Associação da Força de Preensão Palmar com indicadores clínicos e nutricionais em pacientes com Doença Renal Crônica em tratamento não dialítico / Association of the Handgrip strength with clinical and nutritional indicatorsin patients with chronic renal disease on non-dialysis treatment

INTRODUÇÃO: A Força de Preensão Palmar (FPP) é um método simples, confiável e tem sido sugerida para o diagnóstico de perda funcional do músculo. Contudo, são escassos os estudos que associe a FPP com medidas nutricionais em pacientes com Doença Renal Crônica (DRC) em tratamento não-dialítico. OBJETIVO: avaliar a associação da FPP e aspectos clínicos e nutricionais de pacientes com DRC em tratamento não-dialítico. MÉTODOS: Trata-se de um estudo transversal realizado no Ambulatório de Nutrição e Nefrologia de um Hospital Universitário de referência na Bahia. Foram avaliados 87 pacientes nos estágios 2-4 de DRC não-dialítico. FPP foi avaliada no braço não dominante. Os valores obtidos foram comparados com um padrão de referência nacional. Foram registrados dados antropométricos, clínicos, laboratoriais e parâmetros de composição corporal. RESULTADOS: Indivíduos com baixa FPP tinham menor tempo de DRC, ângulo de fase, massa corporal magra, massa celular corporal, hemoglobina, e maiores valores de PCR e maior idade (p ≤ 0,05). No sexo feminino, pacientes com baixa força apresentaram maior idade e tinham menores níveis de hemoglobina, ureia e diagnóstico de Diabetes (p ≤ 0,05). Quanto ao sexo masculino apresentaram maior idade, menor IMC, CMB, MCM, MCC, taxa de filtração glomerular e ângulo de fase (p ≤ 0,05). CONCLUSÃO: A FPP apresentou forte correlação com a Massa Corporal Magra (MCM) e Massa Celular Corporal (MCC) sugerindo que esta ferramenta pode ser utilizada para predizer perda de massa magra em pacientes com DRC não dialítica

INTRODUCTION: Handgrip strength (HGS) is a simple and reliable method with has been suggested for the diagnosis of functional loss of muscle. However, there are few studies that associate HGS with nutritional measures in patients with chronic renal disease (CKD) in nondialysis-dependent. OBJECTIVE: To investigate the association of HGS and clinical and nutritional aspects of patients with nondialysis-dependent CKD. METHODS: This is a cross-sectional study patients performed at the Clinic of Nutrition and Nephrology of a University Hospital of reference in Bahia. We evaluated 99 patients in stages 2-4 of nondialysis-dependent CKD. FPP was evaluated in the non-dominant arm. The values obtained were compared with a national reference standard. Anthropometric, clinical, laboratory and body composition parameters were recorded. RESULTS: Subjects with low FPP had shorter time for CKD, phase angle, lean body mass (MCM), body cell mass (MCC), hemoglobin, and higher CRP values and older age (p < 0.05). Regardless of sex, individuals with low FPP were older (p < 0.01). No sexo feminino, pacientes com baixa força tinham menores níveis de hemoglobina, ureia e maior prevalência de diabetes mellitus (p < 0,05). As for males, the lower FPP was associated with lower body mass index (BMI), arm muscle circumference (CMB), MCM, MCC, glomerular filtration rate and phase angle (p < 0.05). The FPP correlated positively with MCC and MCM (p < 0.001). CONCLUSION: The findings suggest that FPP can be used to predict loss of lean mass in patients with nondialysis-dependent CKD

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Effect of Aerobic Exercise on Markers of Bone Metabolism of Overweight and Obese Patients With Chronic Kidney Disease.

OBJECTIVE: The aim of the study was to investigate the effect of aerobic exercise on markers of bone metabolism in overweight and obese nondialysis-dependent patients with chronic kidney disease. METHODS: This is a post-hoc study with 39 sedentary patients (55.5 ± 8.3 years, body mass index 31.2 ± 4.4 kg/m2, estimated glomerular filtration rate 26.9 ± 11.7 mL/minute) who were randomly assigned to the aerobic exercise group (n = 24) or the control group (n = 15). The aerobic training (walking) was prescribed according to ventilatory threshold and was performed 3 times per week during 24 weeks. Carboxylated and undercarboxylated osteocalcin (GLA and GLU), sclerostin and tartrate-resistant acid phosphatase isoform 5b (TRAP-5b), parathyroid hormone, total alkaline phosphatase (AP), body composition, cardiorespiratory, and functional capacity tests were measured at baseline and after the follow-up. RESULTS: At baseline, carboxylated osteocalcin (GLA) and undercarboxylated osteocalcin (GLU) were inversely correlated with estimated glomerular filtration rate (r = -0.64; r = -0.38, respectively). Both osteocalcin fragments were positively correlated with total AP (GLA: r = 0.36; GLU: r = 0.53). An inverse correlation was found between GLA and sclerostin with body fat (r = -0.36; r = -0.46, respectively). GLU was negatively correlated with markers of muscle mass (r = -0.34). TRAP-5b and sclerostin were inversely correlated with 6-minute walk test and time up and go test, respectively (r = -0.34; r = -0.35, respectively). After 24 weeks, all physical capacity parameters increased in the exercise group (P < .001). Except for total AP that increased after 24 weeks in the exercise group (P < .05), no other changes were observed in both groups in relation to the bone metabolism biomarkers investigated. CONCLUSION(S): In this post-hoc study, the aerobic training used did not promote relevant changes in the bone metabolism markers investigated.

Razão TG/HDL-c, indicadores antropométricos e bioquímicos de risco cardiovascular no renal crônico em tratamento conservador / TG/HDL-c reason, anthropometrics and biochemical indicators of cardiovascular risk in chronic renal in conservative treatment

Introdução: As doenças cardiovasculares (DCV) representam no Brasil a principal causa de morbimortalidade e sua prevalência cresce em todo o mundo. O paciente com doença renal crônica apresenta alto risco de desenvolvimento da doença e este risco eleva-se na presença de dislipidemia. Triglicérides (TG) elevado e lipoproteína de alta densidade (HDL-c) reduzida são preditores independentes de eventos cardiometabólicos. O excesso de tecido adiposo também está envolvida com risco de DCV. Portanto a utilização de preditores do desenvolvimento de DCV, como a razão triglicerídeos/HDL colesterol (TG/HDL-c) e indicadores antropométricos de avaliação de gordura corporal são importantes na prática clínica. Objetivo: Avaliar a associação entre a razão TG/HDL e indicadores antropométricos de risco cardiovascular em pacientes renais crônicos em tratamento conservador. Métodos: Estudo transversal, envolvendo 90 pacientes clinicamente estáveis atendidos ambulatorialmente. A razão TG/HDL-c foi definida de acordo com equação preestabelecida, sendo considerado risco para DCV valores >2,5 para mulheres e >3,5 para homens. Os parâmetros antropométricos utilizados foram o índice de massa corporal (IMC) e a circunferência da cintura (CC). Dados sociais, de estilo de vida, clínicos e bioquímicos também foram coletados. Na comparação entre os dois grupos (razão TG/HDL-c elevado e razão TG/HDL adequado) foi utilizado o teste t de Student para os dados paramétricos e de Mann-Whitney para os dados não paramétricos. As proporções foram comparadas pelo teste do quiquadrado. Os ajustes entre Razão TG/HDL, IMC e CC foram realizadas através da análise de regressão logística. Resultados: Da amostra avaliada, 50 pacientes (55,6%) apresentaram razão TG/HDL elevada. Pacientes com IMC e CC alterada apresentavam maior risco de DCV, avaliado através da razão TG/HDL-c. Houve diferença estatisticamente significante entre os indicadores antropométricos utilizados, IMC e CC, e razão TG/HDL-c quando estratificado em elevado e adequado. Entretanto, na análise ajustada, não foi observada associação entre o IMC ou a CC e a razão TG/HDL. Conclusão: Os resultados demonstram que após ajustes com possíveis variáveis de confusão não houve associação entre os valores da razão TG / HDL-C e indicadores antropométricos de adiposidade, IMC e CC. Os resultados deste estudo levam a questionar a real influência do excesso de peso e da obesidade central na razão TG/HDL-c (AU)

Introduction: Cardiovascular diseases (CVD) are a major cause of morbidity and mortality, and its prevalence is growing worldwide. Patients with chronic kidney disease (CKD) are at high risk of group, especially those with dyslipidemia. Triglycerides (TG) and high-density lipoprotein (HDL-c) are independent predictors of cardiovascular events. Excessive adipose tissue also increases the cardiovascular risk. Therefore, CVD predictors, such as the Triglycerides / HDL cholesterol (TG / HDL-c) ratio and the anthropometric measurements for assessing body fat are important in clinical practice. Objective: To evaluate the association between TG / HDL ratio, anthropometric measurements and the cardiovascular risk in CKD patients on dialysis. Methods: A cross-sectional study involving 90 clinically stable outpatients. The TG / HDL-c ratio was defined according to a predetermined equation, considering high CVD risk values greater than 2.5 for women and greater than 3.5 for men. The anthropometric parameters used were the body mass index (BMI) and the waist circumference (WC). Social data, lifestyle, clinical and biochemical data were also collected. Results: Fifty patients (55.6%) had a high TG / HDL ratio. Patients with abnormal BMI and WC were at a higher cardiovascular risk, as measured by the TG / HDL-c ratio. There was a statistically significant difference between the anthropometric measurements (BMI and the WC), and the TG / HDL-c ratio in the stratified analysis. However, in the adjusted analysis no association between the BMI or the WC and the TG/HDL ratio was observed. Conclusion: There was no association between the TG / HDL-C ratio and the adiposity measurements (BMI and WC) in the adjusted analysis. The results of this study question the real influence of overweight and central obesity in the TG / HDL-c ratio (AU)

Inflammatory, nutritional and clinical parameters of individuals with chronic kidney disease undergoing conservative treatment / Inflamación, estado clínico y nutricional de pacientes renales crónicos en tratamiento conservador

Introduction: due to the relevance of inflammation in individuals with chronic kidney disease (CKD), inflammation should be taken into account in the interpretation of the clinical-nutritional status. Objective: assess the association between inflammation, nutritional and clinical parameters in patients with CKD. Materials and methods: 92 patients with CKD. C-reactive protein (CRP) was used as an inflammation marker. Assessed nutritional parameters were anthropometry and biochemical exams. Evaluated clinical parameters were comorbidities, CKD characteristics, lipid profile, lipid-lowering agents, urea, creatinine and total leukocytes. Comparisons between two groups (with or without inflammation) were performed using Student’s t-test or chi-square test. Results: 15 (16.3%) patients had CRP above greater than or equal to 10mg/L and were considered with inflammation. In the group with inflammation, 05 (33%) had hypoalbuminemia as compared with 05 (6.5%) in the group without inflammation (p = 0.002). Lipid values were lower in the group with inflammation, with mean total cholesterol 171 (± 41.2) mg/dL and mean LDL-C 95 (± 31.2) mg/dL as compared with the group without inflammation, which had and a mean total cholesterol 198 (± 46) mg/dL and mean LDL-C 124 (± 40.1) mg/dL, p = 0,038 and p = 0.011, respectively. No other statistically significant differences between groups were found. Conclusion: inflammation was associated with changes in the total cholesterol and LDL levels and with an increased incidence of hypoalbuminemia. We suggest that serum albumin levels should only be used to assess nutritional status in the absence of inflammation and CRP levels ought to be considered in nutritional status interpretation in patients with CKD (AU)

Introducción: la inflamación es un problema frecuente en pacientes con enfermedad renal crónica (ERC) y se debe relacionar con el estado clínico y nutricional de estos. Objetivo: evaluar si existe una asociación entre la inflamación y los parámetros clínicos y nutricionales en los pacientes con ERC. Material y métodos: fueron evaluados 92 pacientes con ERC. Se utilizo la proteína C reactiva (PCR) como marcador de la inflamación. Los parámetros nutricionales evaluados fueron antropometría y exámenes bioquímicos. Los parámetros clínicos evaluados fueron comorbilidades, características de la ERC, perfil lipidico, hipolipemiantes, urea, creatinina y leucocitos totales. Para analizar las diferencias entre los grupos (con o sin inflamación) se utilizo el test t de Student o el test de Chi-cuadrado. Resultados: 15 pacientes (16,3%) presentaban PCR más o igual a 10,0 mg/dL y tenían inflamación. De estos, 05 (33%) tuvieron hipoalbuminemia, en comparacion con 05 (6,5%) en el grupo sin inflamación (p = 0,002). Los valores de lípidos fueron inferiores en el grupo con inflamación, con colesterol total medio de 171 mg/dL (} 41,2) e LDL-C medio de 95 mg / dL (} 31,2) en comparación con aquellos sin inflamación con medias de 198 mg / dL (} 46) y 124 mg/dL (} 40,1), respectivamente. No se encontraron otras diferencias significativas entre los grupos. Conclusión: la inflamación se ha asociado con modificaciones en el colesterol total, LDL e hipoalbuminemia. Se concluye que la albumina sérica solo se debe utilizar para evaluar el estado nutricional en ausencia de inflamación. El nivel de PCR es un marcador sensible de la inflamación y debe ser empleado en la interpretación del estado nutricional en pacientes con ERC (AU)