Impact of metabolic syndrome on resting energy expenditure in patients with chronic kidney disease.

BACKGROUND & AIMS: Resting energy expenditure (REE) changes in patients with chronic kidney disease (CKD) may contribute to mortality increase. The obesity and inflammation is associated with high REE and when not compensated by adequate intake, may determine an unfavorable clinical outcome in this population. We aimed to evaluate the influence of metabolic syndrome (MetS) on REE in CKD patients. METHODS: One hundred eighty-three patients were stratified according to glomerular filtration rate (GFR) and divided in groups: without CKD (GFR > 60 ml/min/1.73 m2) and CKD (GFR < 60 ml/min/1.73 m2) and according to the presence or absence of MetS. REE was measured by indirect calorimetry; body composition was assessed by bioelectrical impedance analysis and blood and urine were collected for biochemical tests. RESULTS: REE was lower in the group with CKD compared with those without CKD (1293 ± 364 vs 1430 ± 370 kcal/d, P = 0.01). The group with CKD without MetS showed decrease in REE compared to the groups without CKD, regardless the presence of Mets, and those with CKD and MetS (1173 ± 315 vs 1392 ± 324 vs 1460 ± 410 vs 1424 ± 376 kcal/d, P < 0.05, respectively). Multivariate analysis showed an independent association of CKD in determining REE when adjusted for lean body mass. The inclusion of MetS as an independent variable in the same analysis model neutralized the impact of CKD on the REE (P = 0.19). Patients without MetS, REE correlated with estimated GFR and the protein equivalent (r = 0.33, P < 0.01, r = 0.21, P = 0.04, respectively), whereas in MetS patients, these correlations were not observed. CONCLUSION: The presence of CKD is independently associated with reduced REE. The observed decrease in REE is reversed in patients with MetS independent of renal function.

Low estimated glomerular filtration rate and chronic kidney failure following liver transplant: a retrospective cohort study.

BACKGROUND: Patients undergoing orthotropic liver transplant (LTx) often present with chronic kidney disease (CKD). Identification of patients who will progress to end-stage renal disease (ESRD) might allow not only the implementation of kidney protective measures but also simultaneous kidney transplant. STUDY DESIGN: Retrospective cohort study in adults who underwent LTx at a single center. ESRD, death, and composite of ESRD or death were studied outcomes. RESULTS: 331 patients, who underwent LTx, were followed up for 2.6 ± 1.4 years; 31 (10%) developed ESRD, 6 (2%) underwent kidney transplant after LTx and 25 (8%) remained on chronic hemodialysis. Patients with preoperative eGFR lesser than 60 ml/min per 1.73 m2 had a 4-fold increased risk of developing ESRD after adjustment for sex, diabetes mellitus, APACHE II score, use of nephrotoxic drugs, and severe liver graft failure (HR = 3.95, 95% CI 1.73, 9.01; p = 0.001). Other independent risk factors for ESRD were preoperative diabetes mellitus and post-operative severe liver graft dysfunction. CONCLUSION: These findings emphasize low eGFR prior to LTx as a predictor for ESRD or death. The consideration for kidney after liver transplant as a treatment modality should be taken into account for those who develop chronic kidney failure after LTx.

Performance of two metabolic syndrome definitions in the estimation of cardiovascular disease among hypertensive patients.

The authors evaluated the significance of metabolic syndrome (MetS) diagnosis, as defined by the National Cholesterol Education Program (NCEP) and by the International Diabetes Federation (IDF), in the evaluation of cardiovascular risk in hypertensive patients. Among 638 patients, the prevalence of MetS was 54.7% when the IDF criteria were used, compared with 45.5% when the NCEP criteria were used. MetS correlated significantly with the presence of cardiovascular disease (CVD). In patients without type 2 diabetes mellitus (T2DM), only MetS diagnosed using the IDF criteria was associated with the presence of CVD. In those with T2DM, MetS was not associated with CVD, regardless of the criteria used. The diagnosis of MetS, using either set of criteria, was associated with the development of T2DM. We conclude that, in hypertensive patients without diabetes, a diagnosis of MetS according to IDF criteria, but not the NCEP criteria, is useful in identifying individuals with a higher probability of incident CVD. In patients with diabetes, a population already considered at high risk for CVD, a diagnosis of MetS, regardless of the criteria used, has no further impact on prognosis.

Sleep-disordered breathing changes after kidney transplantation: a polysomnographic study.

BACKGROUND: Sleep disorders are common in patients with end-stage renal disease (ESRD) and are not improved by either conventional haemodialysis or peritoneal dialysis. Sleep-disordered breathing (SDB) is associated with cardiovascular disease and contributes to high mortality found in patients with ESRD. Cure of SDB after transplantation has been anecdotally reported. METHODS: Thirty-four non-diabetic patients with ESRD were studied, and clinical, laboratory test and polysomnographic features were determined and compared prior to and after transplantation and between groups with or without SDB, defined as having an apnoea-hypopnoea index (AHI) >or=5. RESULTS: An AHI >or=5 was present in nine patients (26.5%) prior to and seven (21%) after transplantation, and no significant reduction of mean AHI was found between study phases (5.3 +/- 7.3 vs 3.1 +/- 4.5; P > 0.05). Transplantation was associated with a significant improvement in sleep architecture. CONCLUSIONS: Kidney transplantation is associated with an improvement in sleep architecture, but does not cure SDB in all patients.

Retençäo nitrogenada em crianças com síndrome nefrítico agudo (SNA) pós-infeccioso / Nitrogenous retention in children with post infectious acute nephritic syndrome (ANS)

Os autores estudaram retrospectivamente 113 pacientes portadores de SNA pós-infeccioso, dignosticados e tratados no Serviço de Pediatria do HU-UFJF, no período de 01/07/88 a 30/06/93, com o intuito de elucidar o significado clínico do achado laboratorial da retençäo nitrogenada (RN) elevada nas primeiras semanas de doença. Foi denominado índice de RN normal os valores da uréia (U)= 22 ñ 5,5 mg/dl e creatinina (Cr)= 0,7 ñ 0,13 mg/dl plasmáticas, determinados em 30 crianças da mesma faixa etária, atendidas no mesmo período e no mesmo serviço por outros motivos, porém sem qualquer comprometimento renal ou sistêmico. Dos 113 casos estudados, 88 pacientes obedeceram aos critérios de admissäo, sendo 19 com RN acima do índice, 69 com RN abaixo do índice de normalidade e 25 foram excluídos. O protocolo de estudo abrangeu a comparaçäo das seguintes variáveis entre grupos com e sem RN elevada: idade, sexo, raça, elevaçäo da pressäo arterial sistólica ou sistodiastólica, presença de oligúria, hipocomplementemia, elevaçäo de ASTO e a duraçäo médica da RN. As únicas variáveis que se correlacionam estatisticamente de maneira significante (p < 0,05) com o achado da RN elevada foram a hipocomplementemia e a oligúria. A RN permaneceu elevada por um tempo médio de 3 meses, na maioria dos casos. Conclusäo: os pacientes portadores de SNA pós-infecciosa podem apresentar RN elevada, sobretudo nas 2 primeiras semanas de doença, prolongando-se até 3 meses, principalmente quando persistem hipocomplementemia e oligúria.