Evaluation of pulse wave velocity and central systolic blood pressure in children and adolescents with chronic kidney disease.

OBJECTIVE: Investigate pulse wave velocity and central systolic blood pressure among pediatric population with chronic kidney disease. METHODS: In this cross-sectional study, 57 patients (61.4% male) aged 6.2 to 17.5 years old, 44 with nondialysis chronic kidney disease and 13 on chronic dialysis, were included in the analysis. The pulse wave velocity and the central systolic blood pressure were measured with an oscillometric device with an inbuilt ARC SolverⓇ algorithm and were compared with previously established percentiles. RESULTS: The prevalence of elevated pulse wave velocity was 21.1% (95%Cl: 11.4-33.9) and elevated central systolic blood pressure was 28.1% (95%CI: 17.0-41.5). According to the generalized linear model, there was a higher risk of elevated pulse wave velocity in patients undergoing chronic dialysis treatment than nondialysis chronic kidney disease patients (adjPR=4.24, 95%CI: 1.97-9.13, p=<0.001). Hypertensive patients (stage 2) had a higher risk of elevated pulse wave velocity than normotensive ones (adjPR=2.70, 95%CI: 1.05-6.95, p=0.040), as did patients younger than 12 years than the older patients (adjPR=2.95, 95%CI: 1.05-8.40, p=0.041). Hypertensive patients had a higher risk of elevated central systolic blood pressure than normotensives (adjPR=3.29, 95%Cl: 1.36-7.94), as did patients undergoing chronic dialysis treatment when comparing to nondialysis chronic kidney disease patients (adjPR=2.08, 95%Cl: 1.07-4.02). CONCLUSION: Younger age, dialysis, and hypertension in children are independently associated with higher pulse wave velocity. Hypertension and dialysis are independently associated with higher central systolic blood pressure.

Evaluation of pulse wave velocity and central systolic blood pressure in children and adolescents with chronic kidney disease

ABSTRACT Objective Investigate pulse wave velocity and central systolic blood pressure among pediatric population with chronic kidney disease. Methods In this cross-sectional study, 57 patients (61.4% male) aged 6.2 to 17.5 years old, 44 with nondialysis chronic kidney disease and 13 on chronic dialysis, were included in the analysis. The pulse wave velocity and the central systolic blood pressure were measured with an oscillometric device with an inbuilt ARC SolverⓇ algorithm and were compared with previously established percentiles. Results The prevalence of elevated pulse wave velocity was 21.1% (95%Cl: 11.4-33.9) and elevated central systolic blood pressure was 28.1% (95%CI: 17.0-41.5). According to the generalized linear model, there was a higher risk of elevated pulse wave velocity in patients undergoing chronic dialysis treatment than nondialysis chronic kidney disease patients (adjPR=4.24, 95%CI: 1.97-9.13, p=<0.001). Hypertensive patients (stage 2) had a higher risk of elevated pulse wave velocity than normotensive ones (adjPR=2.70, 95%CI: 1.05-6.95, p=0.040), as did patients younger than 12 years than the older patients (adjPR=2.95, 95%CI: 1.05-8.40, p=0.041). Hypertensive patients had a higher risk of elevated central systolic blood pressure than normotensives (adjPR=3.29, 95%Cl: 1.36-7.94), as did patients undergoing chronic dialysis treatment when comparing to nondialysis chronic kidney disease patients (adjPR=2.08, 95%Cl: 1.07-4.02). Conclusion Younger age, dialysis, and hypertension in children are independently associated with higher pulse wave velocity. Hypertension and dialysis are independently associated with higher central systolic blood pressure.

Evaluation of carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease / Avaliação da espessura médio-intimal da carótida e fatores associados à doença cardiovascular em crianças e adolescentes com doença renal crônica

ABSTRACT Objective: To assess the carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease. Material and methods: Observational, cross-sectional study carried out at the Universidade Federal de São Paulo (chronic kidney disease outpatient clinics) with 55 patients (60% males) with a median age of 11.9 years (I25-I75: 9.2-14.8 years). Of the 55 patients, 43 were on conservative treatment and 12 were on dialysis. Serum laboratory parameters (creatinine, uric acid, C-reactive protein, total cholesterol and fractions, and triglycerides), nutritional status (z-score of body mass index, z-score of height/age), body fat (fat percentage and waist circumference), and blood pressure levels were evaluated. The carotid intima-media thickness measure was evaluated by a single ultrasonographer and compared with percentiles established according to gender and height. Data collection was performed between May 2015 and March 2016. Results: Of the children and adolescents with chronic kidney disease, 74.5% (95% CI: 61.0; 85.3) showed an increase (>P95) in carotid intima-media thickness. In patients with stages I and II hypertension, 90.9% had increased carotid intima-media thickness. Nutritional status, body fat and laboratory tests were not associated with increased carotid intima-media thickness. After multivariate adjustment, only puberty (PR = 1.30, p = 0.037) and stages I and II arterial hypertension (PR = 1.42, p = 0.011) were independently associated with carotid intima-media thickness alterations. Conclusion: The prevalence of increased carotid thickness was high in children and adolescents with chronic kidney disease. Puberty and arterial hypertension were independently associated with increased carotid intima-media thickness.

RESUMO Objetivo: Avaliar a espessura médio-intimal da carótida e os fatores associados à doença cardiovascular em crianças e adolescentes com doença renal crônica. Material e métodos: Estudo observacional transversal feito na Universidade Federal de São Paulo (ambulatórios de doença renal crônica) com 55 pacientes (60% do sexo masculino) com mediana de 11,9 anos (I25-I75: 9,2-14,8). Dos 55 pacientes, 43 estavam em tratamento conservador e 12 em terapia dialítica. Foram avaliados os parâmetros laboratoriais séricos (creatinina, ácido úrico, proteína C-reativa, colesterol total e frações e triglicérides), estado nutricional (escore z de índice de massa corpórea, escore z de estatura/idade), gordura corporal (percentual de gordura e circunferência abdominal) e pressão arterial. A medida da espessura médio-intimal da carótida foi avaliada por um único ultrassonografista e comparada com percentis estabelecidos de acordo com o sexo e a estatura. A coleta de dados foi feita entre maio de 2015 e março de 2016. Resultados: Das crianças e adolescentes com doença renal crônica, 74,5% (IC 95%: 61,0; 85,3) apresentaram aumento (> P95) da espessura médio-intimal da carótida. Nos pacientes com hipertensão arterial estágios I e II, 90,9% apresentaram aumento da espessura médio-intimal da carótida. O estado nutricional, a gordura corporal e os exames laboratoriais não apresentaram associação com o aumento da espessura médio-intimal da carótida. Após ajuste multivariado, apenas a puberdade (RP = 1,30; p = 0,037) e a hipertensão arterial estágios I e II (RP = 1,42; p = 0,011) mostraram-se independentemente associados à alteração da espessura médio-intimal da carótida. Conclusão: A prevalência do aumento da espessura da carótida foi elevada em crianças e adolescentes com doença renal crônica. A puberdade e a hipertensão arterial mostraram-se independentemente associadas ao aumento da espessura médio-intimal da carótida.

Evaluation of carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease.

OBJECTIVE: To assess the carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease. MATERIAL AND METHODS: Observational, cross-sectional study carried out at the Universidade Federal de São Paulo (chronic kidney disease outpatient clinics) with 55 patients (60% males) with a median age of 11.9 years (I25-I75: 9.2-14.8 years). Of the 55 patients, 43 were on conservative treatment and 12 were on dialysis. Serum laboratory parameters (creatinine, uric acid, C-reactive protein, total cholesterol and fractions, and triglycerides), nutritional status (z-score of body mass index, z-score of height/age), body fat (fat percentage and waist circumference), and blood pressure levels were evaluated. The carotid intima-media thickness measure was evaluated by a single ultrasonographer and compared with percentiles established according to gender and height. Data collection was performed between May 2015 and March 2016. RESULTS: Of the children and adolescents with chronic kidney disease, 74.5% (95% CI: 61.0; 85.3) showed an increase (>P95) in carotid intima-media thickness. In patients with stages I and II hypertension, 90.9% had increased carotid intima-media thickness. Nutritional status, body fat and laboratory tests were not associated with increased carotid intima-media thickness. After multivariate adjustment, only puberty (PR=1.30, p=0.037) and stages I and II arterial hypertension (PR=1.42, p=0.011) were independently associated with carotid intima-media thickness alterations. CONCLUSION: The prevalence of increased carotid thickness was high in children and adolescents with chronic kidney disease. Puberty and arterial hypertension were independently associated with increased carotid intima-media thickness.

Avaliação nutricional de crianças com doença renal crônica / Nutritional status of children with chronic renal failure

OBJETIVO:Desnutrição constitui uma frequente complicação em crianças portadoras de doença renal, sendo a baixa estatura o principal sinal clínico. O objetivo deste estudo é analisar o estado nutricional de crianças portadoras de doença renal por meio da antropometria. MÉTODOS:Estudo transversal que avaliou 21 (43 por cento) meninos e 28 (57 por cento) meninas, com idades entre 5,3 e 19,5 anos. As crianças foram divididas em três grupos, de acordo com o clearance (mL/min/1,73m2): Grupo 1, clearance >37 (n=19); Grupo 2, entre 15 e 37 (n=9) e Grupo 3 com clearance <15 (n=21). A partir do peso e da estatura, calcularam-se os seguintes indicadores: Peso/Idade (P/I), Estatura/Idade (E/I) e índice de massa corpórea (IMC) e obtiveram-se os escores Z respectivos. Escores Z menores que -2 foram considerados desnutrição. Os grupos foram comparados por ANOVA. RESULTADOS:Não se evidenciaram diferenças entre os grupos no que diz respeito aos dados antropométricos. 19 pacientes (38,8 por cento) apresentaram baixa estatura e 22 (44,8 por cento), baixo peso. Também não se observaram diferenças entre os grupos quando comparados pelos valores dos indicadores P/I, E/I e IMC. Os valores dos escores Z para os indicadores P/I, E/I e IMC foram: P/I - Grupo 1: -1,9±1,8; Grupo 2: -2,6±3,1; Grupo 3: -2,5±1,4 (p=0,47); E/I - Grupo 1: -1,5±1,2; Grupo 2: -2,3±1,8; Grupo 3: -2,1±1,1 (p=0,18) e IMC - Grupo 1: -1,2±1,4; Grupo 2: -1,7±3,9; Grupo 3: -1,6±1,3 (p=0,82). CONCLUSÕES: A amostra estudada apresentou alta prevalência de desnutrição. Mesmo considerando-se o estágio da doença, não se encontraram diferenças significativas entre os grupos.

OBJECTIVE:Malnutrition is a frequent complication among children with renal diseases. Short stature is the main clinical sign. The aim of this study is to analyze the nutritional status of children with renal disease using anthropometry. METHODS: This cross sectional study enrolled 21 (43 percent) boys and 28 (57 percent) girls with age ranging from 5.3 to 19.5 years. They were divided in three groups based on their creatinine clearance (mL/min/1.73m²): Group 1, >37 (n=19); Group 2, between 15 and 37 (n=9) and Group 3, <15 (n=21). Weight and height were obtained in order to calculate the following indexes: Weight/age (W/A), height/age (H/A) and body mass index (BMI); then, Z scores were obtained. Malnutrition was defined as Z scores below -2. ANOVA test was used to compare groups. RESULTS: There were no differences among the groups for anthropometric data. 19 patients (38.8 percent) presented short-stature and 22 (44.8 percent) low-weight. Z scores were similar among groups relative to W/A, H/A and BMI values. W/A Z score values were: Group 1: -1.9±1.8; Group 2: -2.6±3.1 and Group 3: -2.5±1.4 (p=0.47). H/A Z scores values were: Group 1: -1.5±1.2; Group 2: -2.3±1.8 and Group 3: -2.1±1.1 (p=0.18). The calculated BMI Z scores were: Group 1: -1.2±1.4; Group 2: -1.7±3.9 and Group 3: -1.6±1.3 (p=0.82). 19 children presented short stature and 22 presented low weight. There were no differences between the studied groups. CONCLUSIONS: The sample presented high prevalence of malnutrition. Even considering the disease stage, there were no nutritional differences between the studied groups.

Efeito da acupuntura no tratamento de pacientes portadores de sono näo reparador / Acupuncture effect in the treatment of patients with non-repairing sleep

Os distúrbios do sono, principalmente o sono näo reparador, constituem um dos achados mais freqüentes na clínica diária. Estäo, geralmente, relacionados à dores crônicas do sistema músculo-esquelético, fadiga crônica e alteraçöes emocionais. Material - Foram estudados 23 pacientes com sono näo reparador, dos quais 22 do sexo feminino e 1 do sexo masculino. O tempo médio de duraçäo da queixa foi de 6 anos e 4 meses (mínimo de 6 meses e máximo de 20 anos). Método - Os pacientes foram avaliados e tratados individualmente, de acordo com suas manifestaçöes clínicas e energéticas. Em todos os pacientes, foram usados os pontos B-62 (Shenmmai), ID-3 (Houxi) e R-3 (Taixi). De acordo com suas sintomatologias, foram utilizados os seguintes pontos específicos: distúrbios emocionais: VG-20 (Baihui), Yin Tang, C-7 (Shenmen) e VC-17 (Shanzhong); enxaqueca: VB-41 (Linqi), TA-5 (Waiguan) e TaiYang; enxaqueca catamenial: VB-3 (Shangguan), VB-4 (Hanyan), VB-5 (Xuanlu), BP-6 (Sanyinjiao) e VC-3 (Zhongji); epigastralgia: E-36 (Zusanli), VC-12 (Zhongwan), IG-4 (Hegu) e E-25 (tianshu); cervicodorsalgia: VB-21 (Jianjing), VG-14 (Dazhui) e VG-16 (Fengfu); lombalgia: B-27 (Xiaochangshu); B-28 (Pangguangshu) e B-32 (Ciliao); gonalgia: 4 pontos curiosos locais do joelho, F-8 (Ququan), E-36 (Zusanli) e VB-34 (Yanglingquan). Foram realizadas duas aplicaçöes semanais de acupuntura, totalizando 15, com agulhas individuais e esterelizadas, 40x30x0,30mm (Lautz). Resultado - Os testes de Freidman, Kappa de concordância e de McNemar, aplicados aos dados, mostraram melhora significante em relaçäo à insônia, cansaço ao acordar (SNR), dores crônicas, contraturas musculares matinais, fadiga, sono tranqüilo e disposiçäo para lazer. Nos parâmetros emocionais, os testes näo mostraram diferença significante entre a situaçäo de pré e pós-tratamento. Conclusäo - O estudo evidenciou melhora significante, segundo a metodologia empregada, no tratamento de pacientes que apresentavam sono näo reparador e seus sintomas associados. Näo se verificou melhora significante nas manifestaçöes emocionais dos pacientes.