23 research outputs found
Low bone turnover is associated with plain X-ray vascular calcification in predialysis patients
Background Vascular calcification (VC) is a common finding in chronic kidney disease (CKD) patients and predicts subsequent cardiovascular morbidity and mortality in this population. Vascular calcification is linked to disordered mineral metabolism and has been associated with bone histomorphometry changes in CKD. However, data on predialysis patients is scarce. Methods A cross-sectional study was conducted on a cohort of 56 CKD patients not yet on dialysis, who underwent a transiliac bone biopsy for histomorphometric evaluation after double tetracycline labeling. Patients had no previous exposure to calcium salts, vitamin D agents, steroids or bisphosphonates. Vascular calcification was assessed at the time of biopsy, using Kauppila (plain X-ray of the lateral lumbar spine) and Adragão (plain X-ray of the pelvis and hands) scores. Results Vascular calcification was seen in two-thirds of the cohort. Subjects with VC were more likely to be male and have diabetes, and had significantly higher sclerostin and osteoprotegerin circulating levels than those without VC. The histomorphometric analysis showed that bone formation rate was significantly lower in VC compared to non-VC patients. In the multivariable logistic regression analysis, bone formation rate was independently associated with the presence of VC. Conclusions Vascular calcification is highly prevalent in predialysis patients, especially in those with diabetes. The independent association between bone formation rate and VC provides evidence of an important interaction between bone and vessel in CKD. Our results suggest that low bone turnover is a non-traditional risk factor for cardiovascular disease in predialysis patients
Sclerostin and DKK1 circulating levels associate with low bone turnover in patients with chronic kidney disease Stages 3 and 4
Background: Disordered mineral and bone metabolism is a common complication of chronic kidney disease (CKD). Bone biopsy remains the gold standard tool for evaluating renal osteodystrophy (ROD), but it is an invasive procedure. Despite a growing interest in the ability of newer bone biomarkers to discriminate between different forms of ROD, data on pre-dialysis patients are scarce. Methods: A cross-sectional study was conducted in a cohort of 56 patients with CKD Stages 3 and 4. Participants underwent a transiliac bone biopsy after a course of double tetracycline labelling. Circulating levels of Wnt signalling inhibitors sclerostin and Dickkopf-1 (DKK1), soluble receptor activator of nuclear factor-¿B ligand (sRANKL) and osteoprotegerin were measured and correlated with histomorphometric analysis results. Results: Most patients had abnormal bone histology and low-turnover bone disease was the predominant form of ROD. Characteristics associated with high bone turnover were worse renal function, lower serum calcium and higher intact parathyroid hormone and fibroblast growth factor-23 levels. Patients with low bone turnover, on the other hand, presented with higher sclerostin along with lower DKK1 and sRANKL levels. In the multivariable logistic regression analysis, sclerostin and DKK1 levels were independently associated with low-turnover bone disease. Conclusions: Our results suggest that circulating levels of Wnt signalling inhibitors sclerostin and DKK1 are predictive of low-turnover bone disease in patients not yet on dialysis. Further research is needed to assess the performance of these bone turnover biomarkers, compared with histomorphometric analysis, in the diagnosis and treatment monitoring of ROD
Endothelial dysfunction is associated with cerebrovascular events in pre-dialysis ckd patients: A prospective study
Background: Patients with chronic kidney disease (CKD) have markedly increased rates of end stage renal disease, major adverse cardiovascular/cerebrovascular events (MACCEs), and mortality. Endothelial dysfunction (ED) is an early marker of atherosclerosis that is emerging as an increasingly important non-traditional cardiovascular risk factor in CKD. There is a lack of clinical studies examining the association between ED and both cardiovascular and renal endpoints in patients with CKD. Aims: We examined the association between reactive hyperemia index (RHI), a validated measure of endothelial function measured by peripheral arterial tonometry (PAT), with traditional cardiovascular risk factors in pre-dialysis CKD patients and prospectively evaluated the role of RHI as predictor of renal and cardiovascular outcomes in this population. Methods: One hundred and twenty pre-dialysis patients with CKD stages 1 to 5 (CKD group) and 18 healthy kidney donor candidates (control group) were recruited and had a successful RHI measurement by PAT. General demographic and clinical information including traditional cardiovascular risk factors were registered from all participants. Thereafter, patients were prospectively followed-up for a median time of 47 (IQR 19–66) months to determine associations of RHI with renal outcomes, MACCEs, hospitalizations or mortality. Results: In the CKD patient population, the mean age was 57.7 ± 15.5 years, the mean eGFR was 54.9 ± 36.7 mL/min/1.73 m2 (CKD-EPI) and 57 were males (47.5%). At baseline, in univariate analysis, RHI in the CKD group correlated positively with eGFR (r = 0.332, p < 0.0001) and correlated negatively with age (r = -0.469, p < 0.0001), Charlson index (r = -0.399, p < 0.0001), systolic blood pressure (r = -0.256, p = 0.005), and proteinuria (r = 0.211, p = 0.027). Reactive hyperemia index in the control group did not significantly differ from RHI observed in patients with CKD stages 1 to 5 (2.09 ± 0.40 vs. 2.01 ± 0.06, p = 0.493). In adjusted analysis, only age (ß = -0.014, p = 0.003) remained independently associated with RHI at baseline. During follow-up, 8 patients suffered a MACCEs, 33 patients experienced renal function deterioration, 17 patients were hospitalized for medical reasons and 6 patients died. RHI at baseline was not significantly associated with CKD progression (1.94 vs. 2.02, p = 0.584), hospitalizations (1.90 vs. 2.04, p = 0.334), and all-cause mortality (1.65 vs. 2.01, p = 0.208) or MACCEs (1.77 vs. 2.01, p = 0.356), but was significantly associated with cerebrovascular events (1.27 vs. 2.02, p = 0.004) and with a composite cardiovascular outcome (MACCEs, hospital admissions and death; 1.73 vs. 2.07, p = 0.035). Conclusion: Our results suggest that RHI may be a predictor for the development of cerebrovascular events in pre-dialysis CKD patients who may benefit from more aggressive preventive measures.This research was funded by FEDER—Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020—Operacional Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, and by Portuguese funds through FCT—Fundação para a Ciência e a Tecnologia/ Ministério da Ciência, Tecnologia e Ensino Superior in the framework of the project “Institute for Research and Innovation in Health Sciences” (POCI-01-0145-FEDER-007274), a grant from Portuguese Society of Nephrology
Circulating renalase as predictor of renal and cardiovascular outcomes in pre-dialysis ckd patients: A 5-year prospective cohort study
Chronic kidney disease (CKD) is an independent risk factor for adverse cardiovascular and cerebrovascular events (MACCEs), and mortality since the earlier stages. Therefore, it is critical to identify the link between CKD and cardiovascular risk (CVR) through early and reliable biomarkers. Acknowledging that CKD and CKD progression are associated with increased sympathetic tone, which is implicated in CVR, and that renalase metabolizes catecholamines, we aimed to evaluate the relationship between renalase serum levels (RNLS) and cardiovascular and renal outcomes. The study included 40 pre-dialysis CKD patients (19F:21M) with median age of 61 (IQ 45–66) years. At baseline, we measured RNLS as well as routine biomarkers of renal and cardiovascular risk. A prospective analysis was performed to determine whether RNLS are associated with CKD progression, MACCEs, hospitalizations and all-cause mortality. At baseline, the median level of RNLS and median estimated glomerular filtration rate (eGFR) were 63.5 (IQ 48.4–82.7) µg/mL and 47 (IQ 13–119) mL/min/1.73 m2, respectively. In univariate analysis, RNLS were strongly associated with eGFR, age and Charlson Index. Over the course of a mean follow-up of 65 (47 to 70) months, 3 (7.5%) deaths, 2 (5%) fatal MACCEs, 17 (42.5%) hospital admissions occurred, and 16 (40%) patients experienced CKD progression. In univariate analysis, RNLS were associated with CKD progression (p = 0.001), hospitalizations (p = 0.001) and all-cause mortality (p = 0.022) but not with MACCEs (p = 0.094). In adjusted analysis, RNLS predicted CKD progression and hospitalizations regardless of age, Charlson comorbidity index, cardiovascular disease, hypertension, diabetes and dyslipidemia. Our results suggest that RNLS, closely related with renal function, might have a potential role as predictor of renal outcomes, hospitalizations, and mortality in pre-dialysis CKD patients.This work was financed by FEDER-Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020-Operacional Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, and by Portuguese funds through FCT-Fundação para a Ciência e a Tecnolo-gia/Ministério da Ciência, Tecnologia e Ensino Superior in the framework of the project “Institute for Research and Innovation in Health Sciences” (POCI-01-0145-FEDER-007274), and a grant from Portuguese Society of Nephrology
A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURO bservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry
Aims: Given the advances in atrial fibrillation (AF) management and the availability of new European Society of Cardiology (ESC) guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of AF in ESC member countries. Methods and results: We conducted a registry of consecutive in- and outpatients with AF presenting to cardiologists in nine participating ESC countries. All patients with an ECG-documented diagnosis of AF confirmed in the year prior to enrolment were eligible. We enroled a total of 3119 patients from February 2012 to March 2013, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common comorbidities were hypertension, coronary disease, and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF. Amiodarone was the most common antiarrhythmic agent used (~20%), while beta-blockers and digoxin were the most used rate control drugs. Oral anticoagulants (OACs) were used in 80% overall, most often vitamin K antagonists (71.6%), with novel OACs being used in 8.4%. Other antithrombotics (mostly antiplatelet therapy, especially aspirin) were still used in one-third of the patients, and no antithrombotic treatment in only 4.8%. Oral anticoagulants were used in 56.4% of CHA 2DS2-VASc = 0, with 26.3% having no antithrombotic therapy. A high HAS-BLED score was not used to exclude OAC use, but there was a trend towards more aspirin use in the presence of a high HAS-BLED score. Conclusion: The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal. © The Author 2013
APICULTURA E RESPONSABILIDADE SOCIAL: DESAFIOS DA PRODUÇÃO E DIFICULDADES EM ADOTAR PRÁTICAS SOCIAL E AMBIENTALMENTE RESPONSÁVEIS
RESUMOO artigo objetiva identificar a percepção e as dificuldades que os produtores têm em adotar práticas mais responsáveis social e ambientalmente. Utilizou-se de método qualitativo, com entrevista semiestruturada com cinco das seis pessoas que participam da Associação de Apicultores. Nesse sentido, a pesquisa utilizou a análise categorial temática, com o desmembramento em categorias conforme os temas que emergem do texto identificando o que eles têm em comum, dividida em quatro categorias temáticas: 3.1 - Perfil dos entrevistados; 3.2 - Determinação da criação de abelhas e da produção do mel; 3.3 - Conhecimento da atividade e importância da associação; 3.4 - Comercialização e responsabilidade social e ambiental. A responsabilidade social em relação ao mel foi evidenciada como um diferencial no produto concentrado nas preocupações com o meio ambiente, influenciando as tomadas de decisões dos apicultores em seus negócios, bem como no comprometimento para a melhoria da qualidade de vida e bem-estar social. Os resultados da pesquisa também demonstraram que a apicultura é uma atividade lucrativa. No entanto, se percebeu que, em decorrência dos associados não estarem bem organizados, têm dificuldades em comercializar seus produtos
UTILIZACÁO DE CORRECTIVOS ORGÁNICOS EM PASTAGENS E FORRAGENS
Após um breve comentario acerca da fertilizacao no período anterior ao aparecimento dos adubos, refere-se o importante papel desempenhado por estes produtos na possibilidade de a Agricultura passar de actividade de subsistencia a actividade económica. Salientam-se, sobretudo para as pastagens e forragens, os inconvenientes de urna incorrecta utilizacao dos adubos, em particular quanto a possíveis excessos de azoto e potássio. Chama-se a atencao para a necessidade de a fertilizacao ter de se reger, cada vez mais, por preceitos ecológicos e o papel que, para tal, pode ser desempenhado pela materia orgánica. Conclui-se com urna referencia a possibilidade de, perante urna cada vez mais acentuada carencia de estrumes, se poderem aplicar como fertilizantes diversos residuos orgánicos, indicando-se como sendo susceptíveis de apresentar maior interesse, no caso das pastagens e forragens, os chorumes e as lamas celulósicas
MENTAL FA TIGUE ASSESSMENT IN DIFFERENT THERMAL ENVIRONMENTS – PROTOCOL
Environmental and personal characteristics influence the behavior of individuals through the limitation of effort levels by a more or less rapid induction of fatigue. In particular, mental fatigue is recognized as a major cause of errors leading to accidents. As a consequence, thermal environment study has gained increasing importance in recent years. In order to contribute to enlarge the knowledge in this field, this work aims to present an essay
protocol to evaluate the influence of the thermal environment on mental fatigue, based on electroencephalographic (EEG) analysis. With this purpose an exploratory study was held with 36 volunteers to validate the protocol. Volunteers simulated an administrative task for one hour. Fatigue assessment was carried out by analyzing Alpha and Beta waves amplitude over time. Assays were performed in a climatic chamber with controlled temperature and humidity: 22°C (40 and 80% RH) and 32°C (40 and 80% RH). Results suggest that both temperature and humidity influence the amplitude of the EEG signal (Alpha and Beta waves) in both hemispheres. The greatest amplitudes were found whenever environmental temperature and/or relative humidity values were higher. At the end of the article the advantages and limitations of mental fatigue assessment are discussed
SUDDEN INFANT DEATH SYNDROME - MOLECULAR AND BIOCHEMICAL INVESTIGATION
RESUMO
SIDS (Sudden Infant Death Syndrome)
é a designação utilizada para
definir a morte súbita do lactente, que
permanece inexplicada após uma cuidadosa
investigação do caso, a qual incluí
a realização de autópsia, o exame do
local da morte e a análise da história
clínica.
Devido à rápida deterioração que
provocam, as doenças metabólicas
constituem potenciais causas de morte
súbita, quer pelas crises que ocasionam
com intoxicação e comprometimento da
sobrevivência do indivíduo, quer por
provocarem alterações que aumentam o
risco de falência de determinados orgãos.
Objectivos: Com este trabalho
pretendemos avaliar o contributo relativo
das doenças metabólicas e dos défices
energéticos nas situações de morte
súbita e inexplicada do lactente, na
população portuguesa.
Pacientes e Métodos: Foram disponibilizadas
para investigação amostras
biológicas congeladas de 51 lactentes
cuja causa de morte era desconhecida.
Os produtos foram colhidos durante a
autópsia e incluíram: soro, urina, humor
vítreo, músculo e fígado. Nos fluídos
biológicos fez-se o estudo dos aminoácidos
e dos ácidos orgânicos e nos
tecidos sólidos o doseamento da actividade
dos vários complexos da cadeia
respiratória mitocondrial e do teor em
glicogénio. Foi ainda efectuada a extracção
de DNA total a partir dos tecidos
sólidos acima referidos o qual foi utilizado
para estudos moleculares. Resultados: Foi possível identificar
através dos estudos moleculares um
caso de intolerância hereditária à frutose
- HFI (homozigotia para a mutação A149P
no gene ALDOB). Nos estudos bioquímicos
foi encontrado um caso positivo
de very long-chain acyl-CoA dehydrogenase
- VLCAD e na maioria das
determinações efectuadas, desvios em
relação aos controlos normais inerentes
ao catabolismo e aos processos de
cadaverização, sendo de salientar: valores
muito elevados dos aminoácidos
séricos e a presença sistemática de
grande quantidade de ácido láctico na
urina.
Conclusões: Nas doenças metabólicas
o risco de recorrência existe e a
identificação de um caso classificado
como SIDS, como sendo na realidade
um erro inato do metabolismo, é importante
para a família, quer em termos de
instituição de tratamento adequado e
adopção de medidas preventivas, quer
em termos de aconselhamento genético. ABSTRACT
SIDS (Sudden Infant Death Syndrome)
is the sudden and unexpected death including
performance of a complete autopsy,
examination of death scene, and review
of clinical history.
Metabolic disorders can lead to sudden
dead because they cause crises of
intoxication and life threatening, with
dysfunction of several organs, that raise
the risk of general failure.
Objectives: Our main objective with
this study, was to evaluate the significance
of metabolic disorders and energy
deficiencies in sudden infant death syndrome,
in Portuguese population.
Patients and Methods: We got biological
frozen samples from 51 children
whose cause of dead was unknown. The
products were collected during autopsy
and included: serum, urine, humour vitreous,
muscle and liver. In the biological
fluids samples we analysed amino acids
as well as organic acids, and in referred
tissues we determinate the activity of the
respiratory chain complexes and the
amount of glycogen. It was also possible
to get total DNA from solid tissues which
was used for molecular studies.
Results: Based on molecular findings,
it was possible to identify one case
of fructose intolerance - HFI (patient homozygous
for A149P in ALDOB gene).
Biochemical studies revealed one case
of very long-chain acyl-CoA dehydrogenase
- VLCAD deficiency. However, in
the majority of the assays performed
deviations from normal controls were
found, due to catabolism post-morten
(plasmatic increase of amino acids and
high excretion of lactic acid in urine).
Conclusions: In metabolic disorders
the risk of recurrence exists. The
misdiagnosed inherited errors of metabolism
as SIDS, it is important for the family,
in terms of treatment, prevention attitude
and genetic counselling.
of an infant which remains unexplainedComissão de Fomento da Investigação em Cuidados
de Saúde. (Projecto do Ministério da Saúde Nº
89/1999