Therapeutic Potential of Photobiomodulation for Chronic Kidney Disease.

Chronic kidney disease (CKD) is a growing global public health problem. The implementation of evidence-based clinical practices only defers the development of kidney failure. Death, transplantation, or dialysis are the consequences of kidney failure, resulting in a significant burden on the health system. Hence, innovative therapeutic strategies are urgently needed due to the limitations of current interventions. Photobiomodulation (PBM), a form of non-thermal light therapy, effectively mitigates mitochondrial dysfunction, reactive oxidative stress, inflammation, and gut microbiota dysbiosis, all of which are inherent in CKD. Preliminary studies suggest the benefits of PBM in multiple diseases, including CKD. Hence, this review will provide a concise summary of the underlying action mechanisms of PBM and its potential therapeutic effects on CKD. Based on the findings, PBM may represent a novel, non-invasive and non-pharmacological therapy for CKD, although more studies are necessary before PBM can be widely recommended.

Acute effect of photobiomodulation therapy on handgrip strength of chronic kidney disease patients during hemodialysis.

Pre-exercise photobiomodulation therapy (PBMT) reduces fatigue and enhances performance in different populations. However, PBMT benefits have never been tested on chronic kidney disease (CKD) patients, who present muscle weakness, fatigue, and reduced functional performance. The objective of this study was to evaluate the acute effect of three different doses of the PBMT on maximal handgrip strength of CKD patients. Fifteen volunteers (58 ± 8 years, 10 male/5 female) under chronic hemodialysis treatment (6 ± 4 years) participated in a randomized, crossover, double-blind, placebo-controlled trial. Each patient was assessed at four hemodialysis sessions with 1 week interval between evaluations. Placebo or PBMT (cluster probe with five 850 nm/200 mW laser diodes) were applied at three sites along the flexors of the finger (total doses of 60, 90, or 120 J per arm). The maximal handgrip strength was evaluated before and after PBMT/placebo treatment in each session. Repeated measures ANOVA and intraclass correlation coefficients (ICC) confirmed no learning effect on handgrip tests, and high scores for test-retest reliability (ICC scores = 0.89 to 0.95). Significant strength increases occurred after PBMT application with doses of 60 J/arm (4.85%, p = 0.005, ES = 0.32) and 90 J/arm (4.45%, p = 0.013, ES = 0.25), while no changes were detected with placebo or 120 J/arm. In conclusion, in consensus with a recent systematic review, a single bout of the 60 J/arm was the best dose/response for increased strength of the small muscles (handgrip strength). In view of the increasing implementation of exercise programs during hemodialysis, the current study opens a new field for PBMT for CKD patients.

Can radioiodine be administered effectively and safely to a patient with severe chronic kidney disease?

Chronic kidney disease is an increasingly widespread problem. The progression of renal failure is associated with the development of various hormonal disorders, including those affecting the thyroid gland. The prevalence of multinodular goitre and differentiated thyroid cancer increases significantly in patients with renal failure. However, radioiodine treatment in patients with severe chronic kidney disease gives rise to a number of difficulties. The only conclusions regarding this treatment thus far have been derived from single case studies. It seems that prospective controlled studies can contribute to the creation of standards for radioiodine treatment in patients with various stages of chronic kidney disease, while maintaining the safety of such treatment for both patients and medical staff. This review gives the response to the question how nowadays to treat the patients with severe chronic kidney disease with radioiodine.

Avaliação a curto prazo da toxicidade renal nos pacientes com tumores neuroedócrinos metasticos submetidos a terapia radionuclídica pepitídeo receptor (PRRT) usando Lutécio-177 marcado com análogo de somastostatina / [Short-term evaluation of renal toxicity in patients with metastatic neuroedocrine tumors undergoing peptide peptide radionuclide therapy (PRRT) using Lutetium-177 labeled with a somastostatin analogue]

"A terapia radionucícida pepitídio receptor (PRRT) constituiu uma nova e promissora ferramenta de terapia para os tumores receptores-positivos como os tumores neuroendócrinos. Essa modalidade de tratamento é limitada devido aos diferentes efeitos radiobiológicos desencadeados pelo radionuclideo, onde a possível influência sobre a função renal e hematopoietica constituem a principal causa de efeitos colaterais. Os rins são os órgãos críticos na PRRT e a perda da função renal se torna aparente após alguns anos após a terapia radionuclídica. Vinte e um pacientes, matriculados na Instituição Nacional do Câncer, com diagnostico de tumor neuroendócrino, cintilografia com octreoscan positiva e ausência de comprometimento renal foram avaliados. A PRRT foi realizada com 177Lu-DOTATATE e solução de aminoácido foi iniciada 30 minutos antes da infusão do radionuclideo, com objetivo de proteção renal. Para avaliação do surgimento de toxicidade renal pós PRRT, o Clearence de creatinina (CL) foi escolhido como uma estimativa da taxa de filtração glomerular (TFG) e o mesmo foi calculado em todos os pacientes antes de iniciar o tratamento, antes e após cada ciclo do tratamento e após o término do tratamento.Como resultado, observamos que os valores do CL, não foram estatisticamente diferentes (p > 0,05). Ou seja, de um modo geral, tanto a terapia, como, o incremento de doses não altera a função renal dos pacientes. A partir dos nossos dados, concluímos que a terapia radionuclídica com 177Lu-DOTATOC, não apresenta toxicidade renal, mostrando-se relativamente segura quando realizada em conjuntura com mecanismos de redução de captação renal e atividade cumulativa de 29,6GBq, fracionada em quatro ciclos. O que esta compatível com os dados da literatura"(AU)

"The peptide peptide radionucicide therapy (PRRT) was a promising new therapy tool for receptor-positive tumors such as neuroendocrine tumors. This type of treatment is limited due to the different radiobiological effects triggered by the radionuclide, where the possible influence on renal and hematopoietic function is the main cause of side effects. The kidneys are the critical organs in PRRT and the loss of kidney function becomes apparent after a few years after radionuclide therapy. Twenty-one patients, enrolled at the National Cancer Institution, diagnosed with neuroendocrine tumor, positive octreoscan scintigraphy and absence of renal impairment were evaluated. PRRT was performed with 177Lu-DOTATATE and an amino acid solution was started 30 minutes before radionuclide infusion, with the purpose of renal protection. To assess the onset of renal toxicity after PRRT, the creatinine clearance (CL) was chosen as an estimate of the glomerular filtration rate (GFR) and it was calculated in all patients before starting treatment, before and after each cycle treatment and after the end of treatment. As a result, we observed that the CL values ​​were not statistically different (p> 0.05). In other words, in general, both the therapy and the increase in doses do not alter the renal function of patients. From our data, we concluded that radionuclide therapy with 177Lu-DOTATOC, does not present renal toxicity, proving to be relatively safe when performed in conjunction with mechanisms of reduction of renal uptake and cumulative activity of 29.6GBq, divided into four cycles. What is compatible with the literature data"(AU)