Untargeted plasma 1H NMR-based metabolomic profiling in different stages of chronic kidney disease.

Chronic kidney disease (CKD) is a serious public health issue affecting thousands of people worldwide. CKD diagnosis is usually made by Estimated Glomerular Filtration Rate (eGFR) and albuminuria, which limit the knowledge of the mechanisms behind CKD progression. The aim of the present study was to identify changes in the metabolomic profile that occur as CKD advances. In this sense, 77 plasma samples from patients with CDK were evaluated by 1D and 2D Nuclear Magnetic Resonance Spectroscopy (NMR). The NMR data showed significant changes in the metabolomic profile of CKD patients and the control group. Principal component analysis (PCA) clustered CKD and control patients into three distinct groups, control, stage 1 (G1)-stage 4 (G4) and stage 5 (G5). Lactate, glucose, acetate and creatinine were responsible for discriminating the control group from all the others CKD stages. Valine, alanine, glucose, creatinine, glutamate and lactate were responsible for the clustering of G1-G4 stages. G5 was discriminated by calcium ethylenediamine tetraacetic acid, magnesium ethylenediamine tetraacetic acid, creatinine, betaine/choline/trimethylamine N-oxide (TMAO), lactate and acetate. CKD G5 plasma pool which was submitted in MetaboAnalyst 4.0 platform (MetPA) analysis and showed 13 metabolic pathways involved in CKD physiopathology. Metabolic changes associated with glycolysis and gluconeogenesis allowed discriminating between CKD and control patients. The determination of involved molecules in TMAO generation in G5 suggests an important role in this uremic toxin linked to CKD and cardiovascular diseases. The aforementioned results propose the feasibility of metabolic assessment of CKD by NMR during treatment and disease progression.

Comparative metabolomic study of high-flux hemodialysis and high volume online hemodiafiltration in the removal of uremic toxins using 1H NMR spectroscopy.

Uremic toxins (UTs) accumulate in the circulation of patients with chronic kidney disease (CKD). High volume hemodiafiltration (HDF) improves clearance of low and medium molecular weight UTs compared to HD. The present study is a post-hoc analysis comparing the metabolomic profile in serum from patients under high flux HD (hf-HD) and HDF in HDFIT, a multicentric randomized controlled trial (RCTs). Per protocol, serum samples were collected pre- and post- dialysis treatments at randomization (baseline) and at the end of the follow up (6 months) and stored in a biorepository. Random (pre- and post-dialysis) samples from nine patients in study arm were selected at baseline and at the end of the follow up. To compare the samples, 26 possibly matching metabolites were identified by a t-test among the four groups using 1H nuclear magnetic resonance (NMR). To evaluate the comparison between the modalities is a single treatment session, the clearance rates (CRs) of each metabolite were calculated based on pre-dialysis and post-dialysis samples. In addition, to evaluate to effect of UT removal during the trial follow up period, the pre-dialysis metabolite concentrations at the baseline and at 6 months were compared among the two arms of the study. There was no significant difference between in the single session CRs of metabolites when hf-HD and HDF were compared. On the other hand, the comparison between baseline and 6-month (long-term evolution) led to the identification of 16 metabolites that differentiated the hf-HD and the HDF evolutions. Most of these 16 metabolites are involved in several important metabolic pathways, such as metabolism of phenylalanine and biosynthesis of phenylalanine, tyrosine, and tryptophan, which are related to UTs and cardiovascular disease development. Although no difference was observed between hf-HD and HDF samples before and after a single session, concentrations of CKD-relevant metabolites and associated pathologies were stable in the HDF samples, but not in the hf-HD samples, over the six-month period, suggesting that HDF enhances long-term stability.

Functional and Oncological Outcomes of Renal Surgery for Hilar Tumors: Informing the Decisions in Risk-Adapted Management.

OBJECTIVE: To describe the safety and efficacy of partial nephrectomy (PN) in comparison to radical nephrectomy (RN) for surgically managed renal hilar tumors. MATERIALS AND METHODS: We retrospectively reviewed institutional records of patients with a small (<5 cm) solitary renal (hilar or non-hilar) mass who underwent PN or RN between 2008 and 2018. Hilar tumors were defined as those at medial position, abutting the renal vessels. Recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier method. RESULTS: Of 1,951 eligible patients, 399 had hilar tumors (292 scheduled for PN, 107 RN) and 1,552 had non-hilar tumors (scheduled for PN). We found no significant differences in survival measures between hilar and non-hilar tumors in patients selected for PN. Patients scheduled for PN for hilar tumors had higher rates of ≥grade II postoperative surgical complications compared to patients scheduled to receive PN for non-hilar tumors (13% vs 8.6%; log-rank P = .018) and non-statistically significantly elevated rates of ≥grade II complications compared to patients scheduled for RN for hilar tumors (13% vs 6.5%; difference 6%, 95% CI 0.4%, 13%; log-rank P = .07). CONCLUSION: PN for hilar and non-hilar renal masses (<5cm) experience comparable oncologic outcomes though increased risk of complications for hilar masses. PN for hilar tumors was associated with better renal function and overall survival with non-statistically elevated risk of grade II or higher complications than RN. A renal tumor located at the hilum should not be a contra-indication for performing PN.

Validity and reproducibility of the sargent jump test in the assessment of explosive strength in soccer players.

The purpose of this study was to check the validity and the intra- and inter-evaluators reproducibility of the Sargent Jump Test, as an instrument of explosive strength measurement of soccer players of the sub-15 class. Forty-five soccer players were randomly selected from different clubs competing in the local soccer championship. All subjects performed one test on the same jump platform model Jumptest(®) (Hidrofit Ltda, Brazil) and two independent Sargent Jump Tests assessed by the same evaluator. Two days later, another Sargent Jump Test was performed simultaneously assessed by 2 evaluators. In all tests, three jumps were performed and the highest one was registered. In order to check the validity, the first Sargent Jump Test results were compared to those from the jump platform, considered the gold standard. To evaluate intra- and inter-evaluator reproducibility, results from the first, second and third Sargent Jump Tests were analyzed. The validity and reproducibility were evaluated by intraclass correlation coefficients (ICC), and by the Bland and Altman test (statistical pack SPSS 11.0), with a significance level set at p<0.05. The values found for validity (r=0.99, p=0.001), for intra-evaluator reproducibility (r=0.99, p=0.001) and for inter-evaluator reproducibility (r=1.0, p=0.001), permitted us to conclude that the Sargent Jump Test is a valid and reproducible instrument for measuring the explosive strength in homogeneous groups, such as those used in the present study.

Resposta autonômica cardíaca e cardiorrespiratória em atletas de voleibol versus indivíduos treinados / Autonomic cardiac and cardiorespiratory responses in volleyball athletes compared to trained individuals

Fundamentos: Durante exercício progressivo descreve-se a redução da variabilidade da frequência cardíaca (VFC) e, no período pós-exercício, o comportamento da VFC parece depender de variáveis como duração, tipo e intensidade do estímulo. Objetivo: Investigar e comparar a modulação autonômica cardíaca, através da análise da VFC, em atletas e indivíduos treinados. Métodos: 14 indivíduos saudáveis do sexo masculino, estratificados em dois grupos : Atletas (AT) (n=7; 24,5 +- 7,6 anos; 76,2 +- 9,2kg; 24,5 +- 5,5kg/m²...