The current study has several limitations. First, the major drawback of the current study was the lack of cognitive measurements, which limited us to study the neuroanatomical signifi- cance of the observed microstructuralalterationsin ESRD. Second, the sample size was rela- tively small and the MRI scanning parameters were suboptimal (e.g., 1.5 T MRI and only one b0 image), which may limit the power in detecting more subtle effects. Future studies with a large cohort of participants and more advanced techniques and optimized parameters are needed. Third, in the current study, we used a voxel-based analysis method to find that ESRD was associated with widespread disruptions of microstructural integrity in both WM and GM regions. However, the voxel-based method may be limited by spatial misalignments and the amount of smoothing [45,46] and thus the current findings should be interpreted with caution. Future studies are required to examine the reproducibility of the current findings over different choices of registration methods and sizes of spatial smoothing. Fourth, some of the current patients suffered from hypertension and/or hyperlipidemia, which may confound our results. To provide preliminary insights into these issues, we compared the DTI metrics (FA, MD, AD and RD) between the patients with and without hypertension/hyperlipidemia. No significant differences were found in any DTI metric (P > 0.05, corrected). These exploratory analyses suggest limited effects of hypertension and hyperlipidemia on the current findings. Neverthe- less, it should be noted that there are still other factors that may contribute to the current
evaluation and ongoing assessment of ESRD are complicated, so it has been suggested that MRI be used before the onset of therapy, so that these initial findings can serve as a basis for later comparisons [3,4,11]. For example, conventional MRI studies have shown focal white matter lesions to be more common in patients undergoing hemodialysis (56%) than in the normal population (27%) . In the past decade, functional imaging studies about ESRD have consistently demonstrated regional microscopic structure and metabolic abnormalitiesin the white matter. Hsieh et al, who used diffusion tensor imaging to measure fractional anisotropy (FA) values in patients with ESRD, reported that patients with ESRD have significant lower FA values than healthy control subjects . Chiu et al reported that significant elevations of the choline/phosphatidylcholine (Cho)/total choles- terol (tCr) and myo-inositol (mI)/tCr ratios in the frontal grey matter, frontal white matter, and temporal white matter as well as in the basal ganglia were found in ESRD group compared with controls . However, these brain imaging methods have limitation in that they are not capable of estimation and visualization of neural activity.
associated with long-range connections and reflects integrative information processing be- tween and across remote regions of the brain that constitutes the basis of cognitive processing . The observed decreases thus suggest impaired functional segregation and integration in the disease, which presumably are due to disrupted interregional coordination both among local neighbors and across distant regions. This was supported by the finding of decreased nodal efficiency in numerous regions caused by ESRD. When normalized by random networks, local efficiency was increased while global efficiency was decreased in the ESRD patients com- pared to HCs. This combination jointly suggests a shift towards regular configurations in ESRD’s brain that favor higher modular processing but lower global coordination compared to the small-world organization. Since the small-world model reflects an optimal balance between local specialization and global integration, these results indicate a disruption in the normal bal- ance of functional brain networks of ESRD. It should be noted that these abnormalities were sensitive to the global signal removal, indicating that the findings should be interpreted with caution.
Abo antigens are expressed on the surface of many cells other than erythrocytes, such as epithelial cells including urothelium, gastrointestinal system, mucosa and the lung. Alterations on the cell surface structures as blood group antigens can lead to changes in the interactions in between cells or cells and extracellular matrix. These changes have been thought to be important for tumor development (16). Possible associations between the Abo blood group and risk of some epithelial malignancies such as gastric and pancreatic cancer have been reported previously. Aird et al. reported such a relationship with gastric cancer. They found that blood group A was signiicantly table II: Comparison of Abo blood groups between patients with diabetic nephropathy and the control group.
Alterations of the vascular mechanical properties and endothelial dysfunction are frequent in chronic renal failure, leading to an increase in cardiovascular morbidity and mortality, as it was shown (Blacher et al 1999). An increase in arterial stiffness reduces the compliance of the large arteries, with a subsequent increase in the ventricular afterload, followed by left ventricular hypertrophy and reduced coronary perfusion (London 2002). Recently, arterial stiffness has been described by many authors (Laurent 2002; Pannier 2005; Agarwal 2007) as an independent predictive factor for cardiovascular mortality and survival in patients on hemodialysis.
Bilirubin is a water-insoluble compound that requires glucuronidation by a microsomal enzyme, the uridine diphosphate glucuronosyltransferase-1 A1 (UGT1A1), to be excreted. The UGT1A1 locus has been mapped to chromo- some 2q37  and one of the most common genetic variants that affects the glucuronidation of bilirubin in Caucasians is a TA duplication polymorphism in the TATA box region of the promoter. Homozygous individuals carrying the A(TA)7TAA allele (c.-41 -40dupTA or [TA]7) have higher levels of uncon- jugated bilirubin, caused by a reduction of 30% in the UGT1A1 transcription . There are few studies on the effect of bilirubin levels and/or of UGT1A1 gene polymorphism in the outcome of CVD in the general population, namely, in the development of coronary artery disease, coronary heart disease, peripheral vascular disease, and stroke. Recent epidemiological evidences showed a reduced incidence of lung disease and all-cause mortality in individuals with high serum bilirubin levels and with Gilbert’s syndrome [18– 20]. Moreover, a study evaluating the impact of bilirubin levels and of UGT1A1 polymorphisms on CVD risk and mortality in ESRD under HD  showed that HD patients with lower serum bilirubin levels presented a more adverse outcome and, therefore, that the 7/7 genotype might have an important effect on preventing CVD events and death. Nevertheless, the mechanisms underlying this protective effect of bilirubin, in the general population and in ESRD patients, still remain obscure. Multiple mechanisms could explain the protective effect of bilirubin, including antioxi- dant and anti-inflammatory pathways, which may be relatedto the powerful redox cycle mediated by biliverdin reductase that may protect against pathological oxidation processes occurring during cardiovascular disease .
anniversary of World Kidney Day (WKD), an initiative of the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort ever mounted to raise awareness among decision-makers and the general public about the importance of kidney disease. Each year WKD reminds us that kidney disease is common, harmful and treatable. The focus of WKD 2015 is on CKD in Disadvantaged Populations. This article reviews the key links between poverty and CKD and the consequent implications for the prevention of kidney disease and the care of kidney patients in these populations.
A 33-year-old caucasian male from Rio Grande (Rio Grande do Sul state - Brazil) contacted the emergency medical service complaining about pain in his right flank. He did not complain about nausea, vomi- ting, fever or asthenia. During physical examination, the patient was in a good general state, had stable vital signs, non- -altered heart and lung auscultation and
Impaired endothelial influence on pinacidil-induced responses may further support our data about reduced basal release of endothelium-derived factors in ESRD. Indeed, NOS/COX inhibitors induced smaller constriction in uremic vs. control arteries. As basal vascular tone is to a large extend NO-dependent , our data implies a reduction in basal production of NO in ESRD. In contrast, a previous study reported increased basal NO production in the forearm of hemodialysis patients . The inconsistent results may be caused by different methodology, and selection of patients. Recently, we demonstrated the lack of NO contribution to shear stress responses in subcutaneous uremic arteries . In the current study, differences in sensitivity between BK and ACh, depending from NOS/COX inhibition in controls but not in ESRD, indicated on distinct NO contribution to agonist-induced relaxation between the two groups. Moreover, the negative correlation between serum ADMA levels and relaxation to ACh and BK in ESRD but not in controls further supports the impaired contribution of NO to agonists- induced responses in uremia.
CKD is associated with two risk factors with a bidirectional relation leading to increased morbidity and mortality in patients with end- stagerenaldisease (ESRD). Those are: cardiovascular disease (CVD) and the inflammation pathogenic mechanisms. Apart from the improved modern renal dialysis techniques, morbidity and mortality indexes for ESRD patients remain quite high. Cardiovascular disease (CVD) is one of the main reasons of this effect with its presence being further enhanced by coexisting situations. The inflammation is another factor that is responsible not only for CKD evolution but also for the appearance of CVD. The inflammation mechanism enhances CVD pathogenicity together with other clinical findings of the uremic syndrome.
Blood pressure was measured through the auscultatory method in the right arm in 3 positions (lying down, sitting, and standing up), with 2-minute intervals between the measurements. A mer- cury-column sphygmomanometer and 12cm-width and 23cm-leng- th adult cuffs were used. The cuff was inflated up to 30 mmHg above the systolic blood pressure level previously measured using the auscultatory method and was slowly deflated at a velocity of 2 to 3 mmHg per second. Systolic blood pressure was determined by the auscultation of the first continuous sound (phase I of the Korotkoff sounds), and diastolic blood pressure was determined by the disappearance of the sound (phase V). Systolic and diastolic blood pressures used in the analysis were determined by using the means of the 3 initial measurements. Patients with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, or both, or patients receiving antihypertensive medication were con- sidered hypertensive. In regard to severity, arterial hypertension was classified as mild, moderate, and severe, according to the classification used at the time of data collection 11 . The patients
Secondary hyperparathyroidism (sHPT) is one of the main endocrine disorders in chronic kidney disease (CKD), being as- sociated with bone and cardiovascular abnormalities, as well as higher mortal- ity. Despite of the advances on its phar- macologic therapy, sHPT still evolves in a considerable number of patients to auton- omy, when parathyroidectomy becomes the only possible treatment. 1 In Brazil,
ABSTRACT: This work aimed to evaluate how aging could influence patients’ perception of health quality of life (HRQOL), as well as, the effect of aging on dialysis adequacy and in hematological, iron status, inflammatory and nutritional markers. In this transversal study were enrolled 305 ESRD patients under online-hemodiafiltration (OL-HDF) (59.67% males; 64.9 ± 14.3 years old). Data about comorbidities, hematological data, iron status, dialysis adequacy, nutritional and inflammatory markers were collected from patient’s records. Moreover, HRQOL score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), was assessed. Analyzing the results according to quartiles of age, significant differences were found for some parameters evaluated by the KDQOL-SF instrument, namely for work status, physical functioning and role-physical, which decreased with increasing age. We also found a higher proportion of diabetic patients, a decrease in creatinine, iron, albumin serum levels, transferrin saturation and nPCR, with increasing age. Moreover, significant negative correlations were found between age and mean cell hemoglobin concentration, iron, transferrin saturation, albumin, nPCR, work status, physical functioning and role-physical. In conclusion, our results showed that aging is associated with a decreased work status, physical functioning and role-physical, with a decreased dialysis adequacy, iron availability and nutritional status, and with an increased proportion of diabetic patients and of patients using central venous catheter, as the vascular access. The knowledge of these changes associated with aging, which have impact in the quality of life of the patients, could be useful in their management.
A hemodiálise (HD) intermitente crónica é o processo de purificação do sangue através da terapia de substituição renal em pessoas com doença renal terminal que geralmente é rea- lizado várias vezes por semana durante 3 a 4 horas, em unidades especialmente equipadas ou de internamento (5) . Esta terapia implica que a pessoa esteja sentada na mesma posição
imunoabsorção enzimática (ELISA) e a IL-6, por citometria de fluxo. Os resultados foram apresentados como mediana, mínimo e máximo; p < 0,05 foi considerado significativo. Resultados: Níveis de TM foram significativamente maiores no grupo G1 em comparação com os demais (G1: 8,38; G2: 5,51; G3: 5,88; G4: 6,33 ng/ml, p < 0,0001), e no grupo R1 comparado com o R2 (R1: 6,65; R2: 6,19 ng/ml, p = 0,02). A concentração de IL-6, avaliada pela intensidade média de fluorescência, foi maior no grupo C2 quando comparada com o C1 (C1: 7,9; C2: 13,35, p = 0,03). Não houve diferença entre os grupos para o FvW. TM correlacionou-se positivamente com IL-6 e creatinina e negativamente com eRFG. A IL-6 foi positivamente correlacionada com o FvW. Conclusão: TM e IL-6 podem ser apontadas como potenciais marcadores para avaliar a função do enxerto renal. A TM relacionou-se mais com a causa primária da DRC, se comparada com FvW e IL-6.
or cutoff points may produce significant variation in the prevalence of DS. 13,18 Specific cutoff points have been recommended when using the BDI questionnaire to evaluate DS in patients with CKD - generally higher than those applied to the general population. 19 Scores in our study cohort ranged from 0 to 51 (out of a possible 63). 11 Some individuals did not exhibit DS, whereas others reported more intense symptoms. Although the difference was not statistically significant, participants in the DS group had been on HD for a longer period than those in the no DS group. Previous studies suggest that incident HD patients - during the first treatment year - are exposed to a higher DS burden. 20,21 However, this finding is contra- dictory, as DS have been suggested to vary with CKD progression, being particularly dependent on clinical out- comes, complications, and adverse effects of HD. 22
All the patients will undergo a standard overnight PSG (Embla, A10 version 3.1.2 Flaga, Hs. Medical Devices, Reykjavik, Iceland) at the Sleep Laboratory of Nove de Julho University. Polysomnography exams will be held the night before the haemodialysis and approximately 12 hours after this dialysis. All recording sensors will be attached to the patient in a non-invasive manner using tape or elastic bands. The following physiological vari- ables will be monitored simultaneously and continu- ously: 4 channels for the electroencephalogram (C3-A2, C4-A1, O1-A2, and O2-A1), 2 channels for the electro- oculogram (EOG-Left-A2 and EOG-Right-A1), 4 chan- nels for the surface electromyogram (muscles of the submentonian region, anterior tibialis muscle, masseter region, and seventh intercostal space), electrocardio- gram (derivation V1 modified), airflow detection via 2 channels through a thermocouple and nasal pressure
Introduction: Decreased heart rate varia- bility (HRV) in patients with endstagerenaldisease (ESRD) undergoing hemo- dialysis is predictive of cardiac death, es- pecially due to sudden death. Objective: To evaluate the effects of aerobic training during hemodialysis on HRV and left ventricular function in ESRD patients. Methods: Twenty two patients were ran- domized into two groups: exercise (n = 11; 49.6 ± 10.6 years; 4 men) and con- trol (n = 11; 43.5 ± 12.8; 4 men). Patients assigned to the exercise group were sub- mitted to aerobic training, performed du- ring the first two hours of hemodialysis, three times weekly, for 12 weeks. HRV and left ventricular function were asses- sed by 24 hours Holter monitoring and echocardiography, respectively. Results: After 12 weeks of protocol, no significant differences were observed in time and fre- quency domains measures of HRV in bo- th groups. The ejection fraction improved non-significantly in exercise group (67.5 ± 12.6% vs. 70.4 ± 12%) and decreased non-significantly in control group (73.6 ± 8.4% vs. 71.4 ± 7.6%). Conclusion: A 12-week aerobic training program perfor- med during hemodialysis did not modify HRV and did not significantly improve the left ventricular function.
There are potential limitations to our study that should be noted. First, we were not able to assess whether differ- ences in diet, social background or education between whites and blacks are responsible for our findings. Additi- onally, differences in health care access provided to black subjects in Europe and the United States have been pro- posed as important determinants of the differences in the rates of PVD found between white and black subjects (13). However, we would not expect major socioeconomic or differences in assistance provided to white and black patients since all subjects were attending the same health system. In fact, we have shown that there is no difference in the proportion of white and black subjects on treatment with antidiabetic medications, statins, acetylsalicylic acid and angiotensin-converting enzyme inhibitors. Even if these factors were involved in the disparities found in the rates of micro- and macrovascular complications between whites and blacks, this information would help clinicians in deciding to decrease or increase their surveillance of these complica- tions while assisting their patients. Second, the cross-sec- tional study design makes it difficult to infer causality be- tween ethnicity and diabetic complications. Thus, while show- ing disparities in the rates of macro- and microvascular complications according to ethnicity, our results do not ad- dress which elements of ethnicity confer a greater risk of these complications to black patients.
The following exclusion criteria were considered for patients not to enter the study: no painful symptoms and muscular involvement, Class III Angle occlusion, indication for or ongoing orthodontic treatment, history of facial and TMJ trauma, history of TMJ dislodgment, need for treatment or extensive dental rehabilitation, systemic medical conditions, such as rheumatic, hormonal, infectious, nutritional and metabolic disorders, history of systemic diseases that might jeopardize the synovial organic joints, including the TMJs, biomechanical common predisposing factors, including skeletal malformations and postural alterations.