Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Evaluation of fruit intake among elderly in São Caetano do Sul, São Paulo, Brazil

OBJECTIVES: To evaluate the consumption of fruits based on the habitual consumption in elderly. METHODS: Crosssectional study in non-probabilistic sample of 295 elderly people, from the research "Food Consumption Assessment in Elderly in São Caetano do Sul, São Paulo, Brazil". Information on fruits intake was obtained from the previously validated Food Frequency Questionnaire, and the consumption of energy and nutrients was assessed by two 24-hour dietary recall, using the Multiple Source Method Program (MSM). A logistic regression was applied to verify socio-demographic factors and lifestyle associated with fruits intake, and the Mann-Whitney test was used to evaluate the differences among the consumption of fruits, energy, macro and micronutrients. RESULTS: More than half of the sample (58%) consumed three or more fruit daily. The fruit intake was positively associated with female gender (OR = 2.00; 95%CI 1.02 - 3.91; p = 0.04) andliving alone (OR = 1.86; 95%CI 1.04 - 3.30; p = 0.03); and negatively associated with malnutrition (OR = 0.36; 95%CI 0.17 - 0.76; p = 0.01). Among seniors who have adequate consumption of fruit it was observed an increased intake of fibers (p = 0.03), vitamin A (p &lt; 0.01), vitamin C (p &lt; 0.01), potassium (p &lt; 0.01) and magnesium (p &lt; 0.01). Although, there was no significant association between energy and macronutrients (p &gt; 0.05). CONCLUSION: The consumption of fruit was influenced by socio-demographic factors and nutritional status, affecting the higher consumption of fiber, vitamin A and C, minerals like potassium and magnesium. Public policies that increased fruit consumption by the elderly could influence the health and quality of life of older people.</p

Dietary patterns and associated factors among the elderly

<div><p>Abstract The aim of the present study was to identify dietary patterns among the elderly, and associate the same with sociodemographic characteristics, health and lifestyle. A cross-sectional study was carried out with a non-probabilistic sample of 295 elderly residents of both genders of the city of São Caetano do Sul, São Paulo, Brazil, who were users of public health units. Dietary patterns were identified considering 44 food items identified through 24-hour dietary recall. Factor analysis by the principal components method was used, adopting loads greater than 0.25 as the cut-off point, followed by Varimax orthogonal rotation. The associations were analyzed by the linear regression method, with variables with p<0.20 in univariate regression selected, and those with p<0.05 maintained in the multivariate model. There was a greater percentage of elderly females (85.1%) and those aged 60-69 years (46.4%). Three dietary patterns were identified: the "traditional" pattern was associated with the male gender (β=0.59, p<0.001) and physically active individuals (β=0.39, p=0.020); the "Pastas, pork and sweets" pattern was associated with the male gender (β=0.38, p=0.025) and retired individuals (β=0.55, p=0.017); and the "Coffee with milk and bread and butter" pattern was associated with an age of 80 years or older (β=0.55, p=0.004) and elderly persons who had difficulty chewing (β=0.38, p=0.013). The dietary patterns identified show that the elderly tend to maintain similar eating habits to the Brazilian population in general, and that diet changes to a similar degree as health and life style conditions.</p></div

Resumos em andamento - Enfermagem

Resumos em andamento - Enfermage

Resumos em andamento - Enfermagem

Resumos em andamento - Enfermage