Navegando por Palavras-chave "CKD"

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    Efeito do exercício aeróbico à distância em relação ao presencial sobre os parâmetros cardiorrespiratórios e capacidade funcional de pacientes com doença renal crônica e excesso de peso
    (Universidade Federal de São Paulo (UNIFESP), 2016-02-29) Aoike, Danilo Takashi [UNIFESP]; Cuppari, Lilian [UNIFESP]; http://lattes.cnpq.br/3552074553183694; http://lattes.cnpq.br/2761150276098022; Universidade Federal de São Paulo (UNIFESP)
    Introduction: In patients with chronic kidney disease (CKD) the presence of overweight or obesity is associated with several metabolic complications, including worsening renal function. In addition, the association between CKD and excess body fat can lead to aggravation of cardiorespiratory capacity, physical function and quality of life of the patients. Studies show that aerobic training improves several aspects of physical capacity of these patients. Although the incorporation of physical exercise on a CKD standard treatment is a challenge and this is recommended by current guidelines for all stages of disease. Besides, the lack of studies showing real benefits of practical and affordable programs further complicates the implementation of training programs for these patients. Objective: The aim of this study was compare the performance of aerobic exercise performed remotely (home-based) with the conducted in person (center-base) on cardiorespiratory and functional capacity of overweight patients with non- dialysis dependent CKD (stage 3 or 4). Methods: This was a prospective, randomized, interventional, controlled trial of a 24 weeks. Forty sedentary patients were studied (27 men), aged 55.5±8.3 years (mean±SD); BMI of 31.2±4.4 kg/m2 and estimated glomerular filtration rate of 26.9±11.7 mL/min/1.73m2. The patients were randomly assigned to the control group or the exercise group. Those who were assigned to the exercise group could choose to perform the home-based exercise or center-based exercise. The control group was instructed not to perform exercise during the follow-up. The patients from the center-based exercise group performed the aerobic training on a treadmill three times per week during 12 weeks on 9 alternate days at the Psychobiology and Exercise Study Centre under supervision of an exercise physiologist. The patients from the home-based exercise group performed aerobic training at locations nearby their home, backyard, park or street three times per week on alternate days during 12 weeks according to the instructions given by exercise physiologist. The exercised groups were subjected to the same continuous aerobic exercise protocol consisted of three weekly sessions on alternate days, at the intensity of anaerobic threshold lasting 30 minutes. The duration was increased by 10 minutes every four weeks until it reached 50 minutes. Patients underwent assessment of cardiorespiratory fitness, functional capacity tests, the questionnaire of quality of life (SF-36), questionnaire of quality of sleep (Pittsburgh sleep quality index) and routine laboratory tests before, after 12 weeks and after 24 weeks of follow-up. Results: A significant increase (p<0.05) of VO2 peak, speed at anaerobic threshold, VO2 at respiratory compensation point and maximum ventilation was observed after 12 weeks of training in the home-based group, reaching values similar to those obtained in the center-based group . As for the functional testing was observed improvement in 6-minute walk test, time up and go test, step test, sit and stand test and arm curl test was found after 12 weeks of training in the home-based group, achieving values not different from those in the center-based group. In both exercised groups the values achieved in the tests were maintained until the end of 24 weeks. No changes in those parameters were observed in the control group. The benefits observed in cardiorespiratory parameters and functional capacity resulting from the exercise reflected in improved quality of life and sleep. In addition, only in the exercised groups there 10 was a decrease in blood pressure, with no change in antihypertensive medication, sodium intake and body weight. No adverse effects were observed. Conclusion: Home-based aerobic training promoted similar benefits to those found in the center-based group in cardiorespiratory fitness, functional capacity, quality of life and sleep besides reducing blood pressure of overweight patients with CKD. The results of this study indicate that home-based exercise is effective and can be used safely.
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    Effect of rosuvastatin and sevelamer on the progression of coronary artery calcification in chronic kidney disease: a pilot study
    (Dustri-verlag Dr Karl Feistle, 2013-07-01) Lemos, Marcelo M. [UNIFESP]; Watanabe, Renato [UNIFESP]; Carvalho, Aluizio B. [UNIFESP]; Jancikic, Alessandra D. B. [UNIFESP]; Sanches, Fabiana M. R. [UNIFESP]; Christofalo, Dejaldo M. [UNIFESP]; Draibe, Sergio A. [UNIFESP]; Canziani, Maria Eugenia F. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Coronary artery calcification (CAC) is highly prevalent among chronic kidney disease (CKD) patients and its strong association with mortality has been recognized early in the course of CKD. the aim of the present study was to test the effect of rosuvastatin and sevelamer hydrochloride on the progression of CAC in nondialyzed CKD patients. Methods: An open-label, randomized and controlled pilot study was conducted including 117 CKD patients (62% men, 56.9 +/- 11.2 years, eGFR 36 +/- 16.5 ml/min) Patients were randomly assigned to rosuvastatin (n = 38; 10 mg/day), to sevelamer hydrochloride (n = 38; 2,400 mg/day) and to control (n = 41) groups. CAC (by multislice computed tomography) and biochemical analyses were performed at baseline and after 24 months. Results: At baseline, CAC was observed in 55%, 58% and 61% of patients in the rosuvastatin, sevelamer hydrochloride and control groups, respectively (p = 0.87). Calcium score at baseline as well as its absolute and relative changes during 24 months were similar among the groups. Low density lipoprotein cholesterol (LDL-c) was higher and decreased significantly in the rosuvastatin group (p < 0.01). the analysis adjusting for LDL-c showed that the drug regimens were not associated with the progression of CAC (drug effect p = 0.85; time-effect p < 0.001; interaction p = 0.76). Conclusions: Treatment with rosuvastatin and sevelamer hydrochloride may not delay the progression of CAC in non-dialysis dependent CKD patients.
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    Hipercalemia e hiperfosfatemia na doença renal crônica: revisão narrativa da literatura dos aspectos nutricionais e clínicos
    (Universidade Federal de São Paulo, 2024-06-19) Iurevich, Bernardo Gamero [UNIFESP]; Abreu, Thaís Virgínia Marques [UNIFESP]; Góes Junior, Miguel Ângelo de [UNIFESP]; http://lattes.cnpq.br/8567997496708083; Universidade Federal de São Paulo (UNIFESP)
    O objetivo deste trabalho foi realizar uma revisão narrativa de literatura, para compreender a importância da terapia nutricional e clínica na Doença Renal Crônica (DRC), com foco nas complicações relacionadas ao potássio e ao fósforo, especificamente a hipercalemia e a hiperfosfatemia, visando analisar como a nutrição desempenha um papel crucial no controle da DRC para evitar complicações graves e melhorar a qualidade de vida dos pacientes. Para isto, foram analisados trabalhos da plataforma de dados disponíveis na PUBMED, Scielo, e nas revistas Brazilian Journal of Nephrology e International Journal of Nephrology, considerando-se o período de 2007 a 2023, nas línguas português, espanhol e inglês, onde 41 trabalhos foram finalmente selecionados de um total de 385 pesquisados na literatura. Os resultados mostraram que o consumo de frutas e hortaliças podem melhorar a sensibilidade à insulina, a inflamação e o estresse oxidativo, sendo mais um fator contribuinte para a diminuição de doenças cardiovasculares e infecciosas. Também podem ter um efeito benéfico em pacientes com constipação, acidose metabólica e no controle glicêmico, ajudando no manejo da hipercalemia. Ainda, o preparo das hortaliças também merece atenção. Em alguns casos, é recomendável a cocção em água, desprezando a água após o cozimento. Ainda, no caso da Hiperfosfatemia, os resultados mostraram que a biodisponibilidade do fósforo varia de acordo com a origem dos alimentos. Em alimentos de origem animal, a biodisponibilidade varia de 30% a 86%, em alimentos de origem vegetal varia 10% e em alimentos industrializados (que contêm aditivos químicos a base de fósforo) apresentou alta biodisponibilidade, de 87% a 100%. Foi observado a importância de ajustes dietéticos criteriosos para o tratamento dos pacientes não dialíticos e evitar comprometer a ingestão proteica em pacientes em estágio dialítico da DRC, nos quais os métodos de diálise frequentemente demonstram limitada eficácia na remoção de fósforo e a inclusão equilibrada de leguminosas na alimentação pode ter um impacto positivo no estado nutricional dos pacientes. Finalmente, pode-se concluir em ambas situações que, um acompanhamento guiado por profissionais de saúde de forma individualizada, é essencial para garantir um controle mais eficaz dos níveis de potássio e fósforo, e desta forma, melhorar a qualidade de vida dos pacientes com DRC.
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    Serum-soluble Fas and serum levels of erythropoietin in chronic kidney disease
    (Dustri-verlag Dr Karl Feistle, 2010-01-01) Goes, M. A. [UNIFESP]; Dalboni, Maria Aparecida [UNIFESP]; Manfredi, Silvia Regina [UNIFESP]; Cendoroglo, Miguel [UNIFESP]; Batista, Marcelo Costa [UNIFESP]; Canziani, Maria Eugênia Fernandes [UNIFESP]; Balakrishnan, V. S.; Pereira, B. J. G.; Draibe, Sergio Antonio [UNIFESP]; Cendoroglo, Maysa Seabra [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Tufts Univ New England Med Ctr
    Background: Soluble Fas levels (sFas) are increased in the serum of uremic patients and are associated with the presence of anemia and recombinant human EPO (rHuEPO) dosage in dialysis patients. It is possible that sFas levels are associated with all increased need for serum erythropoietin levels (Epo) in chronic kidney disease and dialysis patients ill order to maintain hematocrit (Hct) levels. Aims: To investigate the relationship between serum sFas levels, serum Epo levels and the ratio between Epo levels and Hct ill uremic patients. Methods: We studied 52 predialysis chronic kidney disease patients (CKD; 33 M, 57 +/- 12 years, hematocrit (Hct) = 37 +/- 7%), 29 peritoneal dialysis patients (PD; 12 M, 54 +/- 14 years, Hct = 36 +/- 7%), 29 hemodialysis patients (HD; 19 M, 47 +/- 14 years, Hct = 33 +/- 5%) and 29 healthy volunteers (control group 17 M, 50 +/- 16 years, Hct = 43 +/- 3%). We examined the relationship between Hct and serum levels of Epo, sFas, C-reactive protein, IL-6 and iron status. The ratio of serum Epo divided by Hct (Epo/Hct) was used as an indicator of Epo responsiveness. Results: Compared to normal subjects, the CKD, PD and HD groups presented lower Hct levels and higher serum levels of sFas, Epo, Epo/Hct and IL-6. serum levels of sFas correlated negatively with albumin (r = -0.24, p = 0.02), IL-6 (r = -0.18, p = 0.04) and Epo/Hct (r = -0.37, p < 0.001). In multivariate analysis, after adjusting for markers of iron store and inflammation, only sFas correlated with Epo/Hct. In the CKD group, there were negative correlations between serum levels of sFas and glomerular filtration rate (GFR) (r = -0.45, p < 0.001) and between Epo/Hct and GFR (r = -0.32; p = 0.02). There was a positive correlation between Epo/Hct and serum levels of sFas in the CKD group (r = 0.31, p = 0.03) and in the HD groups (r = 0.58, p = 0.001). Conclusion: Our findings show that serum sFas is associated with higher Epo/Hct ratio, suggesting that sFas may be a marker of Epo hyporesponsiveness ill uremia. Further studies are needed to deter-mine whether sFas is just a marker of Epo hyporesponsiveness or is also involved in its pathophysiology.
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    Vascular calcification in peritoneal dialysis patients
    (Multimed Inc, 2008-03-01) Ammirati, Adriano Luiz [UNIFESP]; Moyses, Rosa Maria Affonso; Canziani, Maria Eugênia Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    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.