Rationale and study design of the prospective, longitudinal, observational cohort study “rISk strAtification in end-stage renal disease” (ISAR) study

Background: The ISAR study is a prospective, longitudinal, observational cohort study to improve the cardiovascular risk stratification in endstage renal disease (ESRD). The major goal is to characterize the cardiovascular phenotype of the study subjects, namely alterations in micro-and macrocirculation and to determine autonomic function. Methods/design: We intend to recruit 500 prevalent dialysis patients in 17 centers in Munich and the surrounding area. Baseline examinations include: (1) biochemistry, (2) 24-h Holter Electrocardiography (ECG) recordings, (3) 24-h ambulatory blood pressure measurement (ABPM), (4) 24 h pulse wave analysis (PWA) and pulse wave velocity (PWV), (5) retinal vessel analysis (RVA) and (6) neurocognitive testing. After 24 months biochemistry and determination of single PWA, single PWV and neurocognitive testing are repeated. Patients will be followed up to 6 years for (1) hospitalizations, (2) cardiovascular and (3) non-cardiovascular events and (4) cardiovascular and (5) all-cause mortality. Discussion/conclusion: We aim to create a complex dataset to answer questions about the insufficiently understood pathophysiology leading to excessively high cardiovascular and non-cardiovascular mortality in dialysis patients. Finally we hope to improve cardiovascular risk stratification in comparison to the use of classical and non-classical (dialysis-associated) risk factors and other models of risk stratification in ESRD patients by building a multivariable Cox-Regression model using a combination of the parameters measured in the study

Metabolic Programming during Lactation Stimulates Renal Na+ Transport in the Adult Offspring Due to an Early Impact on Local Angiotensin II Pathways

BACKGROUND: Several studies have correlated perinatal malnutrition with diseases in adulthood, giving support to the programming hypothesis. In this study, the effects of maternal undernutrition during lactation on renal Na(+)-transporters and on the local angiotensin II (Ang II) signaling cascade in rats were investigated. METHODOLOGY/PRINCIPAL FINDINGS: Female rats received a hypoproteic diet (8% protein) throughout lactation. Control and programmed offspring consumed a diet containing 20% protein after weaning. Programming caused a decrease in the number of nephrons (35%), in the area of the Bowman's capsule (30%) and the capillary tuft (30%), and increased collagen deposition in the cortex and medulla (by 175% and 700%, respectively). In programmed rats the expression of (Na(+)+K(+))ATPase in proximal tubules increased by 40%, but its activity was doubled owing to a threefold increase in affinity for K(+). Programming doubled the ouabain-insensitive Na(+)-ATPase activity with loss of its physiological response to Ang II, increased the expression of AT(1) and decreased the expression of AT(2) receptors), and caused a pronounced inhibition (90%) of protein kinase C activity with decrease in the expression of the α (24%) and ε (13%) isoforms. Activity and expression of cyclic AMP-dependent protein kinase decreased in the same proportion as the AT(2) receptors (30%). In vivo studies at 60 days revealed an increased glomerular filtration rate (GFR) (70%), increased Na(+) excretion (80%) and intense proteinuria (increase of 400% in protein excretion). Programmed rats, which had normal arterial pressure at 60 days, became hypertensive by 150 days. CONCLUSIONS/SIGNIFICANCE: Maternal protein restriction during lactation results in alterations in GFR, renal Na(+) handling and in components of the Ang II-linked regulatory pathway of renal Na(+) reabsorption. At the molecular level, they provide a framework for understanding how metabolic programming of renal mechanisms contributes to the onset of hypertension in adulthood

A importância do cuidador no contexto da saúde do idoso La importancia del cuidador en el contexto de la salud del anciano The importance of the caregiver in the elderly health context

Trata-se de um estudo bibliográfico que busca discutir a temática "idoso dependente de cuidados e a capacitação do cuidador no contexto domiciliar". A análise foi realizada a partir de autores que desenvolveram estudos sobre envelhecimento com dependência, cuidado familiar e ações direcionadas ao cuidador informal. Os temas destacados para esta análise foram: o papel do cuidador informal no cuidado do idoso dependente; a vivência de ser um cuidador familiar; e os modelos de atenção e suporte direcionados ao cuidador informal. O estudo demonstra a importância da ampliação de estratégias que tenham o cuidador como sujeito principal, cabendo ao profissional de saúde e às políticas públicas valorizarem a rede de suporte ao idoso dependente. Esta rede é importante como base do processo de cuidar com qualidade.<br>Se trata de un estudio bibliográfico que busca discutir la tematica del anciano dependiente y la capacitación del cuidador en el contexto domiciliar. La análisis fue realizada a partir de autores que desarollaron estudios sobre envejecimiento con dependencia, cuidado familiar y acciones direccionadas al cuidador informal. Los temas destacados para esta análisis fueron: el papel del cuidador informal en el cuidado al idoso dependiente; la vivencia de ser un cuidador familiar; y los modelos de atención y suporte dirigidos para el cuidador informal. El estudio muestra la importancia de la ampliación de estrategias que tengan el cuidador como sujeto principal, siendo de competencia del profesional de salud y de las políticas públicas valoraren la red de soporte al idoso dependiente y tenerla como aliada en el proceso de cuidar con calidad.<br>The present study is a bibliographic research that aims to discuss the theme "the dependent elderly and caregiver's skills in domiciliary context". The authors who developed studies on dependent elderly, familiar care and non-professional care actions were consulted. The themes emphasized were: the role of non-professional caregivers; the experience of caring a relative, and models of assistance and support for non-professional caregivers. The study shows the importance of establishing strategies of support for the community Care. It is up to the health professionals and to the public policies to value a support system to the dependent aged cared in community. This system should be the base for a qualified process of care