Oxidation State in Peritoneal Dialysis in Patients with Type 2 Diabetes Mellitus.

End-stage renal disease (ESRD) progression is closely related to oxidative stress (OS). The study objective was to determine the oxidant and antioxidant status in peritoneal dialysis (PD) patients with type 2 diabetes mellitus (DM). An analytical cross-sectional study from the PD program was carried out with 62 patients, 22 with and 40 without DM. Lipoperoxides (LPO) levels in patients with DM, 3.74 ± 1.09 mM/L, and without DM, 3.87 ± 0.84 mM/L were found to increase compared to healthy controls (HC) 3.05 ± 0.58 mM/L (p = 0.006). The levels of the oxidative DNA damage marker (8-OH-dG) were found to be significantly increased in patients with DM, 1.71 ng/mL (0.19-71.92) and without DM, 1.05 ng/mL (0.16-68.80) front to 0.15 ng/mL (0.15-0.1624) of HC (p = 0.001). The antioxidant enzyme superoxide dismutase (SOD) activity was found to be significantly increased in patients with DM, 0.37 ± 0.15 U/mL, and without DM, 0.37 ± 0.17 compared to HC, 0.23 ± 0.05 U/mL (p = 0.038). The activity of the enzyme glutathione peroxidase (GPx) showed a significant increase (p < 0.001) in patients with DM, 3.56 ± 2.18 nmol/min/mL, and without DM, 3.28 ± 1.46 nmol/min/mL, contrary to the activity obtained in HC, 1.55 ± 0.34 nmol/min/mL. In conclusion, we found an imbalance of oxidative status in patients undergoing PD with and without DM through the significant increase in LPO oxidants and the marker of oxidative damage in DNA. The activity of the antioxidant enzymes SOD and GPx were significantly increased in patients with and without DM undergoing PD, possibly in an attempt to compensate for the deregulation of oxidants. Antioxidant enzymes could be promising therapeutic strategies as a complement to the management of chronic kidney diseases.

The Influence of the Severity of Early Chronic Kidney Disease on Oxidative Stress in Patients with and without Type 2 Diabetes Mellitus.

Early Chronic Kidney Disease (CKD) is a condition that tends to progress to End-Stage Kidney Disease (ESKD). Early diagnosis of kidney disease in the early stages can reduce complications. Alterations in renal function represent a complication of diabetes mellitus (DM). The mechanisms underlying the progression of CKD in diabetes could be associated with oxidative and inflammatory processes. This study aimed to evaluate the state of inflammation and oxidative stress (OS) on the progression of CKD in the early stages in patients with and without type 2 diabetes mellitus (T2DM). An analytical cross-sectional study was carried out in patients with CKD in early stages (1, 2, 3) with and without T2DM. The ELISA method determined the expression of pro-inflammatory cytokines IL-6 and TNF-α as well as lipoperoxides (LPO), nitric oxide (NO), and superoxide dismutase activity (SOD). Colorimetric methods determined glutathione peroxidase (GPx) and total antioxidant capacity (TAC). Patients with CKD and T2DM had significantly decreased antioxidant defenses for SOD (p < 0.01), GPx (p < 0.01), and TAC (p < 0.01) compared to patients without T2DM. Consequently, patients with T2DM had higher concentrations of oxidant markers, NO (p < 0.01), inflammation markers, IL-6 (p < 0.01), and TNF-α than patients without T2DM. CKD stages were not related to oxidative, antioxidant, and inflammatory marker outcomes in T2DM patients. Patients without T2DM presented an increase in SOD (p = 0.04) and a decrease in NO (p < 0.01) when the stage of CKD increased. In conclusion, patients with T2DM present higher levels of oxidative and inflammatory markers accompanied by a decrease in antioxidant defense. However, these oxidative status markers were associated with CKD stage progression in patients without T2DM. Thus, NO and SOD markers could help detect the early stages of CKD in patients who have not yet developed metabolic comorbidities such as T2DM.

Soporte nutricional en lesión renal aguda / Nutritional support in acute kidney injury

El desgaste proteico energético (DPE) es altamente prevalente en pacientes con lesión renal aguda (LRA), lo que incrementa la mortalidad, complicaciones y el uso de recursos sanitarios. Los objetivos del soporte nutricional (SN) incluyen: adecuar el aporte de nutrientes, prevenir el DPE, preservar la masa corporal magra, mantener el estado nutricional, evitar otros trastornos metabólicos, mejorar la cicatrización de heridas, apoyar la función inmune y reducir la mortalidad. Los pacientes con LRA en terapia de reemplazo renal (TRR) deben recibir al menos 1.5 g/kg/d de proteína y no más de 30 kcal no proteicas/kg/d. Se deben tomar en cuenta las pérdidas de macronutrientes y micronutrientes especialmente en los diferentes tipos de TRR, así como las alteraciones metabólicas, subalimentación o sobrealimentación. La nutrición enteral debe ser la primera elección de alimentación, sin embargo, la nutrición parenteral sola o combinada debe ser utilizada para alcanzar los objetivos nutricionales. El SN debe ser temprano durante las primeras 24-48 hrs. Los requerimientos nutricionales y el tipo de SN deben ser individualizados y reevaluados con frecuencia en pacientes con LRA (AU)

Protein-energy wasting (PEW) is highly prevalent in patients with acute kidney injury (AKI), increasing mortality, complications and use of health resources. The goals of nutritional support (NS) include: adequate intake of nutrients, prevent PEW, preservation of lean body mass, maintenance of nutritional status, avoidance of further metabolic derangements, enhancement of wound healing, support of immune function and reduction in mortality. Patients with AKI on renal replacement therapy (RRT) should receive at least 1.5 g/kg/d of protein and not more than 30 nonprotein kcal/kg/d. It should be taken into account losses macronutrients and micronutrients specially in the different types of RRT, metabolic alterations and underfeeding or overfeeding. Enteral nutrition should be the first choice of feeding, however, alone or complementary parenteral nutrition should be used to achieve nutritional goals. NS should be early in the first 24-48 hrs. The nutritional requirements and type of NS should be frequently reassessed and individualized in patients with AKI (AU)

Oxidative Stress in Diabetic Nephropathy with Early Chronic Kidney Disease.

The increase in the prevalence of diabetes mellitus (DM) and the secondary kidney damage produces diabetic nephropathy (DN). Early nephropathy is defined as the presence of microalbuminuria (30-300 mg/day), including normal glomerular filtration rate (GFR) or a mildly decreased GFR (60-89 mL/min/1.73 m(2)), with or without overt nephropathy. The earliest change caused by DN is hyperfiltration with proteinuria. The acceptable excretion rate of albumin in urine is <30 mg/day. Albuminuria represents the excretion of >300 mg/day. Chronic kidney disease (CKD) is characterized by abnormalities in renal function that persist for >3 months with health implications. Alterations in the redox state in DN are caused by the persistent state of hyperglycemia and the increase in advanced glycation end products (AGEs) with ability to affect the renin-angiotensin system and the transforming growth factor-beta (TGF-ß), producing chronic inflammation and glomerular and tubular hypertrophy and favoring the appearance of oxidative stress. In DN imbalance between prooxidant/antioxidant processes exists with an increase in reactive oxygen species (ROS). The overproduction of ROS diminishes expression of the antioxidant enzymes (manganese superoxide dismutase, glutathione peroxidase, and catalase). The early detection of CKD secondary to DN and the timely identification of patients would permit decreasing its impact on health.

[ASSOCIATION OF SERUM ALBUMIN AND SUBJECTIVE GLOBAL ASSESSMENT ON INCIDENT PERITONEAL DIALYSIS PATIENTS]. / ASOCIACIÓN DE ALBÚMINA SÉRICA Y VALORACIÓN GLOBAL SUBJETIVA EN PACIENTES INCIDENTES EN DIÁLISIS PERITONEAL.

INTRODUCTION: serum albumin the biomarker most frequently used as one of three biochemical criteria for diagnosis of protein energy wasting (PEW). However, as a nutritional parameter it's unreliable in chronic kidney disease (CKD). The subjective global assessment (SGA) has been recommended for nutritional evaluation and the PEW in CKD. OBJECTIVE: determine association between the levels of serum albumin and SGA in patients with end stage renal disease (ESRD) who started peritoneal dialysis (PD). METHODS: a cross-sectional study in patients with ESRD were evaluated prior to starting PD. Levels of serum albumin were determined and nutritional assessment was performed by SGA. RESULTS: 69 patients, 46 (67%) men and 23 (33%) women, average age 39.97 ± 18.30 years old, serum albumin 2.75 ± 0.65 g/dl, creatinine 18.91 ± 10.98 mg/dl, urea 314.80 ± 152.74 mg/dl and BMI 23.37 ± 3.79 kg/m2, median of GFR 3 (1-12) mL/min/1.73m2. The SGA showed that 34.8% was well nourished, 40.6% had risk of moderate PEW and the 24.6% had severe PEW. There was no association (p = ns) between the levels of serum albumin and SGA. CONCLUSION: the present study shows hypoalbuminemia and PEW are very frequent. The identification of levels of serum albumin and SGA at the beginning of PD in our population could be predictors of mortality. Serum albumin is not a useful tool for nutritional assessment in patients with ERSD who initiate PD.

Introducción: la albúmina sérica es el biomarcador más frecuentemente utilizado como uno de los tres criterios bioquímicos para el diagnóstico del desgaste proteico energético (DPE). Sin embargo, como parámetro nutricional es poco fiable en la enfermedad renal crónica (ERC). La valoración global subjetiva (VGS) ha sido recomendada para la evaluación nutricional y del DPE en ERC. Objetivo: determinar la asociación de los niveles de albúmina sérica y la VGS en pacientes con insuficiencia renal crónica terminal (IRCT) que iniciaron diálisis peritoneal (DP). Métodos: estudio transversal analítico en pacientes con IRCT que fueron evaluados previo a iniciar DP. Se determinaron niveles de albúmina sérica y se realizó una evaluación nutricional mediante la VGS. Resultados: 69 pacientes, 46 (67%) hombres y 23 (33%) mujeres, con una media de edad de 39,97 ± 18,30 años, albúmina sérica 2,75 ± 0,65 g/dl, creatinina 18,91 ± 10,98 mg/dl, urea 314,80 ± 152,74 mg/dl e IMC 23,37 ± 3,79 kg/m2, la mediana de TFG 3 (1-12) mL/min/1,73m2. La VGS mostró que el 34,8% estaba bien nutrido, el 40,6% tenía riesgo de DPE o moderado y el 24,6% presentaba un DPE severo. No existió asociación (p = ns) entre los niveles de albúmina sérica y la VGS. Conclusión: el presente estudio muestra que la hipoalbuminemia y el DPE son muy frecuentes. La identificación de los niveles de albúmina sérica y la VGS al iniciar DP en nuestra población pudieran ser predictores de mortalidad. La albúmina sérica no es una herramienta útil para la evaluación nutricional en pacientes con IRCT que iniciarán DP.