Exercise for depression and depressive symptoms in older adults: an umbrella review of systematic reviews and Meta-analyses.

OBJECTIVES: We aimed to gather and update the evidence on the impact of exercise on late-life depression. METHOD: We conducted an umbrella review of meta-analyses of randomized controlled trials (RCTs) that assessed the effects of an exercise intervention for depression in older adults (e.g. 60+). Searches were conducted in Scopus, Web of Science, Embase, PubMed, BIREME, LILACS, SciELO, Cochrane Library for Systematic Reviews, and Opengray.eu. Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). Data analysis was performed with RStudio (version 4.0.2) and the generic inverse-variance method was used to pool the effect sizes from the included studies. RESULTS: Twelve meta-analyses of 97 RCTs were included. The AMSTAR 2 rating was considered critically low in five studies, low in six studies, and high in one study. The effect size expressed by the standardized mean difference (SMD) varied between studies from -0.90 (95% CI = -1.51; -0.28) to -0.14 (95% CI = -0.36; 0.07) in favor of the exercise intervention. Pooling of the effect sizes produced a statistically significant moderate effect in which exercise was associated with lower levels of depression and depressive symptoms (OR = 2.24, 95% CI 1.77; 2.84). CONCLUSION: Our findings suggest that exercise produces a moderate improvement in depression and depressive symptoms in older patients. We recommend providing physical activity for older adults. KEY-POINTS: We investigated the effects of exercise interventions for depression in older adults.Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.1951660.

Association between glomerular filtration rate (measured by high-performance liquid chromatography with iohexol) and plasma oxalate.

INTRODUCTION: Secondary hyperoxalemia is a multifactorial disease that affects several organs and tissues in patients with native or transplanted kidneys. Plasma oxalate may increase during renal failure because it is cleared from the body by the kidneys. However, there is scarce evidence about the association between glomerular filtration rate and plasma oxalate, especially in the early stages of chronic kidney disease (CKD). METHODS: A case series focuses on the description of variations in clinical presentation. A pilot study was conducted using a cross-sectional analysis with 72 subjects. The glomerular filtration rate (GFR) and plasma oxalate levels were measured for all patients. Results: Median (IQR) GFR was 70.50 [39.0; 91.0] mL/min/1.73 m2. Plasma oxalate was < 5.0 µmol/L in all patients with a GFR > 30 mL/min/1.73m2. Among the 14 patients with severe CKD (GFR < 30 mL/min/1.73 m2) only 4 patients showed a slightly increased plasma oxalate level (between 6 and 12 µmol/L). CONCLUSION: In non-primary hyperoxaluria, plasma oxalate concentration increases when GFR < 30mL/min/1.73 m2 and, in our opinion, values greater than 5 µmol/L with a GFR > 30 mL/min/1.73 m2 are suggestive of primary hyperoxaluria. Further studies are necessary to confirm plasma oxalate increase in patients with low GFR levels (< 30mL/min/1.73 m2).

Association between glomerular filtration rate (measured by high-performance liquid chromatography with iohexol) and plasma oxalate / Associação entre taxa de filtração glomerular (medida por cromatografia liquida de alto desempenho com iohexol) e oxalato plasmático

ABSTRACT Introduction: Secondary hyperoxalemia is a multifactorial disease that affects several organs and tissues in patients with native or transplanted kidneys. Plasma oxalate may increase during renal failure because it is cleared from the body by the kidneys. However, there is scarce evidence about the association between glomerular filtration rate and plasma oxalate, especially in the early stages of chronic kidney disease (CKD). Methods: A case series focuses on the description of variations in clinical presentation. A pilot study was conducted using a cross-sectional analysis with 72 subjects. The glomerular filtration rate (GFR) and plasma oxalate levels were measured for all patients. Results: Median (IQR) GFR was 70.50 [39.0; 91.0] mL/min/1.73 m2. Plasma oxalate was < 5.0 µmol/L in all patients with a GFR > 30 mL/min/1.73m2. Among the 14 patients with severe CKD (GFR < 30 mL/min/1.73 m2) only 4 patients showed a slightly increased plasma oxalate level (between 6 and 12 µmol/L). Conclusion: In non-primary hyperoxaluria, plasma oxalate concentration increases when GFR < 30mL/min/1.73 m2 and, in our opinion, values greater than 5 µmol/L with a GFR > 30 mL/min/1.73 m2 are suggestive of primary hyperoxaluria. Further studies are necessary to confirm plasma oxalate increase in patients with low GFR levels (< 30mL/min/1.73 m2).

RESUMO Introdução: A hiperoxalemia secundária é uma doença multifatorial que afeta vários órgãos e tecidos em pacientes com rins nativos ou transplantados. O oxalato plasmático pode aumentar durante a insuficiência renal porque é eliminado do corpo pelos rins. No entanto, há evidências escassas sobre a associação entre taxa de filtração glomerular e oxalato plasmático, especialmente nos estágios iniciais da doença renal crônica (DRC). Métodos: uma casuística centrada na descrição das variações na apresentação clínica. Foi realizado um estudo piloto a partir da análise transversal com 72 indivíduos. As taxas de filtração glomerular (TFG) e os níveis plasmáticos de oxalato foram medidos para todos os pacientes. Resultados: A TFG mediana (IIQ) foi de 70,50 [39,0; 91,0] mL/min/1,73 m2. O nível plasmático de oxalato foi < 5,0 µmol/L em todos os pacientes com TFG > 30 mL/min/1,73 m2. Entre os 14 pacientes com DRC grave (TFG < 30 mL/min/1,73 m2), apenas quatro apresentaram ligeiro aumento do nível plasmático de oxalato (entre 6 e 12 µmol/L). Conclusão: Na hiperoxalúria não primária, a concentração plasmática de oxalato aumenta quando TFG < 30 mL/min/1,73 m2 e, em nossa opinião, valores superiores a 5 µmol/L com TFG > 30 mL/min/1,73 m2 sugerem presença de hiperoxalúria primária. Estudos adicionais são necessários para confirmar o aumento do oxalato plasmático em pacientes com níveis baixos de TFG (< 30 mL/min/1,73 m2).