High-sensitivity C-reactive protein, apolipoproteins, and residual diuresis in chronic kidney disease patients undergoing hemodialysis.

BACKGROUND: Residual diuresis (RD) is the simplest method for measuring renal residual function in patients with chronic kidney disease (CKD). A reduction in RD is associated with intensification of the inflammatory process caused by uremia. However, little is known regarding the relation between RD and inflammatory markers in these patients. We verify possible associations among the hs-CRP, atherogenic factors, and RD, in patients with CKD undergoing hemodialysis. METHODS: This study enrolled 80 patients with CKD undergoing hemodialysis. Patients were stratified according to RD in anuric (RD-) group (n = 47) and non-anuric (RD+) group (n = 33). Urine volumes were collected in a 24 h period during the interdialytic period. Serum high-sensitivity C-reactive protein (hs-CRP), and apolipoprotein (Apo) A1 and B levels were measured after fasting for 12 h. RESULTS: Serum hs-CRP levels were higher in the RD- group than in the RD+ group (P = 0.015). In the total group, hs-CRP was significantly correlated with RD (r = - 0.25, P = 0.025) and Apo AI (r = - 0.25, P = 0.024). A greater proportion of patients had reduced plasma concentrations of Apo AI in the RD- group (31.9 %) compared with the RD+ group (9.1 %) (P = 0.014). CONCLUSION: This study shows a relationship between RD and the hs-CRP in patients undergoing hemodialysis. Although the inflammatory state was verified in a large part of the CKD population, patients without RD had more elevated hs-CRP serum levels than those with RD.

Icodextrin reduces insulin resistance in non-diabetic patients undergoing automated peritoneal dialysis: results of a randomized controlled trial (STARCH).

BACKGROUND: Insulin resistance is a common risk factor in chronic kidney disease patients contributing to the high cardiovascular burden, even in the absence of diabetes. Glucose-based peritoneal dialysis (PD) solutions are thought to intensify insulin resistance due to the continuous glucose absorption from the peritoneal cavity. The aim of our study was to analyse the effect of the substitution of glucose for icodextrin on insulin resistance in non-diabetic PD patients in a multicentric randomized clinical trial. METHODS: This was a multicenter, open-label study with balanced randomization (1:1) and two parallel-groups. Inclusion criteria were non-diabetic adult patients on automated peritoneal dialysis (APD) for at least 3 months on therapy prior to randomization. Patients assigned to the intervention group were treated with 2L of icodextrin 7.5%, and the control group with glucose 2.5% during the long dwell and, at night in the cycler, with a prescription of standard glucose-based PD solution only in both groups. The primary end-point was the change in insulin resistance measured by homeostatic model assessment (HOMA) index at 90 days. RESULTS: Sixty patients were included in the intervention (n = 33) or the control (n = 27) groups. There was no difference between groups at baseline. After adjustment for pre-intervention HOMA index levels, the group treated with icodextrin had the lower post-intervention levels at 90 days in both intention to treat [1.49 (95% CI: 1.23-1.74) versus 1.89 (95% CI: 1.62-2.17)], (F = 4.643, P = 0.03, partial η(2) = 0.078); and the treated analysis [1.47 (95% CI: 1.01-1.84) versus 2.18 (95% CI: 1.81-2.55)], (F = 7.488, P = 0.01, partial η(2) = 0.195). CONCLUSIONS: The substitution of glucose for icodextrin for the long dwell improved insulin resistance measured by HOMA index in non-diabetic APD patients.

Mast cell population in the development of diabetic nephropathy: Effects of renin angiotensin system inhibition.

Considering the importance of the renin-angiotensin system (RAS) in diabetic nephropathy (DN) and the link between mast cells (MC) and the RAS, this study evaluated the effects of RAS blockade on the MC cell population in the kidneys from rats with experimental diabetes. Wistar rats were divided into six groups: control non-diabetic (C); sham (S); diabetic (D); and D treated with enalapril (EN), losartan (LO), or aliskiren (AL). Ninety days after diabetes induction, glomerular filtration rate (GFR) and urinary albumin excretion (UAE) were determined. Kidneys were collected for MC counting. RAS blockers minimized changes in morphometrical parameters (EN), cortical collagen (LO, AL), GFR (AL) and UAE (EN, LO). An increased number of MC was observed in the kidneys from D animals. Only AL treatment prevented this increase. MC may be involved in some aspects of DN pathogenesis and the possible protective effects of AL on the kidneys might involve MC modulation.

Comparison between Central and Brachial Blood Pressure in Hypertensive Elderly Women and Men.

AIM: To compare the values of central and brachial systemic blood pressure (SBP) between women and men over 60 years of age with systemic arterial hypertension. METHODS: This study was a quantitative, descriptive, cross-sectional study with elderly patients admitted to and selected from spontaneous and scheduled demand at basic health units in Uberlândia, Minas Gerais, Brazil, between March 2013 and March 2014. We included 69 study participants and compared central and brachial SBP using a Sphygmocor® XCEL device (AtCor Medical, Sydney, Australia). RESULTS: Significant differences were found in the blood pressure values of the whole population in the central versus brachial systolic blood pressure (SP) [140(21) versus 153(23) mmHg] and in the central versus brachial pulse pressure (PP) [55(18) versus 70(18) mmHg]. Additionally, females exhibited higher blood pressure levels than males [central SP 144(23) versus 134(16) mmHg and brachial SP 161(26) versus 148(18) mmHg and central PP 62(17) versus 45(14) mmHg and brachial PP 80(21) versus 63(15) mmHg, resp.]. CONCLUSION: Elderly women exhibited higher blood pressure values than elderly hypertensive men.

Captopril no tratamento de pacientes com insuficiência cardíaca congestiva: avaliaçäo cicloergométrica / Captopril in the Treatment of Patients With Congestive Heart Failure. Evaluation in Bicycle Ergometric Test

Objetivo - Analisar a capacidade física de pacientes com insuficiência cardíaca congestiva (ICC), classes I e II da New York Heart Association (NYHA), submetidos à cicloergometria: 1) sob tratamento convencional com digital e diuréticos; 2) com um inibidor da enzima de conversão da angiotensina captopril, associado ao tratamento convencional; 3) usando captopril associado a digital e diurético. Métodos - Estudo randomizado e duplo cego utilizando 20 pacientes com ICC (I e II), submetidos ao teste cicloergométrico em diferentes fases terapêuticas. A carga inicial foi de 5 watts e aumentada progressivamente até o aparecimento de sintomas limitantes. Resultados - A introdução do captopril no esquema convencional de tratamento da ICC ou associado a digital e diurético promove significante aumento na duração do exercício físico, no consumo de oxigênio e na carga total desenvolvida, nos pacientes submetidos ao teste cicloergométrico. Conclusão - Nas formas iniciais de ICC, captopril melhorou a capacidade física dos pacientes em relação ao tratamento convencional e a terapêutica diurética pode ser substituída pelo inibidor da enzima de conversão da angiotensina com igual eficácia

Purpose - To analyze the physical performance of the patients with congestive heart failure (CHF), grades I and II of the New York Heart Association (NYHA), submitted to ergometric test: 1) under conventional treatment with digitalis and diuretic; 2) with an angiotensin converting enzyme inhibitor, captopril, associate with conventional treatment; 3) using captopril associated with digitalis or diuretic. Methods - A randomized double blind study was performed in 20 patients with CHF (I and II - NYHA) submitted to ergometric test in differents therapeutic phases. The initial workload was 5 watts and load was increased until the appearance of limiting symptoms. Results - The introduction of captopril to the conventional treatment for CFH or associated with digitalis or diuretic promotes significant increase in the duration of the physical exercise, in the oxygen consumption and in the total workload during the ergometric test. Conclusion - In the initial forms of CHF, captopril provides better physical performance when compared with conventional treatment and the diuretic treatment can be changed for the angiotensin converting enzyme inhibitor with equal efficacy