associated with serum oxidative stress. The overload training program was deleterious relative to loadless training program, increasing myocardial oxidative stress.