Turmeric supplementation with piperine is more effective than turmeric alone in attenuating oxidative stress and inflammation in hemodialysis patients: A randomized, double-blind clinical trial.

PURPOSE: Turmeric has renop rotective effects that can act to reduce oxidative stress and inflammation in hemodialysis (HD) patients. Piperine has been indicated as a bioavailability enhancer of turmeric and consequently of its biological effects. However, data on the efficacy of the turmeric/piperine combination in HD patients are limited. We aimed to verify whether turmeric supplementation in combination with piperine has a superior effect to turmeric alone in increasing antioxidant capacity and reducing oxidative stress and inflammation in HD patients. METHODS: This randomized, double-blind clinical trial was conducted in HD patients (age 20-75 years). Patients were supplemented with turmeric (3 g/day) or turmeric/piperine (3 g turmeric + 2 mg piperine/day) for 12 weeks. Malondialdehyde (MDA), antioxidant enzymes catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), high-sensitivity C-reactive protein (hs-CRP), and ferritin were evaluated at baseline and the end of the study. RESULTS: There was a reduction in the MDA and ferritin levels in the turmeric/piperine group and in the comparison between groups at the end of the study [MDA: -0.08(-0.14/0.01) nmol/mL versus -0.003(-0.10/0.26) nmol/mL, p = 0.003; ferritin: -193.80 ±â€¯157.29 mg/mL versus 51.99 ±â€¯293.25 mg/mL, p = 0.018]. In addition, GPx activity reduced in the turmeric group (p = 0.029). No changes were observed for CAT, GR, and hs-CRP. CONCLUSION: Turmeric plus piperine was superior to turmeric alone in decreasing MDA and ferritin levels. The use of a combination of turmeric and piperine as a dietary intervention may be beneficial for modulating the status oxidative and inflammation in HD patients. BRAZILIAN REGISTRY OF CLINICAL TRIALS NUMBER: RBR-2t5zpd; Registration Date: May 2, 2018.

Antioxidant and anti-inflammatory response to curcumin supplementation in hemodialysis patients: A randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND AND OBJECTIVES: Hemodialysis (HD) patients are vulnerable to malnutrition and cardiovascular complications due to many factors, including oxidative stress and inflammation. Curcumin supplementation is associated with attenuation of proinflammatory cytokines and increased activity of antioxidant enzymes, but its effects in HD patients are unknown. This study aimed to evaluate the effect of curcumin supplementation on oxidative stress and inflammation in HD patients. METHODS: This randomized, double-blind, placebo-controlled trial enrolled 43 HD patients and divided them into two groups: supplemented with curcumin (1 g/day) or placebo (corn starch) for 12 weeks. Demographic information and blood samples were taken at the start and the end of the study to determine serum malondialdehyde (MDA) concentrations, antioxidant enzyme activity, and high-sensitivity C-reactive protein (hs-CRP). RESULTS: The curcumin group showed a significant increase in catalase activity [Δ = 1.13 ± 2.87 versus Δ = -1.08 ± 2.68; p = 0.048] and preserved glutathione peroxidase activity [Δ = -4.23 ± 11.50 versus Δ = -14.44 ± 13.96; p < 0.01] compared with the placebo group. However, no significant changes were found in MDA concentrations, glutathione reductase activity, and hs-CRP concentrations after the intervention. CONCLUSION: Curcumin supplementation for 12 weeks had potential effects on antioxidant response, but it was not enough to reduce oxidative stress markers and inflammation in HD patients. This trial was registered at EnsaiosClínicos.gov.br under registration number RBR-2t5zpd.

Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis / Adaptação transcultural do instrumento Thirst Distress Scale (TDS) para o português brasileiro e propriedades psicométricas em pacientes em hemodiálise

Abstract Objective: To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). Methods: The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). Results: The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). Conclusion: Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.

Resumo Objetivo: Realizar a adaptação transcultural da escala Thirst Distress Scale (TDS) para o português brasileiro e estudar suas propriedades psicométricas em pacientes em hemodiálise (HD). Métodos: Foram realizadas traduções, retrotraduções, discussão com especialistas e avaliação psicométrica, com aplicação da versão final em 126 pacientes em HD e reteste em 70 pacientes da amostra inicial. A consistência interna do instrumento foi obtida pelo alfa de Cronbach. Para analisar a concordância com a intensidade de sede, avaliada pela Escala Visual Analógica (EVA), foi utilizado o teste Kappa e a estratégia gráfica de Bland-Altman. Para avaliar a reprodutibilidade, foi realizado teste de correlação intraclasse (CCI). Resultados: Para obtenção da versão final da escala TDS em português brasileiro, intitulada TDS-BR, foi necessária adaptação de vocabulário em três itens e mudança de tempo verbal em seis itens. Houve boa compreensão da escala pelos pacientes em HD, consistência interna satisfatória (0,84, p<0,001), concordância moderada com a Escala Visual Analógica (EVA) (kappa=0,44; p<0,001) e reprodutibilidade quase perfeita (CCI=0,87; p<0,001). Conclusão: Os resultados obtidos indicam a aplicabilidade e confiabilidade do instrumento na língua portuguesa (Brasil). A ferramenta, por ser de fácil compreensão e baixo custo, além de ter boa aceitação, pode ser um instrumento relevante no manejo da sede de pacientes em HD.

Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis.

OBJECTIVE: To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). METHODS: The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). RESULTS: The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). CONCLUSION: Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.