Exercício aeróbico baseado no primeiro limiar ventilatório em pacientes com excesso de peso e doença renal crônica: impacto sobre a capacidade cardiorrespiratória e funcional

INTRODUCTION: Chronic kidney disease (CKD) and obesity are both associated with reduced physical capacity. The potential benefit of aerobic training on physical capacity has been recognized. The exercise intensity can be established using different methods mostly subjective or indirect. Ventilatory threshold (VT) is a direct and objective method that allows prescribing exercise intensity according to individual capacity. OBJECTIVES: To evaluate the impact of aerobic training at VT intensity on cardiopulmonary and functional capacities in CKD patients with excess of body weight. METHODS: Ten CKD patients (eight men, 49.7 ± 10.1 years; BMI 30.4 ± 3.5 kg/m², creatinine clearance 39.4 ± 9.8 mL/min/1.73 m²) underwent training on a treadmill three times per week during 12 weeks. Cardiopulmonary capacity (ergoespirometry), functional capacity and clinical parameters were evaluated. RESULTS: At the end of 12 weeks, VO2PEAK increased by 20%, and the speed at VO2PEAK increased by 16%. The training resulted in improvement in functional capacity tests, such as six-minute walk test (9.2%), two-minute step test (20.3%), arm curl test (16.3%), sit and stand test (35.7%), and time up and go test (15.3%). In addition, a decrease in systolic and diastolic blood pressures was observed despite no change in body weight, sodium intake and antihypertensive medication. CONCLUSION: Aerobic exercise performed at VT intensity improved cardipulmonary and functional capacities of overweight CKD patients. Additional benefit on blood pressure was observed. These results suggest that VT can be effectively applied for prescribing exercise intensity in this particular group of patients.INTRODUÇÃO: O excesso de peso e a doença renal crônica (DRC) estão associados à baixa capacidade cardiorrespiratória (CR) e funcional (CF). Já foi observado que o treinamento aeróbico (TA) melhora a CR e CF. Métodos indiretos e subjetivos são comumente empregados para a prescrição da intensidade do TA. O limiar ventilatório (LV) é um método direto e objetivo que permite prescrever a intensidade do TA de acordo com a capacidade física do paciente. OBJETIVOS: Avaliar o impacto do TA com base na intensidade do LV sobre a CR e CF de pacientes com excesso de peso e portadores de DRC na fase não dialítica. MÉTODOS: Dez pacientes (oito homens; 49 ± 10,1 anos, IMC 30,4 ± 3,5 kg/m² , depuração de creatinina 39,4 ± 9,8 mL/min/1,73m²) foram submetidos à TA 3 vezes por semana durante 12 semanas. CR (ergoespirometria), CF e parâmetros clínicos foram avaliados. RESULTADOS: O TA promoveu aumento de 20% no consumo pico de O2 (VO2PICO), 16% na velocidade alcançada no VO2PICO e melhora em 9,2% na caminhada de seis minutos, 20,3% na marcha estacionária, 35,7% no sentar e levantar, 16,3% na resistência muscular de membro superior e 15,3% no tempo de ir e voltar. A pressão arterial diminuiu sem modificação nos anti-hipertensivos, no peso ou no consumo de sódio. CONCLUSÃO: Os resultados indicam que o TA baseado na intensidade do LV melhora a CR, CF e pressão arterial de pacientes portadores de DRC com excesso de peso. Isso sugere que o TA baseado na intensidade LV é eficaz e pode ser empregado com segurança nesses pacientes.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP)UNIFESP Fundação Oswaldo RamosUNIFESP, Fundação Oswaldo RamosSciEL

O valor da espessura cortical renal em predizer a função renal em pacientes renais crônicos

Objetivo: determinar se existe relação linear entre a espessura do córtex renal, comprimento bipolar e a espessura do parênquima renal em pacientes com insuficiência renal crônica que apresentam diferentes taxas de filtração glomerular (TFGs) e avaliar a reprodutibilidade dessas medidas. Materiais e métodos: exames ultrassonográficos foram realizados em 54 pacientes com insuficiência renal crônica, por dois radiologistas, de modo independente e duplo-cego. A estimativa da TFG foi calculada pela equação de Cockcroft-Gault. A concordância interobservador e o coeficiente de correlação linear (r) foram calculados para estabelecer se existe relação entre medidas renais e a TFG. Resultados: a espessura do córtex renal apresentou moderada correlação com a TFG (r = 0,478; p < 0,001). O comprimento bipolar e a espessura do parênquima apresentaram fraca correlação, com valores de r = 0,380 (p = 0,004) e r = 0,277 (p = 0,116), respectivamente. A concordância interobservador foi excelente para a espessura cortical (0,754) e comprimento bipolar (0,833) e satisfatória para a espessura do parênquima (0,523). Conclusão: a reprodutibilidade das medidas obtidas entre os radiologistas foi boa. A relação entre a TFG estimada com a espessura do córtex renal apresentou moderada correlação e o comprimento bipolar e a espessura do parênquima renal apresentaram fraca correlação.Objective: to determine the presence of linear relationship between renal cortical thickness, bipolar length, and parenchymal thickness in chronic kidney disease patients presenting with different estimated glomerular filtration rates (GFRs) and to assess the reproducibility of these measurements using ultrasonography. Materials and methods: ultrasonography was performed in 54 chronic renal failure patients. The scans were performed by two independent and blinded radiologists. The estimated GFR was calculated using the Cockcroft-Gault equation. Interobserver agreement was calculated and a linear correlation coefficient (r) was determined in order to establish the relationship between the different renal measurements and estimated GFR. Results: the correlation between GFR and measurements of renal cortical thickness, bipolar length, and parenchymal thickness was, respectively, moderate (r = 0.478; p < 0.001), poor (r = 0.380; p = 0.004), and poor (r = 0.277; p = 0.116). The interobserver agreement was considered excellent (0.754) for measurements of cortical thickness and bipolar length (0.833), and satisfactory for parenchymal thickness (0.523). Conclusion: the interobserver reproducibility for renal measurements obtained was good. A moderate correlation was observed between estimated GFR and cortical thickness, but bipolar length and parenchymal thickness were poorly correlated

Coronary calcification and associated factors in peritoneal dialysis patients

As doença cardiovasculares, em especial a aterosclerose, estão entre as principais causas de óbito na população em diálise. Existem atualmente vários métodos não invasivos de avaliação de doença aterosclerótica, entre eles se destaca a determinação da calcificação coronariana através de estudo tomográfico. Existem poucas informações em relação à prevalência de calcificação coronariana e fatores associados no: pacientes submetidos a diálise peritoneal. Nós utilizamos a Tomografia Coronariana por Múltiplos Detectores (MSCT) para determinar a prevalência de calcificação coronariana em 49 pacientes em diálise peritoneal, e tentamos correlacionar o escore de cálcio coronariano com parâmetros clínicos, com distúrbios do metabolismo cálcio e fósforo, perfil lipídico e com marcadores inflamatórios. Além disso comparamos os resultados da Tomografia Coronariana com o diagnóstico de doença cardíaca isquêmica determinado por cintilografia de perfusão miocárdica. Vinte pacientes (41 por cento) não apresentaram calcificação coronariana; nos 29 pacientes (59 por cento) com calcificação a mediana do escore de cálcio foi de 234.7 unidades Agatston (variação de 10.3 a 2351). Na análise univariada o escore de cálcio correlacionou-se positivamente com idade (r=0.42; p=0.002), anti-oxLDL (r=0.31; p=0.03) e história prévia de doença coronariana (r=0.32; p=0.05) e negativamente com HDL-cholesterol (r=-0.3p=0.02). Não houve correlação entre o escore de cálcio e produto cálcio fósforo, PTH intacto, colesterol total, LDL e marcadores inflamatório Entretanto , quando a população foi dividida em quartis de escore de cálcio, a concentrações de PCR e sFas foram significantemente maiores naquele pacientes no 3 (10.9 mg/L vs 2.6 mg/L p= 0,03) e 4 (1372 ng/L vs.1111 ng/L p=0.048) quartis respectivamente. Na analise de regressão linear múltipla idade (OR=1.12; p=0.006), história prévia de doença coronariana (OR=18.3;p=0.02) e HDL (OR=0.94;p=0.03) foram independentemente associados a calcificação coronariana. Considerando somente paciente jovens (< 45 anos), o escore de cálcio correlacionou-se positivamente com concentrações de fósforo(r=0.52; p=0.04) e índice de Massa Corporal (r=0.86; p<0.01) e negativamente com HDL(r=0.56; p=0.03). Onze pacientes (36 por cento) apresentaram resultado positivo da Cintolografia Miocárdica (99 Tc MIBI)…(au).BV UNIFESP: Teses e dissertaçõe

The progression and the impact of vascular calcification in peritoneal dialysis patients

BV UNIFESP: Teses e dissertaçõe

Vascular calcification in peritoneal dialysis patients

Vascular calcification ( VC) is being recognized as a common complication at all stages of chronic kidney disease, particularly in patients on dialysis. Traditional and nontraditional cardiovascular risk factors both appear to be involved in the development of VC in this population. Although few studies focusing exclusively on peritoneal dialysis (PD) patients are available, some data support the view that VC constitutes an independent prognostic marker of morbidity and mortality in the PD population. In this review, we discuss the potential pathophysiologic pathways of VC in PD patients, and we examine the relevant clinical data.Univ Fed Sao Paulo, Div Nephrol, Sao Paulo, BrazilUniv Sao Paulo, Div Nephrol, Sao Paulo, BrazilUniv Fed Sao Paulo, Div Nephrol, Sao Paulo, BrazilWeb of Scienc

IMPACT OF AEROBIC EXERCISE ON VISCERAL FAT OF NONDIALYSIS DEPENDENT OVERWEIGHT CKD PATIENTS: A PILOT STUDY

This is a randomized controlled study that aimed to assess the impact of aerobic exercise on visceral fat of overweight CKD patients. Twenty-six sedentary patients in stages 3–4 of CKD (73% men; 52.3±8.6 years, BMI 30.6±4.3 kg/m2) were included. Patients were assigned to aerobic exercise group (EG; n=13) or control group (CG; n=13). The aerobic training was conducted on a treadmill at the ventilatory threshold three times per week during 12 weeks. The CG patients remained without practicing exercise during follow up. Visceral and subcutaneous fat were assessed by computed tomography, and lean body mass (LBM) by DEXA. At the end of 12 weeks, visceral fat decreased 5% in EG and increased 3% in CG (p=0.02). Waist circumference decreased 1.5% in EG and increased 0.8% in CG (p=0.02). No changes were observed in body weight and subcutaneous fat. LBM tended to increase in EG and decrease in CG (p=0.09). In addition, blood pressure decreased (p<0.01) despite no change in body weight, 24 h urinary sodium and antihypertensive medication. Our results suggest aerobic exercise as an effective approach to reduce visceral fat while maintaining lean body mass in CKD patients

Associated factors related to chronic kidney disease progression in elderly patients.

BackgroundChronic Kidney Disease (CKD) is a worldwide public health problem. The prevalence of CKD is rising especially in elderly, as consequence of population-ageing related to socioeconomic development and better life expectancy. There are scarce studies evaluating CKD progression and its associated factors in elderly patients.MethodsThis is a retrospective observational study including 340 patients (≥ 65 years old) CKD stages 3a-5 non-dialysis, incidents in an outpatient CKD clinic, followed by 2.1 years. CKD progression was assessed by the slope of eGFR calculated by CKD-EPI and BIS 1 equations. The patients were divided in progressor and non-progressor groups (eGFR slope ResultsKidney function declined in 193 (57%) patients. In this group, the progression rate was -2.83 (-5.1 / -1.1) mL /min /1.73 m2 /year. Compared to non progressor, the progressor patients were younger [72 (69-78) vs. 76 (69-80) years; p = 0.02]; had higher proportion of diabetic nephropathy, higher serum phosphorus [3.8 (3.3-4.1) vs. 3.5 (3.9-4.1) mg/dL; p = 0.04] and proteinuria [0.10 (0-0.9 vs. 0 (0-0.3)] g/L; p = 0.007)] at the admission. In the logistic regression analysis adjusted for gender and eGFR, proteinuria was independently associated with CKD progression [OR (Odds Ratio) (1.83; 95% CI, 1.17-2.86; p ConclusionCKD progression was observed in the majority of elderly CKD patients and proteinuria was the most important factor associated to the decline of kidney function in this population

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

Home-based exercise has been shown to provide benefits in terms of physical capacity in the general population, but has been scarcely investigated in patients with chronic kidney disease (CKD).To evaluate the impact of a home-based aerobic training on the cardiopulmonary and functional capacities of overweight non-dialysis-dependent patients with CKD (NDD-CKD).Twenty-nine sedentary patients (55.1 +/- A 11.6 years, BMI = 31.2 +/- A 6.1 kg/m(2), eGFR = 26.9 +/- A 17.4 mL/min/1.73 m(2)) were randomly assigned to a home-based exercise group (n = 14) or to a control group (n = 15) that remained without performing exercise. Aerobic training was performed three times per week for 12 weeks. A cardiopulmonary exercise test, functional capacity and clinical parameters were evaluated.A significant increase, ranging from 8.3 to 17 %, was observed in the cardiopulmonary capacity parameters, such as maximal ventilation (p = 0.005), VO2peak (p = 0.049), ventilatory threshold (p = 0.040) and respiratory compensation point (p < 0.001), of the exercise group. A simultaneous improvement in the functional capacity tests [6-min walk test (p < 0.001), time up and go test (p < 0.001), arm curl test (p < 0.001), sit and stand test (p < 0.001), 2-min step test (p < 0.001) and back scratch test (p = 0.042)] was also found in patients who were submitted to the exercise. Exercised patients experienced a decrease in systolic and diastolic blood pressure, average 10.6 % (p < 0.001) and 9.2 % (p = 0.007), respectively, and a trend toward improved renal function (p = 0.1). No change in any parameter was found in the control group during the follow-up.The home-based aerobic exercise program was feasible, safe and effective for the improvement in the cardiopulmonary and functional capacities of overweight NDD-CKD patients.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Oswaldo Ramos FoundationCentro de Estudos em Psicobiologia e Exercicio/Associacao de Fundo e Incentivo a PesquisaUniversidade Federal de São Paulo, Div Nephrol, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Nutr Program, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Nutr Program, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04039000 São Paulo, BrazilFAPESP: 2009/147860Web of Scienc

Coronary artery calcification, systemic inflammation markers and mineral metabolism in a peritoneal dialysis population

Aims: To assess the prevalence of coronary artery calcification (CAC) in peritoneal dialysis (PD) patients and to determine whether comorbidities such as inflammation, dyslipidemia and mineral metabolism disorders correlate with its development. Methods: Forty-nine PD patients (45% male; median age, 52 years) were submitted to multislice computed tomography. Inflammatory markers, anti-oxidized LDL antibody, calcium-phosphate balance and lipid profiles were assessed. Results: Twenty-nine patients (59.2%) presented CAC (median calcium score, 234.7 Agatston units). Patients with CAC were older than those without, more frequently presented a history of coronary artery disease or hypertension and had lower HDL cholesterol levels, as well as presenting higher levels of osteoprotegerin and LDL oxidation. the logistic regression revealed that the independent determinants of CAC were age (odds ratio = 1.12; p = 0.006) and number of prescribed anti-hypertensive drugs (odds ratio = 2.38; p = 0.048). When the population was stratified by calcium score quartile, soluble Fas levels were significantly higher in patients with severe calcification. in patients younger than 45, CAC correlated positively with phosphorus levels (r = 0.52; p = 0.04). Conclusion: in PD patients, CAC is highly prevalent. Our results indicate that conditions such as inflammation and mineral disturbances are associated with its development. Copyright (c) 2006 S. Karger AG, Basel.Universidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilWeb of Scienc