Henrique Novais Mansur

Sarcopenia in chronic kidney disease

Sarcopenia is a chronic condition associated with physiological aging process and is defined by the reduction of the mass, muscle strength and function. In Chronic Kidney Disease (CKD), sarcopenia is prevalent and is associated with increased morbidity and mortality and the occurrence of cardiovascular complications. By analyzing sarcopenia in patients with renal insufficiency, complex mechanisms that contribute to loss of muscle mass are highlighted, such as activation of mediators that stimulate the ubiquitin-proteasome system (SUP) ATP-dependent, inflammation, metabolic acidosis, angiotensin II and some hormonal factors. The therapeutic approach to sarcopenia in CKD includes exercises, correction of metabolic acidosis, hormone replacement therapy and insulin resistance. Thus, it is of paramount importance early recognition of sarcopenia in this population, in order to establish effective therapeutic interventions, thus avoiding the full range of complications associated with muscle wasting in CKD.

Frailty and quality of life: a cross-sectional study of Brazilian patients with pre-dialysis chronic kidney disease

PurposeChronic kidney disease (CKD) induces frailty and worsens quality of life (QOL), even in the early stages of the disease and in young patients. However, there is a lack of knowledge about the relationship between frailty and QOL in CKD patients. Thus, we investigated this relationship in a sample of CKD patients.MethodsA cross-observational study was conducted, in which 61 CKD patients receiving pre-dialysis treatment were assessed. All participants completed the Short Form-36 Health Survey (SF-36). We used valid and reliable methods to classify subjects as frail or non-frail according to Johansen’s et al. (2007) criteria. A one-way analysis of variance (ANOVA) and chi-square tests were used to compare the groups. In addition, Spearman’s correlation analysis was conducted to measure associations between identified variables and frailty. We also performed simple linear regression using the SF-36 physical and mental composite scores.ResultsAlmost half of the sample (42.6%) exhibited evidence of frailty. The groups differed significantly in terms of age, gender, and all SF-36 domains, excluding Social Functioning and Role Emotional. Frailty was significantly associated with all SF-36 domains, again excluding Social Functioning and Role Emotional. Regression analysis revealed no significant between-group differences in composite physical and mental health scores generated by the SF-36 (p > 0.05).ConclusionFrail and non-frail CKD patients differed significantly in seven of the eight SF-36 domains. The frail group displayed diminished physical and mental functioning when their SF-36 scores were divided by their physical and mental composite scores. Frailty was correlated with QOL domains, with the exception of the social domain. There is a need for interventions targeting the characteristics of frailty, to provide better treatment and optimize overall QOL.AbstractIntroduçãoÉ conhecido que a doença renal crônica implica em pior qualidade de vida e em fragilidade, mesmo em fases iniciais da doença e em sujeitos mais jovens. Existe uma lacuna no conhecimento relacionando fragilidade e qualidade de vida em pacientes com doença renal crônica (DRC), em especial nos pacientes em pré-diálise. Objetivo: Investigar a qualidade de vida, a fragilidade e as possíveis relações entre elas, em uma população com DRC.MétodosEstudo observacional e transversal com 61 pacientes com DRC entre os estágios 3 a 5 em fase pré-dialítica. Os participantes responderam à escala do questionário SF-36, que se caracteriza por uma versão reduzida do questionário da Medical Outcomes Study, traduzida e validada para o português. Para avaliação da fragilidade, utilizamos a proposta de Johansen et al. (2007), sendo os sujeitos classificados em frágeis e não frágeis. A comparação entre os grupos foi realizada por ANOVA one-way com análise post hoc de Tukey e pelo teste de qui-quadrado, conforme o tipo de variável analisada. Além disso, foi realizada a correlação de Pearson ou Spearman para medir a associação entre variáveis identificadas e a fragilidade. Realizamos, também, uma regressão linear simples, ajustada para sexo e idade pelos escores físico e mental do SF-36.ResultadosA média de idade foi 60,5 ± 11,5 anos. Do total de pacientes, 42,6% apresentavam fragilidade. Os grupos foram diferentes entre si quanto à idade, ao sexo e todos os domínios do SF-36, exceto nos aspectos sociais e nos aspectos emocionais. Quando correlacionamos a fragilidade com as variáveis do estudo, encontramos forte associação com todos os domínios da qualidade de vida, exceto nos aspectos sociais e nos aspectos emocionais. Através da análise de regressão ajustada para idade e sexo, houve diferença entre o grupo frágil no escore físico e no escore mental.ConclusãoDos oito domínios do SF-36, sete foram diferentes entre os grupos de fragilidade e, quando separados pelo score físico e mental, o grupo frágil mostrou-se pior. Além disso, também houve correlação entre fragilidade e os domínios de qualidade de vida, com exceção aos aspectos sociais. Intervenções sobre os componentes da fragilidade são necessários para melhor conduzir o tratamento dos pacientes e melhorar sua qualidade de vida.

Association of hypovitaminosis D with Systemic Lupus Erythematosus and inflammation.

INTRODUCTION Nowadays it is described a high prevalence of hypovitaminosis D in Systemic Lupus Erythematosus (SLE), which is associated with some clinical manifestations and increased inflammatory activity. OBJECTIVE To evaluate the association between vitamin D insufficiency with SLE and inflammatory markers. METHODS Cross-sectional study, in which have been evaluated 45 SLE patients and 24 controls without the disease. Levels of 25-hydroxyvitamin D [25(OH) D] less than 30 ng/mL were considered inadequate. Disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). High sensitivity C reactive protein (hsCRP) and interleukin-6 (IL-6) were evaluated for verification of the inflammatory status. For assessment of renal involvement, analysis of abnormal elements and urinay sediment (AES), quantitative hematuria and pyuria, proteinuria and creatinine clearance in 24-hour urine and serum anti-double stranded DNA were performed. RESULTS The prevalence of 25(OH)D insufficiency was 55% in SLE patients and 8% in the controls participants (p = 0.001). The median of 25(OH)D was lower in patients than in controls. Patients with insufficient 25(OH)D had higher levels of IL-6 and higher prevalence of hematuria in the AES. There was no correlation between vitamin D and SLEDAI or lupus nephritis. CONCLUSION In our study, vitamin D deficiency was more prevalent in patients with SLE and was associated with higher levels of IL-6 and hematuria.

Sarcopenia in patients with chronic kidney disease not yet on dialysis: Analysis of the prevalence and associated factors

Introduction Sarcopenia is a chronic condition that is associated with aging and characterized by a reduction of muscle mass, strength, and function. Sarcopenia is prevalent in patients with chronic kidney disease (CKD) and associated with increased morbidity and mortality, as well as cardiovascular complications. Objectives To investigate the prevalence of sarcopenia in patients with CKD not yet on dialysis and its correlation with clinical and laboratory variables and inflammatory markers. Methods A total of 100 patients of both sexes aged over 18 were evaluated. Sarcopenia was defined using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. Sociodemographic and clinical data, activities of daily living, functional capacity, and physical activity were also evaluated. Inflammation was assessed by the serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin (IL) 4 and 6. Results The prevalence of sarcopenia was 11.9% and 28.7% using the EWGSOP and FNIH criteria, respectively. Sarcopenia was more prevalent in the more advanced stages of CKD (34.5% in stages 2 and 3A; and 65.5% in stages 3B, 4, and 5) and associated with worse performance in activities of daily living (p = 0.049), lower walking speeds (p < 0.001), and higher body mass indexes (BMIs) (p = 0.001) in the non-adjusted model. In addition, patients with sarcopenia had lower functional capacity (p = 0.012) and higher prevalence of physical inactivity (p = 0.041) compared with patients without sarcopenia. After adjustment for confounding variables, sarcopenia was still significantly correlated with walking speed (p = 0.004) and BMI (p = 0.002). HsCRP levels were inversely correlated with appendicular lean mass adjusted for BMI (p = 0.007) and were also positively associated with BMI (p = 0.001). IL4 levels were positively correlated with walking speed (p = 0.007) and lean mass in the lower limbs (p = 0.022). Conclusions Sarcopenia is common in patients with CKD, particularly in the most advanced stages of the disease. We observed an association between the levels of inflammatory markers and peripheral lean body mass, physical performance, and BMI. This association between sarcopenia and modifiable factors highlights the importance of early diagnosis and the implementation of therapeutic measures to minimize adverse outcomes in patients with CKD not yet on dialysis.

Nomogram for estimation of glomerular filtration rate based on the CKD-EPI Formula

Senhor Editor, Com a nova definicao proposta pelo The National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF KDOQITM) em 2002,1 o diagnostico da doenca renal cronica (DRC) tornou-se mais facil, permitindo a sua identificacao em todos os estagios, particularmente nos iniciais, quando, frequentemente, cursa na ausencia de sinais e sintomas. Esta nova definicao e composta de um componente de lesao do parenquima renal, por exemplo, a documentacao de perda urinaria anormal de proteina e/ou hematuria de origem glomerular e [...]

Impact of social vulnerability on the outcomes of predialysis chronic kidney disease patients in an interdisciplinary center

INTRODUCTION Numerous studies examined the associations between socio-demographic, economic and individual factors and chronic kidney disease (CKD) outcomes and observed that the associations were complex and multifactorial. Socioeconomic factors can be evaluated by a model of social vulnerability (SV). OBJECTIVE To analyze the impact of SV on the outcomes of predialysis patients. METHODS Demographic, clinical and laboratory data were collected from a cohort of patients with predialysis stage 3 to 5 who were treated by an interdisciplinary team (January 2002 and December 2009) in Minas Gerais, Brazil. Factor, cluster and discriminant analysis were performed in sequence to identify the most important variables and develop a model of SV that allowed for classification of the patients as vulnerable or non-vulnerable. Cox regression was performed to examine the impact of SV on the outcomes of mortality and need for renal replacement therapy (RRT). RESULTS Of the 209 patients examined, 29.4% were classified as vulnerable. No significance difference was found between the vulnerable and non-vulnerable groups regarding either mortality (log rank: 0.23) or need for RRT (log rank: 0.17). In the Cox regression model, the hazard ratios (HRs) for the unadjusted and adjusted impact of SV on mortality were found to be 1.87 (confidence interval [CI]: 0.64-5.41) and 1.47 (CI: 0.35-6.0), respectively, and the unadjusted and adjusted impact of need for RRT to be 1.85 (CI: 0.71-4.8) and 2.19 (CI: 0.50-9.6), respectively. CONCLUSION These findings indicate that SV did not influence the outcomes of patients with predialysis CKD treated in an interdisciplinary center.

Impacts of frailty on the negative health outcomes of elderly Brazilians

1 Fundação Instituto Mineiro de Estudos e Pesquisas em Nefrologia. Juiz de Fora, MG, Brasil. 2 Instituto Federal de Educação, Ciência e Tecnologia Sudeste de Minas Gerais, Faculdade de Educação Física. Rio Pomba, MG, Brasil. 3 Universidade Federal de Juiz de Fora, Faculdade de Medicina/Psicologia, Programa de Pós-Graduação em Psicologia, Programa de Pós-Graduação em Saúde. Juiz de Fora, MG, Brasil.