Água para hemodiálise: estudo comparativo entre os resultados das análises fiscais e as análises de rotina realizadas em unidades de diálise no estado do Rio de Janeiro

Hemodialysis and renal transplant are both modalities of renal replacement therapy that allow patients to maintain a good quality of life. Water is a major component used in this procedure and proper maintenance is very important as the presence of hidden bacteria and other low-molecular-weight organisms could contaminate it. In Brazil, as a determination from ANVISA, water quality should be monitored monthly through routine analyses (RAs) of dialysis units (DUs). In Rio de Janeiro, monitoring of such guidelines is provided by the Program for Monitoring Water Quality (PMWQ) of the Sanitary Control Agency in conjunction with INCQS/FIOCRUZ through annual supervised analyses (SAs). Objective: To compare the results of RAs conducted by DUs with the results obtained by SAs. Methods: We conducted a transversal comparative study between the results of RAs and SAs at 4 selected points in the treatment system and water distribution of 22 DUs. Results: Eighteen of the 22 DUs showed similar results (81.8%) between the samples, whereas 4 (18.2%) presented different results. Of these, 3 had SAs with unsatisfactory results and RAs with satisfactory results, whereas 1 had SAs with satisfactory results and RAs with unsatisfactory results. Conclusion: SAs and RAs showed concordant results for more than 80% DUs, indicating that the instruments for assessing the quality of the DU water currently employed by the Department of Health are able to accurately represent the results of RAs.A hemodiálise, assim como o transplante renal, é uma forma de terapia de substituição da função renal que permite aos pacientes a manutenção das condições clínicas necessárias a uma boa qualidade de vida. A água é o maior insumo consumido neste procedimento sendo de relevante importância o seu controle adequado, pois nela podem estar ocultos bactérias e outros contaminantes de baixo peso molecular. No Brasil, por determinação da ANVISA, a qualidade da água deve ser monitorada mensalmente através das análises de rotina (ARs) das unidades de diálise (UDs). No Rio de Janeiro (RJ), o acompanhamento de tais diretrizes é feito pelo Programa de Monitoramento da Qualidade da Água (PMQA) das Vigilâncias Sanitárias em conjunto com o INCQS/FIOCRUZ, através de análises fiscais (AFs) anuais. Objetivo: Comparar os resultados das ARs, realizadas pelas UDs, com os resultados obtidos pelas AFs. Método: Foi realizado um estudo comparativo, do tipo transversal, entre os resultados das ARs e AFs, em quatro pontos selecionados no sistema de tratamento e distribuição da água de 22 UDs. Resultados: Dezoito das 22 UDs apresentaram resultados similares (81,8%) entre as amostras, enquanto quatro (18,2%) apresentaram resultados diferentes. Destas, três apresentaram AFs insatisfatórias e ARs satisfatórias, enquanto uma apresentou AF satisfatória com AR insatisfatória. Conclusão: As AFs e as ARs apresentaram resultados similares acima dos 80%, indicando que os instrumentos de avaliação da qualidade da água das UDs, empregados atualmente pelos órgãos de Vigilância Sanitária, traduziram a realidade histórica das ARs

The protective role of fucosylated chondroitin sulfate, a distinct glycosaminoglycan, in a murine model of streptozotocin-induced diabetic nephropathy.

Heparanase-1 activation, albuminuria, and a decrease in glomerular heparan sulfate (HS) have been described in diabetic nephropathy (DN). Glycosaminoglycan (GAG)-based drugs have been shown to have renoprotective effects in this setting, although recent trials have questioned their clinical effectiveness. Here, we describe the effects of fucosylated chondroitin sulfate (FCS), a novel GAG extracted from a marine echinoderm, in experimentally induced DN compared to a widely used GAG, enoxaparin (ENX).Diabetes mellitus (DM) was induced by streptozotocin in male Wistar rats divided into three groups: DM (without treatment), FCS (8 mg/kg), and ENX (4 mg/kg), administered subcutaneously. After 12 weeks, we measured blood glucose, blood pressure, albuminuria, and renal function. The kidneys were evaluated for mesangial expansion and collagen content. Immunohistochemical quantifications of macrophages, TGF-β, nestin and immunofluorescence analysis of heparanase-1 and glomerular basement membrane (GBM) HS content was also performed. Gene expression of proteoglycan core proteins and enzymes involved in GAG assembly/degradation were analyzed by TaqMan real-time PCR.Treatment with GAGs prevented albuminuria and did not affect the glucose level or other functional aspects. The DM group exhibited increased mesangial matrix deposition and tubulointerstitial expansion, and prevention was observed in both GAG groups. TGF-β expression and macrophage infiltration were prevented by the GAG treatments, and podocyte damage was halted. The diabetic milieu resulted in the down-regulation of agrin, perlecan and collagen XVIII mRNAs, along with the expression of enzymes involved in GAG biosynthesis. Treatment with FCS and ENX positively modulated such changes. Heparanase-1 expression was significantly reduced after GAG treatment without affecting the GBM HS content, which was uniformly reduced in all of the diabetic animals.Our results demonstrate that the administration of FCS prevented several pathological features of ND in rats. This finding should stimulate further research on GAG treatment for this complication of diabetes

The GAGs effectively reduced heparanase-1 expression in the glomeruli of treated DM rats.

<p>From A–D, immunofluorescence photomicrographs of heparanase-1–stained renal glomerular sections with an evident increase in expression in the DM (B) animals that was prevented by FCS (C) and ENX (D) administration, as confirmed by a semiquantitative scoring system (E). The data represent the means ± SEMs. *<i>p<</i>0.0001 vs. groups; #<i>p<</i>0.01 vs. ENX. Bar = 25 µm.</p

Gene expression of proteoglycan core proteins in DM and GAGs treated groups related to control.

<p>Gene expression of: agrin, the major GBM proteoglycan; perlecan and collagen XVIII, predominantly mesangial proteoglycans; decorin, a small rich-leucine proteoglycan and glypican-1, a cell suface associated proteoglycan. Gray columns, DM; dark gray, FCS and black, ENX. *<i>p<</i>0.01 vs. control; #<i>p<</i>0.05 vs. DM.</p

Functional parameters at the end of the experiment.

<p>The results are presented as the means ± SEMs. BWt, body weight; RWt, renal weight; SBP, systolic blood pressure; SCr, serum creatinine; eGFR, estimated glomerular filtration rate; DM, diabetic group; FCS, diabetic group treated with fucosylated chondroitin sulfate; ENX, diabetic group treated with enoxaparin;</p><p>*all of the diabetic groups vs. control;</p>#<p>DM vs. FCS and ENX groups;</p><p>**<i>p<</i>0.01 DM vs. control.</p><p>Functional parameters at the end of the experiment.</p

Morphological aspects of the mesangial axis and tubulointerstitial area in the experimental animals at the end of the study.

<p>A–D show PAS-stained glomerular photomicrographs with a significant increase in the mesangial area in the DM group (B) compared to the control group (A) and no increase in the DM groups treated with FCS (C) or ENX (D). In E, a semi-quantitative analysis demonstrated a 1.4-fold increase in the mesangial area in the DM group compared to the other groups. In F–I, PAS-stained renal sections show expansion of the interstitial area with tubular dilation in the DM group (G), compared to the control animals (F) and GAG-treated groups (H and I). In J, the semiquantitative analysis shows a discrete but significant expansion in the DM group. In L–N, the Sirius Red staining area shows a trend toward increased deposition of collagen fibers in the interstitial area in the DM animals (M) compared to the other groups but without statistical significance, as shown in (O). In N–P, Masson’s trichrome staining depicts the expansion of the interstitial area in the DM rats due to edema and tubular dilation compared to the treated groups. The data represent the means ± SEMs. *<i>p<</i>0.001, **<i>p<</i>0.0001. A–N, bar = 25 µm; N–P, bar = 50 µm.</p

Gene expression analysis for glycosaminoglycan modifying/degrading enzymes in DM and GAGs treated groups related to control.

<p>Gray columns, DM; dark gray, FCS and black, ENX. *<i>p<</i>0.05 vs. control. HPSE, heparanase-1; CS, chondroitin sulfate; NDST-1, N-deacetylase/N-sulfotransferase; HS-3-ST-1, heparan sulfate-3-O-sulfotransferase 1.</p