ABSTRACT
INTRODUCTION: The effect of kidney transplantation on endothelial dysfunction and autonomic dysfunction in uremia remains controversial, and few studies have evaluated this question. Endothelial dysfunction and autonomic dysfunction, both, can be assessed non-invasively using laser Doppler flowmetry (LDF). This study evaluated cutaneous microvascular blood flow and reactivity using LDF in patients undergoing kidney transplantation. METHODS: This prospective longitudinal cohort study involved forty patients with chronic kidney disease (CKD) undergoing kidney transplantation, compared with 40 patients without kidney disease. Using a laser Doppler flowmetry, post-occlusive reactive hyperemia (PORH) [resting flow, peak flow, ratio between peak and resting flow, hyperemic area, PORH index] and sympathetic constrictor response to inspiratory breath-hold [mean minimum inspiratory values] were evaluated. RESULTS: Resting flow (RF) and sympathetic constrictor response to inspiratory breath-hold (mean minimum inspiratory values), were lower in the CKD group at one week and three months after transplantation (p<0.005). Mean minimum inspiratory values increase in the CDK group, three months after transplantation. CONCLUSION: Compared with controls with no CKD, in CKD patients undergoing kidney transplantation, microcirculation by laser Doppler flowmetry shows improvement after three months.
ABSTRACT
BACKGROUND: Gestational diabetes mellitus (GDM) is increasing worldwide and has been associated with adverse perinatal outcomes and high risk for chronic disease both for the mother and for the child. Physical exercise is feasible for diabetic pregnant women and contributes to better glycemic control and to a decrease in adverse perinatal outcomes. However, there are no randomized controlled trials (RCT) assessing the effects of aquatic physical exercise on GDM control and adverse maternal and fetal outcomes. METHODS/DESIGN: An RCT will be conducted at Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Brazil. A total of 72 pregnant women will be studied; 36 gestational diabetics will undergo an aquatic physical exercise program in a thermal pool, 3 times per week over 2 months. The primary endpoint will be glucose level control and use of insulin; secondary endpoints will be the following maternal and fetal outcomes: weight gain during pregnancy, blood pressure, pre-eclampsia diagnosis, intrauterus growth restriction, preterm birth, Cesarean section, macrosomia and maternal or neonatal intensive care admission. Endpoints between intervention and control group will analyzed by t test for unpaired data and χ² test, and the level of significance will set at <0.05. DISCUSSION: The physical proprieties of water make aquatic exercises ideal for pregnant women. An aquatic physical exercise program developed for GDM women will be trialed in a thermal pool and under the supervision of physiotherapist to ensure compliance. It is expected that this study will provide evidence as to the effect of aquatic physical exercise on GDM control. TRIAL REGISTRATION: ClinicalTrial.gov, NCT01940003.
