Phosphate and IL-10 concentration as predictors of long-covid in hemodialysis patients: A Brazilian study.

Background: The global burden of persistent COVID-19 in hemodialysis (HD) patients is a worrisome scenario worth of investigation for the critical care of chronic kidney disease (CKD). We performed an exploratory post-hoc study from the trial U1111-1237-8231 with two specific aims: i) to investigate the prevalence of COVID-19 infection and long COVID symptoms from our Cohort of 178 Brazilians HD patients. ii) to identify whether baseline characteristics should predict long COVID in this sample. Methods: 247 community-dwelling older (>60 years) patients (Men and women) undergoing HD (glomerular filtration rate < 15 mL/min/1.73m2) with arteriovenous fistula volunteered for this study. All patients presented hypertension and diabetes. Patients were divided in two groups: without long-COVID and with long-COVID. Body composition, handgrip strength, functional performance, iron metabolism, phosphate, and inflammatory profile were assessed. Patients were screened for 11-months after COVID-19 infection. Results were considered significant at P < 0.05. Results: We found that more than 85% of the COVID-19 infected patients presented a severe condition during the infection. In our sample, the mortality rate over 11-month follow was relatively low (8.4%) when compared to worldwide (approximately 36%). Long COVID was highly prevalent in COVID-19 survivors representing more than 80% of all cases. Phosphate and IL-10 were higher in the long COVID group, but only phosphate higher than 5.35 mg/dL appears to present an increased prevalence of long COVID, dyspnea, and fatigue. Conclusion: There was a high prevalence of COVID-19 infection and long COVID in HD patients from the Brazilian trial 'U1111-1237-8231'. HD clinics should be aware with phosphate range in HD patients as a possible target for adverse post-COVID events.

Dynamic not isometric training blunts osteo-renal disease and improves the sclerostin/FGF23/Klotho axis in maintenance hemodialysis patients: a randomized clinical trial.

This study compared the effectiveness of dynamic resistance training (DRT) versus isometric RT (IRT) on osteogenesis and hormonal mechanisms involved in maintenance hemodialysis (MHD) patients. One hundred and ninety-three MHD patients were randomized into three groups: control (CTL) (n = 60), DRT (n = 66), and IRT (n = 67). A first visit was required for an anamnesis to evaluate the number of medications, biochemical, and anthropometric measurements (dialysis adequacy, creatinine, urea, body mass, height, and body mass index). Grip strength, bone mineral density (BMD), and renal-bone markers were assessed pre- and postprotocol. The DRT and IRT training was 6 mo with a frequency of three times per week, on alternate days. Each training session consisted of three sets of 8 to 12 repetitions at lower and moderate intensities. Both training sessions were prescribed approximately 1 h prior to dialysis. Statistical significances were adopted with P < 0.05. There was a greater dropout in the IRT group (24%) as compared with the DRT group (14%), which in turn had less adverse clinical effects (67%, 24%, and 61% for CTL, DRT, and IRT, respectively). DRT promoted gains in BMD in different body locations, in addition to increasing pro-osteogenic factors (Klotho and calcitriol) and reducing those related to bone loss, such as sclerostin, FGF23, and PTH. There was an improvement in Ca × PO43 for DRT, whereas these benefits did not occur in the IRT group (P < 0.05). These novel findings suggest that the DRT generates biopositive adaptations in bone tissue in MHD and can be used as a nonpharmacological strategy to improve BMD.NEW & NOTEWORTHY This study shows, for the first time, the effect of dynamic and isometric resistance training on bone mineral density in hemodialysis patients, providing a new understanding of the possible participation of the sclerostin/FGF23/Klotho axis, vitD, PTH, and calcium × phosphate product in this process. However, isometric resistance training may not be sufficient to induce these benefits. Therefore, this study supports the potential therapeutic role of dynamic resistance training counteracting chronic kidney disease-mineral and bone disorder.

A capacidade preditiva de indicadores de composicao corporal, aptidao aeróbia e coordenacao motora sobre a atencao e funcao executiva em criancas de 6 a 11 anos / The predictive capacity of anthropometric indicators, body composition, aerobic fitness and motor coordination on the performance of attention and executive function in children aged 6 to 11 years

Verificar a associação e indicadores de predição do desempenho atencional e função executiva frente as variáveis antropométricas, aeróbias e motoras de crianças. Participaram do estudo 351 estudantes com idades entre 6 a 11 anos, alunos de três escolas, duas da rede privada e uma pública situadas no Distrito Federal. Os pesquisadores realizaram 3 visitas para aplicação dos instrumentos de pesquisa, realizados de forma randomizada, sendo determinadas por sorteios. Os instrumentos de pesquisa foram aplicados dentro das dependências da escola, divididos em três blocos: 1) teste de atenção por cancelamento e teste de trilhas A e B (aplicados de forma coletiva); 2) testes de capacidade aeróbia Intermittent Recovery Test ­ level 1 (Yo-Yo); 3) anamnese, composição corporal e o teste Körperkoordination für Kinder (KTK). A competência motora ≥70,5 e ≥69,45 escores mostrou-se preditora da atenção (área=0,63; IC=0,55-0,70) e função executiva (área=0,86; IC=0,82-0,90), respectivamente e estes indicadores representam 2,52 e 8,41 vezes mais chances de acontecerem em comparação as crianças que obtiveram menor valores de escore motor. A circunferência da cintura apresentou-se como um bom preditor da atenção (área=0,68; IC=0,61-0,76), e função executiva (área=0,61; IC=0,53-0,58), desta forma, as crianças com circunferência da cintura ≤ 63,5 e ≤ 69,5 apresentaram uma proporção de 60 a 28% maior de chances de alcançarem maiores valores de atenção e função executiva respectivamente. O percentual de gordura corporal também demonstrou capacidade de preditiva da atenção (≤27,7% área=0,61; IC=0,53-0,68) e função executiva (≤25,8% área=0,62; IC=0,5 6-0,69). A circunferência da cintura, percentual de gordura corporal e coordenação motora destacaram-se por apresentarem capacidade preditiva sobre o desempenho da atenção e FE. Ademais, a co ordenação motora e circunferência da cintura podem ser utilizadas como indicadores de risco ou performance daatenção e FE em crianças de 6 a 11 anos....(AU)