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1.
Braz J Med Biol Res ; 53(3): e9614, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32159613

RESUMEN

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. However, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be it primary, secondary, or tertiary. This article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management, and treatment are often lacking. Hence, there is an urgent need to increase the awareness of preventive measures throughout populations, professionals, and policy makers.


Asunto(s)
Carga Global de Enfermedades , Equidad en Salud , Accesibilidad a los Servicios de Salud , Insuficiencia Renal Crónica/epidemiología , Diagnóstico Precoz , Política de Salud , Promoción de la Salud , Humanos , Tamizaje Masivo/economía , Servicios Preventivos de Salud/métodos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/prevención & control , Factores de Riesgo
4.
Am J Physiol Renal Physiol ; 318(2): F475-F485, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31841390

RESUMEN

Tobacco smoking has been identified as a risk factor in the progression of chronic kidney disease (CKD). In previous studies, we showed that nicotine induces cyclooxygenase (COX)-2 expression in vivo and in vitro and that the administration of nicotine in vivo worsens the severity of renal injury in a model of subtotal renal ablation. In the present study, we tested the role of COX-2-derived prostaglandins on the deleterious effects of nicotine in CKD. Sham and 5/6 nephrectomy (5/6Nx) rats received tap water or nicotine (100 µg/mL) in the drinking water for 12 wk. Additional groups also systemically received the COX-2 inhibitor NS-398 (1.5 mg·kg-1·day-1 via osmotic minipump). The administration of nicotine worsened renal injury and proteinuria in 5/6Nx rats and increased proteinuria in sham rats. 5/6Nx rats had increased cortical production of the prostaglandins PGE2, PGI2, PGD2, and PGF2α and of thromboxane A2. In these rats, nicotine reduced the production of all prostaglandins examined except thromboxane A2. Treatment with the COX-2 inhibitor NS-398 resulted in complete inhibition of all prostaglandins studied and ameliorated renal injury and proteinuria in 5/6Nx rats on nicotine but not in 5/6 Nx rats on tap water. Nicotine also reduced the expression of megalin in all groups examined, and this was partially prevented by COX-2 inhibition. In the present study, we showed that in CKD, nicotine worsens renal injury at least in part by producing an imbalance in the production of prostaglandins. This imbalance in the production of prostaglandins likely plays a role in the deleterious effects of smoking on the progression of CKD.


Asunto(s)
Ciclooxigenasa 2/metabolismo , Riñón/efectos de los fármacos , Nicotina/toxicidad , Agonistas Nicotínicos/toxicidad , Prostaglandinas/metabolismo , Insuficiencia Renal Crónica/inducido químicamente , Animales , Inhibidores de la Ciclooxigenasa 2/farmacología , Dinoprost/metabolismo , Dinoprostona/metabolismo , Modelos Animales de Enfermedad , Regulación hacia Abajo , Epoprostenol/metabolismo , Riñón/enzimología , Riñón/patología , Proteína 2 Relacionada con Receptor de Lipoproteína de Baja Densidad/metabolismo , Masculino , Nefrectomía , Prostaglandina D2/metabolismo , Proteinuria/inducido químicamente , Proteinuria/enzimología , Ratas Sprague-Dawley , Insuficiencia Renal Crónica/enzimología , Insuficiencia Renal Crónica/patología , Insuficiencia Renal Crónica/prevención & control , Transducción de Señal , Tromboxano A2/metabolismo
5.
Diabetes Metab Syndr ; 13(4): 2585-2591, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31405680

RESUMEN

BACKGROUND: Illness perceptions (IP) involve coping strategies and behavioural responses that can influence glycaemic control. Despite the importance of good glycaemic control, the majority of patients in Asia are not achieving glycaemic targets. An evaluation of IP in association with glycaemic control, medication adherence and chronic kidney disease (CKD) in Type 2 diabetes mellitus patients (T2DM) was carried out in an outpatient setting in Malaysia METHOD: A cross-sectional study was conducted using the Revised Illness Perception Questionnaire in a purposive sample of 384 T2DM patients. RESULTS: There were 55.7% females, median age was 58.2 years and median duration of diabetes was 13 years. The majority (79.4%) of patients had poor diabetes control (HbA1c ≥ 7.0%) and 39.6% of patients had low medication adherence. Patients with good glycaemic control had a higher Timeline Acute/Chronic and Emotional Representations score, hence they held the correct belief that diabetes is chronic and experienced negative emotions. Highly adherent patients had a higher Illness Coherence (χ2 = 21.385, p < 0.001) score but a lower Consequences (χ2 = 17.592, p < 0.001) and Emotional Representations (χ2 = 16.849, p < 0.001) score indicating good understanding and less negative perceptions of disease burden. Patients in a more advanced stage of CKD had a significantly higher Timeline Cyclical score (χ2 = 18.718, p = 0.001), believing that diabetes was unpredictable. CONCLUSION: Dimensions of IP have been shown to be significantly associated with the assessed variables, therefore intervention studies with education, support and counselling should be conducted in Asia with the ultimate aim of empowering patients through IP-targeted management.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Conocimientos, Actitudes y Práctica en Salud , Hiperglucemia/psicología , Hipoglucemia/psicología , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Insuficiencia Renal Crónica/psicología , Anciano , Biomarcadores/análisis , Estudios Transversales , Diabetes Mellitus Tipo 2/psicología , Femenino , Estudios de Seguimiento , Humanos , Hiperglucemia/epidemiología , Hiperglucemia/prevención & control , Hipoglucemia/epidemiología , Hipoglucemia/prevención & control , Malasia/epidemiología , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Educación del Paciente como Asunto , Percepción , Prevalencia , Pronóstico , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/prevención & control , Encuestas y Cuestionarios
6.
Nutrients ; 11(8)2019 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-31412575

RESUMEN

Healthy dietary patterns may promote kidney health and prevent adverse renal outcomes. Although reviews have summarized the findings from studies on dietary patterns for chronic kidney disease (CKD) management, less is known about dietary patterns for maintaining kidney health prior to CKD development. The current review summarized the results from observational studies from March 2009 to March 2019 investigating associations between dietary patterns and renal outcomes in the general population. The main renal outcome assessed was CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2). A total of twenty-six research articles met the inclusion criteria. Adherence to the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets were significantly associated with a decreased risk of CKD in the majority of the studies. Furthermore, a posteriori "unhealthy" dietary patterns were associated with an increased risk of CKD. In conclusion, the findings from this review suggest that adherence to DASH and Mediterranean dietary patterns may be useful in promoting kidney health and preventing CKD in the general population. More studies, in particular among minorities, are warranted to investigate the role of diet, a potentially modifiable factor, in promoting kidney health.


Asunto(s)
Dieta Mediterránea , Enfoques Dietéticos para Detener la Hipertensión , Conducta Alimentaria , Tasa de Filtración Glomerular , Riñón/fisiopatología , Insuficiencia Renal Crónica/prevención & control , Adulto , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Valor Nutritivo , Prevalencia , Estudios Prospectivos , Factores Protectores , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/fisiopatología , Factores de Riesgo , Adulto Joven
7.
Rev Med Suisse ; 15(653): 1106-1111, 2019 May 29.
Artículo en Francés | MEDLINE | ID: mdl-31148421

RESUMEN

Diabetic nephropathy is a leading cause of chronic kidney disease and dialysis. We know that a good diabetes control slows the progression of kidney disease, but the risk of hypoglycemia is greater in patients with chronic kidney disease and contributes to their mortality. Chronic kidney disease and diabetes are major cardiovascular risk factors with additive effects. Decreasing cardiovascular mortality is a major aim in chronic kidney disease. The ideal antidiabetic molecule in these patients should reduce the risk of dialysis, reduce cardiovascular mortality and carry no risk of hypoglycaemia. This article aims to summarize for the general practician the nephrological implications of new antidiabetic drugs and their use in chronic kidney disease patients.


Asunto(s)
Diabetes Mellitus Tipo 2 , Nefropatías Diabéticas , Hipoglucemiantes , Fallo Renal Crónico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/prevención & control , Humanos , Hipoglucemiantes/uso terapéutico , Fallo Renal Crónico/tratamiento farmacológico , Fallo Renal Crónico/prevención & control , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/prevención & control
9.
Diabetes Metab Syndr ; 13(3): 2292-2298, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31235171

RESUMEN

OBJECTIVE: To evaluate if the recommendations of appropriate health care for Chronic Kidney Disease (CKD) are implemented in patients with Diabetes Mellitus (DM) and Systemic Arterial Hypertension (SAH). METHODS: This is a descriptive study conducted between January and March 2019 in Divinópolis, in the Brazilian state of Minas Gerais. Patients aged 18 years or older with CKD, DM and/or SAH were followed up at the municipal nephrology outpatient clinic. An interview was conducted using a structured questionnaire to assess care, which was categorized as adequate or inadequate, based on the health care recommendations of the national guidelines for care of patients with CKD. RESULTS: 42 participants with CKD participated in the study. All participants had SAH and 42.9% (n = 18) also had DM. It was evidenced that 81.0% (n = 34) of the individuals with CKD had adequate health care, especially among patients in earlier stages (3A and 3B) and those who progressed to renal replacement therapy. However, 80.0% (n = 8) of the participants in the intermediate stage (stage 4) were inadequately followed up by the nephrologist and multidisciplinary team. CONCLUSIONS: Patients in intermediate stages do not receive follow-up with a multidisciplinary team at the recommended frequency. The preventive approach of the progression of renal disease in the intermediate stage in the studied municipality was not within the recommendations of the Ministry of Health.


Asunto(s)
Diabetes Mellitus/fisiopatología , Hipertensión Pulmonar/complicaciones , Manejo de Atención al Paciente/normas , Arteria Pulmonar/patología , Insuficiencia Renal Crónica/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Manejo de Atención al Paciente/estadística & datos numéricos , Pronóstico , Insuficiencia Renal Crónica/etiología , Factores de Riesgo
11.
BMJ ; 365: l1346, 2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-31043374

RESUMEN

OBJECTIVE: To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood. DESIGN: National cohort study. SETTING: Sweden. PARTICIPANTS: 4 186 615 singleton live births in Sweden during 1973-2014. EXPOSURES: Gestational age at birth, identified from nationwide birth records in the Swedish birth registry. MAIN OUTCOME MEASURES: CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors. RESULTS: 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families. CONCLUSIONS: Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.


Asunto(s)
Edad Gestacional , Nacimiento Prematuro/epidemiología , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/prevención & control , Adolescente , Adulto , Niño , Preescolar , Diagnóstico Precoz , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Embarazo , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/etiología , Factores de Riesgo , Suecia/epidemiología , Adulto Joven
12.
J Bras Nefrol ; 41(1): 1-9, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31063178

RESUMEN

Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization's Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.


Asunto(s)
Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/terapia , Prestación de Atención de Salud , Salud Global , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/prevención & control , Equidad en Salud , Humanos , Nefrólogos , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/prevención & control , Terapia de Reemplazo Renal , Factores de Riesgo , Determinantes Sociales de la Salud
13.
Circulation ; 139(17): 1985-1987, 2019 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-31009585
14.
Lancet ; 393(10184): 1937-1947, 2019 05 11.
Artículo en Inglés | MEDLINE | ID: mdl-30995972

RESUMEN

BACKGROUND: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. METHODS: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18-85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR) 25-75 mL/min per 1·73 m2 of body surface area, and a urine albumin-to-creatinine ratio (UACR) of 300-5000 mg/g who had received maximum labelled or tolerated renin-angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders) were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days) or end-stage kidney disease (eGFR <15 mL/min per 1·73 m2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure) in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. FINDINGS: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325) or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4-2·9). 79 (6·0%) of 1325 patients in the atrasentan group and 105 (7·9%) of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR] 0·65 [95% CI 0·49-0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%) of 1325 patients in the atrasentan group and 34 (2·6%) of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85-2·07]; p=0·208). 58 (4·4%) patients in the atrasentan group and 52 (3·9%) in the placebo group died (HR 1·09 [95% CI 0·75-1·59]; p=0·65). INTERPRETATION: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. FUNDING: AbbVie.


Asunto(s)
Atrasentán/administración & dosificación , Creatinina/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Nefropatías Diabéticas/prevención & control , Antagonistas de los Receptores de la Endotelina A/administración & dosificación , Insuficiencia Renal Crónica/prevención & control , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Atrasentán/uso terapéutico , Creatinina/orina , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/orina , Método Doble Ciego , Antagonistas de los Receptores de la Endotelina A/uso terapéutico , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/orina , Albúmina Sérica Humana/orina , Resultado del Tratamiento , Adulto Joven
15.
Clin Exp Nephrol ; 23(8): 1031-1038, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31030309

RESUMEN

BACKGROUND: The type of lifestyle guidance that is effective for preventing development of chronic kidney disease (CKD) is unknown. Here, we aim to investigate the effects of a participatory structured group education (SGE) program on the development of CKD in a population-based study. METHODS: We retrospectively analyzed 1060 adult special health check-up examinees with CKD. Examinees with an estimated glomerular filtration rate (eGFR) from 50 to 60 mL/min/1.73 m2 and/or proteinuria 1+ were encouraged to attend an SGE program. The SGE program included participatory small group discussions on the attendees' remaining risk factors. The primary outcome of this study was the change in eGFR per year. RESULTS: The changes in eGFR in examinees who attended the SGE program (n = 209, + 2.9 mL/min/1.73 m2 [95% confidence interval (CI) + 1.9 to + 3.9]) significantly improved compared with control (n = 383, + 1.2 mL/min/1.73 m2 [95% CI + 0.5 to + 1.9], p = 0.006). Attending an SGE program was independently and positively related to the changes in eGFR at 1 year after attendance, after adjusting for classical covariates (ß = 1.55 [95% CI 0.37-2.73], p = 0.01). Attending an SGE program was effective for the examinees with a lower eGFR compared with those with only proteinuria. CONCLUSIONS: Our SGE program showed the beneficial effects of preventing the development of CKD, independent of classical factors. The type of SGE program that is more effective for preventing development of CKD should be investigated in a long-term analysis.


Asunto(s)
Procesos de Grupo , Conocimientos, Actitudes y Práctica en Salud , Educación del Paciente como Asunto/métodos , Participación del Paciente , Proteinuria/terapia , Insuficiencia Renal Crónica/prevención & control , Conducta de Reducción del Riesgo , Anciano , Progresión de la Enfermedad , Femenino , Tasa de Filtración Glomerular , Humanos , Riñón/fisiopatología , Masculino , Factores Protectores , Proteinuria/diagnóstico , Proteinuria/fisiopatología , Proteinuria/psicología , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/psicología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
16.
Nat Rev Nephrol ; 15(7): 423-433, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30914797

RESUMEN

Approximately 70% of cases of kidney cancer are localized or locally advanced at diagnosis. Among patients who undergo surgery for these cancers, 30-35% will eventually develop potentially fatal metachronous distant metastases. Effective adjuvant treatments are urgently needed to reduce the risk of recurrence of kidney cancer and of dying of metastatic disease. To date, almost all of the tested adjuvant agents have failed to demonstrate any benefit. Only two trials of an autologous renal tumour cell vaccine and of the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor sunitinib have shown positive results, but these have been criticized for methodological reasons and conflicting data, respectively. The results of two additional trials of targeted agents as adjuvant therapies have not yet been published. Novel immune checkpoint inhibitors are promising approaches to adjuvant therapy in kidney cancer, and a number of trials are now underway. An important component of the management of patients with kidney cancer, particularly those who undergo radical resection for localized renal cell carcinoma, is the preservation of kidney function to reduce morbidity and mortality. The optimal management of these patients therefore requires a multidisciplinary approach involving nephrologists, oncologists, urologists and pathologists.


Asunto(s)
Carcinoma de Células Renales/terapia , Quimioterapia Adyuvante , Neoplasias Renales/terapia , Inhibidores de la Angiogénesis/farmacología , Antineoplásicos Inmunológicos/farmacología , Ensayos Clínicos como Asunto , Humanos , Recurrencia Local de Neoplasia , Nefrectomía , Inhibidores de Proteínas Quinasas/farmacología , Receptores de Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/prevención & control , Medición de Riesgo
17.
Clin Exp Nephrol ; 23(7): 908-919, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30895529

RESUMEN

BACKGROUND: Constipation is frequently observed in patients with chronic kidney disease (CKD). Lactulose is expected to improve the intestinal environment by stimulating bowel movements as a disaccharide laxative and prebiotic. We studied the effect of lactulose on renal function in adenine-induced CKD rats and monitored uremic toxins and gut microbiota. METHODS: Wistar/ST male rats (10-week-old) were fed 0.75% adenine-containing diet for 3 weeks to induce CKD. Then, they were divided into three groups and fed as follows: control, normal diet; and 3.0- and 7.5-Lac, 3.0% and 7.5% lactulose-containing diets, respectively, for 4 weeks. Normal diet group was fed normal diet for 7 weeks. The rats were observed for parameters including renal function, uremic toxins, and gut microbiota. RESULTS: The control group showed significantly higher serum creatinine (sCr) and blood urea nitrogen (BUN) 3 weeks after adenine feeding than at baseline, with a 8.5-fold increase in serum indoxyl sulfate (IS). After switching to 4 weeks of normal diet following adenine feeding, the sCr and BUN in control group remained high with a further increase in serum IS. In addition, tubulointerstitial fibrosis area was increased in control group. On the other hand, 3.0- and 7.5-Lac groups improved sCr and BUN levels, and suppressed tubulointerstitial fibrosis, suggesting preventing of CKD progression by lactulose. Lac groups also lowered level of serum IS and proportions of gut microbiota producing IS precursor. CONCLUSION: Lactulose modifies gut microbiota and ameliorates CKD progression by suppressing uremic toxin production.


Asunto(s)
Adenina , Bacterias/efectos de los fármacos , Microbioma Gastrointestinal/efectos de los fármacos , Riñón/efectos de los fármacos , Lactulosa/farmacología , Prebióticos , Insuficiencia Renal Crónica/prevención & control , Uremia/prevención & control , Animales , Bacterias/metabolismo , Biomarcadores/sangre , Nitrógeno de la Urea Sanguínea , Creatinina/sangre , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Fibrosis , Riñón/metabolismo , Riñón/patología , Riñón/fisiopatología , Masculino , Estrés Oxidativo/efectos de los fármacos , Ratas Wistar , Insuficiencia Renal Crónica/inducido químicamente , Insuficiencia Renal Crónica/microbiología , Insuficiencia Renal Crónica/fisiopatología , Uremia/inducido químicamente , Uremia/microbiología , Uremia/fisiopatología
18.
Chin J Integr Med ; 25(3): 163-167, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30815804

RESUMEN

Chronic kidney disease (CKD) is a clinical syndrome with a series of clinical manifestations and metabolic disorders caused by many diseases, which are characterized by progressive deterioration or irreversible damage of renal structures and functions. With the progress of epidemiological research, CKD has brought about huge economic and psychological burdens. There is a considerable risk of cardiovascular events or death than progression to end-stage renal disease for patients. Particular attentions should be paid to the new goals of reducing cardiovascular events and all-cause mortality. It is important to analyze the etiology and pathogenesis according to patients' ages, regions, primary disease as well as different stages of disease, and choose the appropriate therapeutic strategies accordingly. In clinical practice, due to the uncertainty of therapeutic effects of modern medicine based on the risk factors, it is necessary to use Chinese medicine (CM) to delay the disease progression and reduce comorbidities. Turbid toxin and blood stasis are two critical pathological factors worthy of concerns in the theory of CM. In addition, appropriate use of CM may help improve the quality of life of patients with CKD.


Asunto(s)
Medicina China Tradicional , Insuficiencia Renal Crónica/tratamiento farmacológico , Hemostasis , Humanos , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/prevención & control
19.
J. bras. nefrol ; 41(1): 1-9, Jan.-Mar. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1019978

RESUMEN

Abstract Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization's Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.


Resumo A doença renal é um problema de saúde pública global, afetando mais de 750 milhões de pessoas em todo o mundo. O ônus da doença renal varia substancialmente em todo o mundo, assim como sua detecção e tratamento. Em muitos contextos, as taxas de doença renal e a provisão de seus cuidados são definidas por fatores socioeconômicos, culturais e políticos que levam a disparidades significativas. O Dia Mundial do Rim 2019 oferece uma oportunidade para aumentar a conscientização sobre doenças renais e destacar as disparidades em seu impacto e estado atual da capacidade global de prevenção e tratamento. Aqui, destacamos que muitos países ainda carecem de acesso a diagnósticos básicos, uma força de trabalho treinada em nefrologia, acesso universal à atenção primária à saúde e terapias de substituição renal. Apontamos para a necessidade de fortalecer a infra-estrutura básica para serviços de cuidados renais para detecção e tratamento precoce de lesão renal aguda e doença renal crônica em todos os países e defender abordagens mais pragmáticas para o fornecimento de terapias de substituição renal. Alcançar a cobertura universal de saúde em todo o mundo até 2030 é um dos Objetivos de Desenvolvimento Sustentável da Organização Mundial da Saúde. Embora a cobertura universal de saúde não inclua todos os elementos do tratamento renal em todos os países, entender o que é viável e importante para um país ou região com foco na redução do impacto e das consequências da doença renal seria um passo importante para alcançar a equidade na saúde renal.


Asunto(s)
Humanos , Salud Global , Prestación de Atención de Salud , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/terapia , Factores de Riesgo , Terapia de Reemplazo Renal , Equidad en Salud , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/prevención & control , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/prevención & control , Determinantes Sociales de la Salud , Nefrólogos
20.
Am J Med Sci ; 357(3): 223-229, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30797503

RESUMEN

BACKGROUND: Diabetic nephropathy remains one of the most common causes of chronic kidney disease in the United States and is associated with significant morbidity and mortality. Recently, there have been emerging data highlighting the role of vitamin D and its analogue in chronic kidney disease especially diabetic nephropathy independent of its effect on bone metabolism. METHODS: This study aimed to evaluate effect of supplementing vitamin D and its analogues on halting or slowing progression of diabetic nephropathy. Electronic databases (PubMed, Scopus, Google scholar) were searched and randomized controlled trials (RCTs) that investigated the use of vitamin D and its analogs for diabetic nephropathy were studied. This meta-analysis of RCTs performed in accordance with Preferred Reporting Items for Systematic review and Meta-analysis statement. RESULTS: This meta-analysis included 9 RCTs and suggested a favorable trend with respect to an effect of vitamin D and its analogues on albuminuria though this did not reach statistical significance (MD, -0.17; 95% CI, -0.34-0.01; P = 0.06]. Serum calcium was unaffected suggesting safe use of these agents. CONCLUSIONS: Use of vitamin D and its analogues may have potential as an adjuvant therapy for reducing albuminuria and slowing progression of diabetic nephropathy but further studies are needed.


Asunto(s)
Nefropatías Diabéticas , Insuficiencia Renal Crónica , Vitamina D/farmacología , Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/terapia , Suplementos Dietéticos , Progresión de la Enfermedad , Humanos , Insuficiencia Renal Crónica/clasificación , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/prevención & control , Vitaminas/farmacología
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