Chronic kidney disease progression: a retrospective analysis of 3-year adherence to a low protein diet.

The potential benefits and dangers of dietary protein restriction in chronic kidney disease (CKD) are still controversial. Thus, the aim of this study is to evaluate the effect of low protein diet (LPD) on the renal function in nondialysis CKD patients. A retrospective study was conducted from 321 nondialysis CKD patient's medical files (65.1 ± 12.7 yrs, 58.2% men). These patients received individualized dietary protein prescription (0.6-0.8 g protein/kg/day). Protein intake was evaluated by food diary and 24 h-food recall. Adherence to the LPD was considered when patients intake from 90 to 110% of the prescribed amount of protein. The patients were divided into 4 groups: (G1) adherent diabetes mellitus (DM) patients (n = 83); (G2) non-adherent DM patients (n = 106); (G3) adherent non-DM patients (n = 75); (G4) non-adherent non-DM patients (n = 57). Renal function was assessed by estimated glomerular filtration rate (eGFR). Both groups of patients (DM and non-DM) that adhered to the LPD showed significant improvement in eGFR (G1: 38.7 ± 13.2 mL/min to 51.1 ± 17.0 mL/min (p < 0.001); G3: 35.1 ± 16.8 mL/min to 46.8 ± 21.4 mL/min (p < 0.001)). In adherent patients, no differences in albumin and BMI were observed at the end of follow up. In non-adherent patients, eGFR significantly decreased in DM group (G2: 44.2 ± 18.5 mL/min to 38.2 ± 15.8 mL/min (p = 0.003)). According to multivariate analysis, annual changes in eGFR were not independent associated with age, gender, BMI, lipid profile, bicarbonate or smoking status. In summary, adherence to low protein diet could be able to improve serum creatinine and eGFR, well-known markers of renal function. However, prospective studies are needed to control confounders which affect renal function and CKD progression

URIC ACID LEVELS CORRELATES WITH INFLAMMATORY MARKERS AND ADHESION MOLECULES IN HEMODIALYSIS PATIENTS

Elevated serum uric acid has been associated to a variety of cardiovascular disease states and with systemic inflammation. The aim of this study was to analyze the association between uric acid levels and inflammatory markers in hemodialysis (HD) patients. This cross-sectional study included 50HD patients (62% men, 54.3±12.6 yrs, BMI 24.4±4Kg/m2) and 21 healthy individuals (45% men, 50.7±15.7 yrs, BMI 25.5±4.0Kg/m2). Uric acid was measured using uricase-PAP method, inflammatory (TNF-α, IL-6 and CRP) and atherosclerosis markers (ICAM-1, VCAM-1, MCP-1 and PAI-1) were measured by a multiplexed particle-based flow cytometric assay. There was a positive correlation between serum uric acid and inflammatory markers, IL-6 (r=0.30, p=0.01), CRP (r=0.37, p=0.003), TNF-α (r=0.40, p=0.001) and adhesion molecules levels, ICAM-1 (r=0.53, p=0.0001), and VCAM-1 (r=0.45, p=0.0001)ParametersHD PatientsHealthy individualsCRP (mg/mL)0.32 ± 0.30*0.11 ± 0.12TNF-α (pg/mL)5.5 ± 2.1*2.4 ± 1.1IL-6 (pg/mL)4.1 ± 1.6*2.7 ± 0.4PAI-1 (ng/mL)7.0 ± 2.76.2 ± 2.1MCP-1 (pg/ml)47.6 ± 24.237.3 ± 19.0VCAM-1 (ng/mL)48.5 ± 8.5*23.8 ± 5.5ICAM-1 (ng/mL)20.5 ± 15.9*7.2 ± 1.2⁎p<0.05In conclusion, these original data suggest that uric acid may have a role in inflammation and atherosclerosis in HD patient

The progins progesterone receptor gene polymorphism is not related to endometriosis‐associated infertility or to idiopathic infertility

OBJECTIVE: This study aimed to determine the frequency of the PROGINS polymorphism in women with endometriosis-associated infertility, in infertile women without endometriosis and in controls. INTRODUCTION: The human progesterone receptor gene has two isoforms that modulate the biological action of progesterone: isoform A, which is capable of inhibiting the activation of the estrogen receptors, and isoform B, which has the capacity to activate the estrogen receptors. Several polymorphisms have been described for this gene, among which one stands out: a polymorphism named PROGINS, which has been speculated to be related to the genesis of endometriosis by several studies with conflicting results. METHODS: This was a prospective study that included 148 patients with endometriosis-associated infertility, 50 idiopathic infertile patients and 179 fertile women as controls. The PROGINS polymorphism was studied by PCR. RESULTS: Genotypes P1P1, P1P2 and P2P2 (P2 representing the PROGINS polymorphism) of the progesterone receptor gene presented frequencies of 93.9%, 5.4% and 0.7%, respectively, in the women with endometriosis-associated infertility (p=0.2101, OR=0.51, 95% CI=0.24-1.09); 94.4%, 4.2% and 1.4%, respectively, in the patients with minimal/mild endometriosis (p=0.2725, OR=0.53, 95% CI=0.20-1.43); 93.5%, 6.5% and 0%, respectively, among the patients with moderate/severe endometriosis (p=0.3679, OR=0.49, 95% CI=0.18-1.31); 86.0%, 14.0% and 0%, respectively, in idiopathic infertile women (p=0.8146, OR=1.10, 95% CI=0.46-2.63); and 88.3%, 10.6% and 1.1%, respectively, in the control group. CONCLUSION: The data suggest that PROGINS is not related either to endometriosis-associated infertility or to idiopathic infertility in the population studied

EFFECTS OF grape powder SUPPLEMENTATION ON INFLAMMATION IN hemodialysis patients.

Polyphenols and antioxidants anti-inflammatory have been considered pharmacological agents to combat oxidative stress in chronic diseases due the reduction in the formation of free radicals (FR). Hemodialysis (HD) patients have an imbalance between oxidant and antioxidant activity, with increased levels of FR and consequently an increase of lipid peroxidation, thereby raising the risk for cardiovascular disease (CVD). The beneficial health effects of grape juice or red wine for these patients have been attributed to the antioxidant activity of its polyphenols. Then, this study aimed to evaluate the effects of grape powder supplementation on inflammation and glutathione peroxidase levels in hemodialysis (HD) patients. Thirty-two HD patients from CIN, RJ, Brazil were studied and randomly into two groups: placebo group- PG (16 patients, 9 men, 52.7 ± 13.7 yrs) and experimental group EG (16 patients, 9 men, 53.0 ± 9.8 yrs). Each patient received 12g/day of powder grape with grape jelly or only grape jelly (placebo) during 5 weeks. The lipid profile, C-reactive protein (CRP) levels and glutathione peroxidase (GPx) activity were evaluated before and after supplementation (Table). The data suggest that the consumption of grape powder was effective to increase the activity of GPx and decreasing the progression the inflammation. Thus, our results indicate that grape powder plays an important role as an antioxidant agent in HD patients.Placebo GroupExperimental GroupBeforeAfterBeforeAfterCRP (mg/mL)2.6±0.22.8±0.2*2.6±0.22.6±0.2LDL-C86.3±38.894.4±34.380.5±25.082.9±22.1Total cholesterol154.6±44.9163.3±44.8143.9±29.2145.4±28.3GPx (U/g prot)17.5±9.829.1±30.719.7±20.341.0±27.7*⁎p<0.0

Handgrip strength and its dialysis determinants in hemodialysis patients

AbstractObjectiveTo evaluate muscle function (MF) of patients on hemodialysis (HD) and to investigate the dialysis determinants of maximal voluntary handgrip strength (HGS).MethodsForty-three patients on HD (25 men, six diabetics, 54.5 ± 12.2 y of age, 62.2 ± 51.4 mo on dialysis) were studied. HGS was measured three times with a mechanical dynamometer (Jamar) before and after HD sessions on the non-fistula side and the highest value was used for analysis. HGS values lower than the 10th percentile of an age-, gender-, and region-specific reference were considered MF loss. Biochemical and dialysis variables (ultrafiltration, interdialytic body weight gain, urea clearance, urea before and after HD, systolic and diastolic blood pressures before and after HD, and difference in systolic and diastolic blood pressures) were also examined.ResultsThe HGS values before and after HD values were significantly higher in men but were not statistically different before and after the HD sessions (29.8 ± 10.3 and 30.2 ± 9.9 kg for men, 14.1 ± 7.0 and 14.5 ± 6.3 kg for women). MF loss was observed in 24 patients (55.8%), 12 women and 12 men. Dialysis variables were not different between patients with and without MF loss and did not correlate with HGS measured before or after an HD session.ConclusionsPatients using HD presented a high prevalence of MF loss as assessed by HGS, and it was not influenced by dialysis variables. HGS may be used as a reliable nutritional marker in HD, measured before or after HD sessions

Analysis of vitamin D receptor gene polymorphisms in women with and without endometriosis

AbstractAn aberrant immunologic mechanism has been suggested to be involved in the pathogenesis of endometriosis. Genetic alterations in the vitamin D receptor gene (VDR) may lead to important defects in gene activation that principally affect immune function. We have hypothesized a possible relationship between endometriosis and/or infertility and the VDR polymorphisms (ApaI, TaqI, FokI, and BmsI). The study was a case–control study including 132 women with endometriosis-related infertility, 62 women with idiopathic infertility, and 133 controls. VDR polymorphisms were studied by restriction fragment length polymorphism. We found relatively similar VDR polymorphism genotype frequencies in cases and controls. When patients with minimal/mild and moderate/severe endometriosis were studied separately, no difference was found. When we compared infertile groups with and without endometriosis there was no statistically significant difference. The data suggest that VDR polymorphisms did not play an important role in the pathogenesis of endometriosis and/or infertility in the Brazilian women studied

Percepção ambiental: Uma experiência de ressignificação dos sentidos

A percepção ambiental consiste na forma como o ser humano compreende o meio ambiente, resultante de conhecimentos e experiências. Ao educador ambiental cabe continuamente resgatar e restabelecer a conexão com o ambiente natural e abordar, por meio da sensibilização, as complexas questões socioambientais. Assim, um grupo de acadêmicos Stricto Sensu em Educação, voltado à Educação Ambiental, realizou uma saída de campo à cidade de Anitápolis – Santa Catarina, objetivando uma imersão no meio natural, para estimular os sentidos para que as sensações permitissem uma reflexão sobre a sua integração ao ambiente. Desenvolveram-se atividades de entrevista, interlocução no ambiente natural e trilha sensitiva, que propiciaram a sensibilização e percepção dos integrantes, permitindo reflexões e o desenvolvimento da afetividade no grupo

There is no relationship between Paraoxonase serum level activity in women with endometriosis and the stage of the disease: an observational study

BACKGROUND: Endometriosis is a chronic condition whose pathophysiology is unknown, but there is evidence suggesting a link with oxidative stress. Paraoxonase is a serum enzyme which circulates associated with high-density lipoprotein (HDL). It acts protecting HDL and LDL of lipid peroxidation. We aimed to compare the serum levels of PON-1 activity in women with endometriosis in different stages of the disease (minimal/mild and moderate/severe). METHODS: 80 infertile women with endometriosis diagnosed by laparoscopy/laparotomy with histologic confirmation of the disease were divided according to the American Society for Reproductive Medicine classification in minimal/mild (n = 33) and moderate/severe (n = 47) cases. Paraoxonase activity and arilesterase activity were measured by spectrophotometry. Body mass index and fasting glucose levels were also determined. RESULTS: The paraoxonase activity were 191.29 ± 22.41 U/l in women with minimal/mild endometriosis and 224.85 ± 21.50 U/l in women with moderate/severe disease (P = 0.274). Considering arilesterase level, the results showed 89.82 ± 4.61 U/l in women with minimal/mild endometriosis and 90.78 ± 3.43 U/l in moderate/severe disease (P = 0.888). CONCLUSIONS: Evidence of lower paraoxonase activity in women with endometriosis was not found in this study. Besides, no difference was found considering minimal/mild or moderate/severe endometriosis