Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2016-08-16T13:27:51Z No. of bitstreams: 1 beatrizdossantospereira.pdf: 3704904 bytes, checksum: 30a0537d5394d6cb609a69894efa6376 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-08-17T12:49:14Z (GMT) No. of bitstreams: 1 beatrizdossantospereira.pdf: 3704904 bytes, checksum: 30a0537d5394d6cb609a69894efa6376 (MD5) / Made available in DSpace on 2016-08-17T12:49:14Z (GMT). No. of bitstreams: 1 beatrizdossantospereira.pdf: 3704904 bytes, checksum: 30a0537d5394d6cb609a69894efa6376 (MD5) Previous issue date: 2016-06-29 / Introdução: No Brasil há um aumento da prevalência de doenças crônicas, constituindo atualmente um problema de Saúde Pública com grande demanda por parte dos serviços de saúde. Dentre estas, encontra-se a Doença Renal Crônica (DRC), com um acréscimo constante do número de pessoas em diálise, presença de altos índices de mortalidade e incapacidades crônicas. Estar em uma condição de doença crônica traz ao paciente sentimentos que, para sua elaboração, será fundamental o papel da equipe de saúde e do cuidador familiar principal. Percebe-se portanto, que assim como o paciente, a família é significativamente afetada pela DRC e por seu tratamento, pois terá que se adaptar à persistência de um quadro clínico que apresenta instabilidade e incertezas, com necessidades de cuidados permanentes, a custo de grande sobrecarga nos mais diversos aspectos de suas vidas. Nesse contexto, em que a família constitui um grupo de risco para o desenvolvimento de sintomas psicológicos (como estresse, depressão etc.), bem como de diversas enfermidades crônicas, muitas vezes provenientes da negligência com o autocuidado, se faz fundamental avaliar como ocorre a elaboração do processo de adoecimento nesse grupo, em seus mais variados aspectos, para que se possa traçar melhores estratégias de intervenção. Objetivo: avaliar a saúde mental de pacientes renais crônicos e seus cuidadores e sua associação com os sintomas de ansiedade, depressão, estresse, fadiga, suporte social e qualidade de vida, bem como com as características clínicas dos pacientes. Método: estudo transversal em 21 pacientes e seus cuidadores, no período de Janeiro a Setembro de 2015. Amostra por conveniência onde foram incluídos participantes com idade >18 anos, há no mínimo 6 meses de tratamento e cuidadores familiares. Foram avaliadas variáveis sociodemográficas, clínicas, laboratoriais e psicológicas. Realizada análise descritiva e a associação entre pacientes e cuidadores. Resultados: Dentre os pacientes foi observado 38,1% com sintomas indicativos de ansiedade e depressão. As médias de Suporte Social Prático foram de 3,15±0,77 e para Suporte Social Emocional 3,16±0,79. Com relação à Fadiga, 14,3% se declaram extremamente cansados e 14,3% declaram fazer todas as atividades que habitualmente faziam. Dos 57,1% que apresentavam estresse, 66,7% estavam na Fase de Resistência com predominância de sintomas psicológicos em 60,0% dos mesmos. O domínio Capacidade Funcional (CF) da Qualidade de Vida mostrou correlação com Hemoglobina (r=0,581, p=0,006) e pacientes não anêmicos apresentaram melhor CF (p=0,075). Nos cuidadores observou-se 33,3% com sintomas indicativos de ansiedade e depressão. No Suporte Social Prático obtiveram média de 2,88 ±0,77 e Suporte Social Emocional com 3,0±0,72. 14,3% relataram estar extremamente cansados e 28,8% afirmaram fazer quase todas as atividades que habitualmente faziam. Na comparação de ambos os grupos observa-se que apresentam resultados semelhantes quanto à presença de ansiedade e depressão e fadiga. Cuidadores recebem menos suporte social que pacientes. Ambos os grupos apresentam predominância semelhante de níveis de estresse, porém, pacientes apresentam maior predominância de sintomas psicológicos. Com relação à Qualidade de vida, nos Aspectos Sociais, Vitalidade, Saúde Mental e o grande Domínio Mental, pacientes e cuidadores apresentam resultados semelhantes. Conclui-se que a Saúde Mental de pacientes e cuidadores apresenta níveis semelhantes e ambos, no contexto da doença renal dialítica, devem obter intervenções específicas. / Introduction: To treat Chronic Kidney Disease (CKD) at the final stage, performance of Renal Replacement Therapies (RRT) is required, these require important changes in living habits and patients frequently need caregivers. These are risk groups for development of physical and psychological symptoms. Objective: evaluate predominance of anxiety, depression, stress, fatigue, social support and quality of life in patients with CKD and their caregivers. Method; cross study of 21 patients and their caregivers, during the period from January to September 2015. Sample according to convenience where patients over 18 years old were included, with at least 6 months of treatment and family member caregivers. Social, demographic, clinical, laboratory and psychological variables were evaluated. Descriptive analysis and association between patients and caregivers were performed. Results: Among patients we observed that 38.1% had symptoms that indicated anxiety and depression. Averages for Practical Social Support were 3.15±0,769 and for Emotional Social Support were 3.16±0,79. As for Fatigue, 14.3% of patients declare themselves extremely tired and 14.3% declared doing all activities they usually performed before. 57.1% presented stress, of these, 66.7% were at the Resistance Stage with predominance of psychological symptoms in 60.0%. The Quality of life domain of Functional Capacity (FC) presented a correlation with Hemoglobin (r=0.581, p=0.006) and non-anemic patients presented better FC. We observed symptoms that indicated anxiety and depression in 33.3% of caregivers. Caregivers obtained average of 2.88 ±0.77 for Practical Social Support and 3.0±0.72 for Emotional Social Support. 14.3% reported being extremely tired and 28.8% declared doing all activities they usually performed before. When comparing both groups we observed they present similar results for presence of anxiety, depression and fatigue. Caregivers receive less social support than patients. Both groups present similar predominance of stress levels, however, patients presented more predominance of psychological symptoms. For Quality of life, patients and caregivers presented similar results for Social Aspects, Vitality, Mental Health and the great Mental Domain. We concluded that Mental Health of patients and caregivers presents similar levels and both, within the context of dialysis renal disease must undergo specific interventions.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-04-03T14:07:47Z No. of bitstreams: 1 danielleguedesandradeezequiel.pdf: 435681 bytes, checksum: f1943522caa7a0bc8f2ee88014392b8c (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-04-03T19:02:04Z (GMT) No. of bitstreams: 1 danielleguedesandradeezequiel.pdf: 435681 bytes, checksum: f1943522caa7a0bc8f2ee88014392b8c (MD5) / Made available in DSpace on 2017-04-03T19:02:04Z (GMT). No. of bitstreams: 1 danielleguedesandradeezequiel.pdf: 435681 bytes, checksum: f1943522caa7a0bc8f2ee88014392b8c (MD5) Previous issue date: 2009-02-06 / Introdução: A influência da síndrome metabólica sobre a hemodinâmica renal de pacientes não diabéticos tem sido pouco estudada. Objetivos: O presente estudo teve como objetivo avaliar parâmetros metabólicos e renais em portadores de síndrome metabólica antes e após perda ponderal. Material e métodos: Foram avaliados 35 indivíduos portadores de SM, antes e após três meses de prescrição de dieta hipocalórica, visando redução mínima de 5% do peso corporal. No período basal, bem como após o período de dieta, foram avaliados: glicose de jejum e 2 horas após 75 g de glicose, insulina, ácido úrico e perfil lipídico. Dentre os parâmetros renais foram avaliadas a microalbuminúria e a depuração de creatinina antes e após sobrecarga protéica aguda para avaliação da reserva funcional renal. Resultados: Foram constituídos dois grupos: pacientes que atingiram a meta de perda de peso (grupo respondedor, n=14) e pacientes que não perderam peso (grupo não respondedor, n=21). No grupo respondedor, houve redução da microalbuminúria de 109±123,2 mg/24h (mediana=163 mg/24h) para 10±6,1 mg/24 h (mediana=11 mg/24h), no período basal e após perda de peso, respectivamente (p=0,01). No período basal, a depuração da creatinina foi 122±66,5 ml/min e 117±45,0 ml/min, antes e após sobrecarga protéica aguda (p=0,443). Após perda de peso, estes valores foram 93±35,6 ml/min e 96±41,7ml/min, antes e após sobrecarga protéica aguda, respectivamente (p=0,776). Após perda de peso, além da redução da depuração da creatinina (122±66,5 ml/min vs 93±35,6 ml/min (p=0,001), foram observados aumento dos níveis de HDL colesterol de 43±11,7 para 52±10,8 (p=0,039), redução dos níveis de triglicérides de 189±79,4 mg/dl para 142±77,8 mg/dl (p=0,031), dos níveis de ácido úrico de 5±1,2 mg/dl para 4 ± 1,1 mg/dl (p=0,057) e do HOMA-IR, de 3,0±2,12 para 1,6±0,66, respectivamente (p=0,057). No grupo não respondedor, a microalbuminúria foi de 78±79 mg/24 h (mediana=174 mg/24 h) e 78±86 mg/24 h (mediana=97 mg/24 h), no período basal e após três meses (p=0,99). A depuração da creatinina no período basal foi 102±29,9 ml/min e 96±24,2ml/min, antes e após sobrecarga protéica aguda, respectivamente (p=0,125). Após intervenção, a depuração da creatinina antes e após sobrecarga protéica aguda foi 98±31,8 ml/min e 86±31,1 ml/min, respectivamente (p=0,355). De modo oposto ao grupo respondedor, neste grupo a depuração da creatinina não se modificou ao longo do estudo (102±29,9 ml/min vs 98±31,8 ml/min) (p=0,95). Da mesma forma, os parâmetros metabólicos como HDL colesterol (43±8,4 vs 41±9,8 mg/dl), triglicérides (206±98,0 vs 224±140,5 mg/dl), ácido úrico (5±0,9 vs 5±1,2 mg/dl) e HOMA-IR (3,4±2,8 vs 2,3±2,6) foram semelhantes no período basal e após três meses. Conclusão: Na mostra estudada, indivíduos não diabéticos portadores de síndrome metabólica apresentavam elevada prevalência de microalbuminúria e hiperfiltração glomerular, alterações estas atenuadas pela perda ponderal. / Introduction: Studies concerning the influence of the metabolic syndrome on renal hemodynamics in non-diabetic patients are scarce. Objectives: The objective of this study was to evaluate metabolic and renal parameters in patients with metabolic syndrome before and after weight loss. Material and methods: Thirty five patients with metabolic syndrome were evaluated before and after 3 months on a hypocaloric diet in order to achieve at least 5% of body weight loss. At baseline as well as after 3 months on diet, samples for fasting glucose, glucose 2 hours after a 75g oral glucose load, insulin, uric acid and lipid profile were collected. Among renal parameters, microalbuminuria and creatinine clearance were measured before and after acute protein overload to estimate the renal functional reserve. Results: Two groups were constituted: patients that reached the goal of weight loss (responder group, n=14) and patient that did not lose weight (non-responder group, n=22). In the responder group, there was reduction of the microalbuminuria from 109±123.2 mg/24h (median=163 mg/24h) to 10±6.1 mg/24 h (median=10.4 mg/24h), in the basal period and after weight loss, respectively (p=0.01). The creatinine clearance was 122±66.5 ml/min, in the basal period and 117±45.0ml/min, after acute protein overload (p=0.443). After weight loss, these values were 93±35.6 ml/min and 96±41.7ml/min, before and after acute protein overload, respectively (p=0.776). After weight loss besides the significant reduction on basal creatinine clearance (122±66.5 ml/min vs 93±35.6 ml/min) (p=0.001), there were increase in HDL cholesterol levels from 42.8±11.7 to 51.8±10.8 (p=0.039), and reduction in triglycerides levels from 189±79.4 mg/dl to 142±77.8 mg/dl (p=0.031), uric acid from 5±1.2 mg/dl to 4±1.1 mg/dl (p=0.057) and HOMA-IR, from 3.0±2.1 to 1.6±0.7, in the baseline and after weight loss, respectively (p=0.057). In the non-responder group, microalbuminuria was 78±79 mg/24 h (median=174 mg/24 h) and 78±86 mg/24 h (median=97 mg/24 h), in the baseline and after three months (p=0.99). The baseline creatinine clearance was 102±29.9 ml/min and 96±24.2ml/min (p=0.125) before and after acute protein overload, respectively. After 3 months, creatinine clearance before and after acute protein overload were 98±31.8 ml/min and 86±31.1 ml/min, respectively (p=0.355). Differently from responders, in non-responders group, the baseline creatinine clearance did not modify throughout the study (102±29.9 ml/min vs 98±31.8 ml/min) (p=0.95). In the same way, the metabolic parameters, HDL cholesterol (43±8.4 vs. 41±9.8 mg/dl), triglycerides (206±98.0 vs. 224±140.5 mg/dl), uric acid (5±0.9 vs. 5±1.2 mg/dl) and HOMA-IR (3.4±2.8 vs. 2.3±2.6) were similar at the baseline and after 3 months on hypocaloric diet. Conclusion: Non-diabetic individuals with metabolic syndrome presented high prevalence of microalbuminuria and glomerular hyperfiltration, which were attenuated by weight loss.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-08-11T13:00:25Z No. of bitstreams: 1 edsonjosedecarvalhomagacho.pdf: 1270417 bytes, checksum: 31d136c0dff33a402802624129e69c27 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-11T13:02:58Z (GMT) No. of bitstreams: 1 edsonjosedecarvalhomagacho.pdf: 1270417 bytes, checksum: 31d136c0dff33a402802624129e69c27 (MD5) / Made available in DSpace on 2017-08-11T13:02:58Z (GMT). No. of bitstreams: 1 edsonjosedecarvalhomagacho.pdf: 1270417 bytes, checksum: 31d136c0dff33a402802624129e69c27 (MD5) Previous issue date: 2014-04-24 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Fatores desencadeantes da Doença Renal Crônica (DRC), como hipertensão e diabetes principalmente, apresentam aumento de prevalência à medida que a população envelhece. Como desconhecemos a prevalência da DRC na pré-diálise na população brasileira e Bang e cols. propuseram um método para rastrear a DRC denominado Tabela Screening For Ocult Renal Disease (Scored), o objetivo do estudo foi validar a tabela Scored no Brasil. Trata-se de um estudo transversal cuja amostra foi de 600 servidores da Universidade Federal de Juiz de Fora (UFJF) preferencialmente. Foram coletados dados sociodemográficos, realizados exames físicos, exames de urina e sangue e os entrevistados responderam à Tabela Scored. Para determinação da presença da DRC, foram considerados os critérios de filtração glomerular (FG) < 60mL/min/1,73m2 e/ou presença de proteinúria/microalbuminúria como marcador de lesão renal identificados em um intervalo mínimo de 90 dias, como proposto pelo grupo de trabalho Kidney Disease Outcomes Quality Iniciative (K/DOQI), apoiado pela National Kidney Foundation (NKF) americana. Para validação do questionário original, foi calculada a sensibilidade, a especificidade, a acurácia, valores preditivos positivo (VPP) e negativo (VPN). O questionário Scored apresentou sensibilidade de 80%, especificidade de 65%, VPP de 14%, VPN de 97% e acurácia de 66%. A DRC foi diagnosticada pelo critério de filtração glomerular estimada < 60mL/min/1,73m2 (8,8%), por relação albumina creatinina alterada (5%) e por presença de hematúria glomerular (16,3%) no primeiro exame, tendo se confirmado no segundo exame por filtração glomerular estimada < 60mL/min/1,73m2 (3,5%), por relação albumina creatinina alterada (3%) e por presença de hematúria glomerular (9,5%). As etapas cumpridas no processo de adaptação transcultural permitiram desenvolver a versão brasileira do questionário Scored, de fácil compreensão, aceitação e de baixíssimo custo, e poderá constituir importante instrumento de rastreio de pessoas com chance de apresentar DRC. Na avaliação laboratorial da DRC, a repetição dos exames para estimativa da FG, pesquisa de proteinúria/microalbuminúria e hematúria glomerular se mostrou fundamental para conclusão diagnóstica, principalmente este último que apresentou percentuais importantes de confirmação. / Triggering factors of Chronic Kidney Disease (CKD), such as hypertension and diabetes mostly, present an increase in the prevalence as the population ages. We are unaware of the prevalence of CKD in the pre-dialysis of the Brazilian population and Bang and Cols proposed a method to track the DRC called SCORED system (Screening For Occult Renal Disease). The aim of the study was to validate the Scored table in Brazil. This is a cross-sectional study which sampled 600 employees of the Universidade Federal de Juiz de Fora (UFJF), preferably. Socio-demographic data were collected, physical examinations, urine and blood were performed and those interviewed answered the Scored Table. To determine the presence of CKD were considered the Glomerular Filtration Rates (GFR) 60mL/min/1,73m2 and also the presence of proteinuria / microalbuminuria as a marker of kidney damage identified at a interval of at least 90 days, as proposed by the working group Kidney Disease Outcomes Quality Initiative (K / DOQI), supported by the american National Kidney Foundation (NKF). For the validation of the original questionnaire, the sensitivity, specificity, and accuracy were calculated, as well as the positive predictive values (PPV) and negative predictive values (NPV). The Scored questionnaire showed a sensitivity of 80%, specificity of 65%, PPV 14%, NPV 97% and an accuracy of 66%. CKD was diagnosed according to the criteria of estimate glomerular filtration rate < 60mL/min/1,73m2 (8,8%), by the relation of amended albumin creatinine (5%) and by the presence of glomerular hematuria (16.3%) at the first examination, being confirmed in the second examination by estimate glomerular filtration rate of 60mL/min/1,73m2 (3,5%), by the relation of amended albumin creatinine (3%) and by the presence of glomerular hematuria. The steps taken in the cross-cultural adaptation process allowed the development of the Brazilian version of the Scored questionnaire, easy to understand, with good acceptance and very low cost, this may constitute an important screening tool for people with chance of having CKD. As for the laboratory evaluation of CKD, repeating the exams to estimate the GF, the search for proteinuria / microalbuminuria and glomerular hematuria proved fundamental to the diagnostic conclusion, especially this latter, which showed significant percentage of confirmation.

Bakgrund: Kronisk njursvikt är ett tillstånd som i senare stadium kräver dialysbehandling. Hemodialys är den mest förekommande typen av dialysbehandling och den sker vanligtvis på en sjukhusavdelning. Hemodialys medför olika komplikationer och biverkningar som kan upplevas jobbiga för patienten. Utöver biverkningar får patienten också vätske- och dietrestriktioner. Dessa faktorer påverkar patiens dagliga liv. Syfte: Syftet är att beskriva patienters upplevelser av att leva med hemodialys vid kronisk njursvikt. Metod: Metoden som använts är en litteraturbaserad studie. Resultat: Resultatet presenteras genom tre huvudkategorier. Patienter beskriver skilda upplevelser av hur hemodialys påverkas kroppen, både till det positiva och negativa. Under behandling uppkommer existentiella tankar och känslor som relaterar till den egna dödligheten. Patienter beskriver att de söker stöd hos både anhöriga och hos vårdpersonal men att det kan vara svårt att diskutera existentiella tankar. Konklusion: Hemodialysbehandlingen har en begränsand effekt på patienters liv, de upplever en ökad känsla av ensamhet. En central faktor för att patienter ska kunna finna stöd är att de känner tillit och trygghet i personalen som vårdar dem. / Background: Chronic kidney disease in later stages demands dialysis-treatment. Haemodialysis is the most common type of dialysis and is usually performed at a hospital ward. Haemodialysis brings different complications and side effects that can be perceived tough for patients. Beyond the side effects the patients also receives fluid and diet restrictions. These factors affects the patient’s everyday life. Aim: The aim is to describe patients, with chronic kidney disease, experiences of living with haemodialysis. Method: The method of choice is a literature-based study. Result: The result is presented in three main categories. Patients describes different experiences of how haemodialysis affects the body, both positive and negative. During the treatment different existential thoughts and feelings related to the own mortality appears. Patients describes that they seek support with both related and health personnel but that it can be tough to talk about existential thoughts. Conclusion: Haemodialysis treatment had a limiting effect on patient’s life, they experience an increased feeling of loneliness. A central factor for patients to be able to find support was that they feel reliance and trust in health personnel.

Background-Heart failure is common in patients with chronic kidney disease. We studied risk factors for incident heart failure among 3557 participants in the CRIC (Chronic Renal Insufficiency Cohort) Study. Methods and Results-Kidney function was assessed by estimated glomerular filtration rate (eGFR) using serum creatinine, cystatin C, or both, and 24-hour urine albumin excretion. During an average of 6.3 years of follow-up, 452 participants developed incident heart failure. After adjustment for age, sex, race, and clinical site, hazard ratio (95% CI) for heart failure associated with 1 SD lower creatinine-based eGFR was 1.67 (1.49, 1.89), 1 SD lower cystatin C-based-eGFR was 2.43 (2.10, 2.80), and 1 SD higher log-albuminuria was 1.65 (1.53, 1.78), all P< 0.001. When all 3 kidney function measures were simultaneously included in the model, lower cystatin C-based eGFR and higher log-albuminuria remained significantly and directly associated with incidence of heart failure. After adjusting for eGFR, albuminuria, and other traditional cardiovascular risk factors, anemia (1.37, 95% CI 1.09, 1.72, P= 0.006), insulin resistance (1.16, 95% CI 1.04, 1.28, P= 0.006), hemoglobin A1c (1.27, 95% CI 1.14, 1.41, P< 0.001), interleukin-6 (1.15, 95% CI 1.05, 1.25, P= 0.002), and tumor necrosis factor-a (1.10, 95% CI 1.00, 1.21, P= 0.05) were all significantly and directly associated with incidence of heart failure. Conclusions-Our study indicates that cystatin C-based eGFR and albuminuria are better predictors for risk of heart failure compared to creatinine-based eGFR. Furthermore, anemia, insulin resistance, inflammation, and poor glycemic control are independent risk factors for the development of heart failure among patients with chronic kidney disease.

Ischemia and reperfusion are natural steps during kidney transplantation, and IRI is considered one of the most important nonspecific factors affecting allograft dysfunction. Transplanted organs experience several episodes of ischemia, in which cold ischemia occurs during allograft storage in preservation solutions. Even though cold ischemia has been studied extensively, all of the studies have been carried out in vitro and ex vivo models. There is no in vivo model available to examine renal IRI induced solely by cold ischemia. In the present study, we developed an in vivo mouse model to study renal IRI induced exclusively by cold ischemia through clamping the renal pedicle for 1 to 5 hours. During the ischemic phase, blood was flushed from the kidney with cold saline through a small opening on the renal vein. The kidney was kept cold in a kidney cup with circulating cooled saline, while the body temperature was maintained at 37℃ during the experiment. The level of kidney injury was evaluated by plasma creatinine, KIM-1, NAGL, GFR, and histology. Plasma creatinine was significantly increased from 0.15±0.04 mg/dl in the sham group to 1.14±0.21 and 2.65±0.14 mg/dl in 4 and 5-hours ischemia groups at 24 hours after cold IRI. The plasma creatinine in mice with ischemic time <3 hours demonstrated no significant increase compared with sham mice. Changes in KIM-1, NAGL, GFR and histology were similar to plasma creatinine. 65 In summary, we developed and characterized a novel in vivo IRI-induced AKI mouse model exclusively produced by cold ischemia.

Introducción y objetivos Los trastornos del sueño son una de las comorbilidades más comunes en pacientes en hemodiálisis. Los objetivos del estudio fueron determinar la prevalencia de mala calidad de sueño y establecer potenciales factores asociados a la mala calidad de sueño. Materiales y métodos Estudio transversal analítico enrolando pacientes con enfermedad renal crónica en hemodiálisis. La variable resultado fue calidad de sueño evaluado mediante la Escala de Pittsburgh, mientras que las variables de exposición fueron el tiempo en hemodiálisis, la historia de diabetes mellitus tipo 2 y de hipertensión arterial, la presencia de sintomatología depresiva, la presencia de anemia y el compromiso urémico. Se usó el modelo de regresión de Poisson para verificar las asociaciones de interés reportándose razones de prevalencia (RP) e intervalos de confianza al 95% (IC95%). Resultados Fueron enrolados un total de 450 pacientes, de los cuales, 259 (57.5%) fueron varones, y con una edad entre 18 y 97 años. La prevalencia de mala calidad de sueño fue de 79.3% (IC95%: 75.6%–83.1%). Se encontró asociación significativa entre mala calidad de sueño y sintomatología depresiva (RP=1.28; IC95%: 1.17-1.39), anemia (RP=1.18; IC95%: 1.04-1.34) y compromiso urémico (RP=1.26; IC95%: 1.17-1.36) después de controlar por potenciales confusores. Conclusiones La presencia de sintomatología depresiva, anemia y el compromiso urémico estuvieron positivamente asociados a mala calidad de sueño en pacientes con enfermedad renal crónica en hemodiálisis. Un gran porcentaje de esta población sufre de mala calidad de sueño. Se sugiere desarrollar estrategias para mejorar la calidad de sueño en estos pacientes. / Introduction and objectives Sleep disorders are one of the most common comorbidities among patients on hemodialysis. The aims of this study were to determine the prevalence of poor sleep quality as well as to establish potential factors associated with poor sleep quality. Materials and Methods A cross-sectional study was performed enrolling patients with chronic kidney disease on hemodialysis. The outcome was sleep quality evaluated using the Pittsburgh Scale, whereas the exposure variables were time on hemodialysis, history of type-2 diabetes and hypertension, depressive symptoms, anemia, and uremia. We used Poisson regression model to determine the association of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). Results A total of 450 patients were enrolled, 259 (57.5%) were male, aged from 18 to 97 years. The prevalence of poor sleep quality was 79.3% (95%CI: 75.6%– 83.1%). Poor sleep quality was associated with depressive symptoms (PR=1.28; 95%CI: 1.17-1.39), anemia (PR=1.18; 95%CI: 1.04-1.34) and uremia (PR=1.26; 95%CI: 1.17-1.36) after controlling for potential confounders. Conclusions The presence of depressive symptoms, anemia and uremia were positively associated with poor sleep quality among patients with chronic kidney disease on hemodialysis. A great proportion of this population had poor sleep quality. Strategies are needed to improve sleep quality in these patients.

Relative changes are detectable in the blood of end-stage renal disease (ESRD) patients during hemodialysis (HD) treatment using optical spectroscopy. However, the potential impacts of several confounding factors that could affect the detection of these changes have not been evaluated. The objectives of this thesis were to: 1) investigate how the variations and/or changes in acid-base and oxygen parameters during HD treatment can affect the optical signature of whole blood of ESRD patients, 2) to investigate the effect of heparin on the optical properties of whole blood and its impact on our method. Blood samples were drawn from 23 ESRD patients at 5 time points during a 4 hour HD treatment and sent for blood gas and blood spectroscopy analyses. No significant correlations were found between the changes in the blood transmittance spectra and acid-base and oxygen parameters. This indicates that the perturbations in these parameters due to HD procedures do not confound the detection of changes in the blood transmittance spectra of ESRD patients during HD treatment. Additionally, the effect of heparin in modifying the optical properties of whole blood does not confound the detection of changes in the blood of ESRD patients due to HD treatment using whole blood-based optical spectroscopy. ANOVA revealed significant (P<0.05) measurable changes in the blood transmittance spectra of ESRD patients during HD treatment. Significant spectral differences (P<0.05) were found between ESRD patients. The lack of uniform spectral characteristics across patients is

Angiotensin-(1-7) [Ang-(1-7)] is a heptapeptide component of the renin angiotensin system and the endogenous ligand for the Mas receptor. Ang-(1-7) is generated mainly via angiotensin converting enzyme 2 (ACE2)-dependent cleavage of Angiotensin (Ang) II. Studies suggest Ang-(1-7) may protect against progression of renal injury in experimental models of chronic kidney disease, although the responses may be dose dependent. The role of Ang-(1-7) in the progression of renal fibrosis in unilateral ureteral obstruction (UUO) remains unclear. We tested the hypothesis that endogenous Ang-(1-7) and low dose exogenous Ang-(1-7) would protect against renal injury in the UUO model, while high dose Ang-(1-7) would exacerbate renal injury. Male C57Bl/6 mice underwent UUO and received vehicle, the Ang-(1-7) antagonist A779, or one of three doses of Ang-(1-7) for 10 days. Treatment with A779 exacerbated renal injury as seen by increased fibronectin, transforming growth factor-β (TGF-β), and α-smooth muscle actin (α-SMA) expression, increased tubulointerstitial fibrosis scores, macrophage infiltration, apoptosis, and NADPH oxidase activity in obstructed kidneys. Paradoxically, delivery of exogenous Ang-(1-7) was associated with increased renal injury regardless of dose. Taken together, these data indicate the Mas receptor may be sensitive to concentrations of Ang-(1-7) within the obstructed kidney and that exogenous Ang-(1-7) stimulates pro-fibrotic and pro-inflammatory signalling through unclear pathways.

Cyclooxygenases (COXs) and their main renal product, prostaglandin E2 (PGE2), regulate many physiological renal functions and are involved in the pathogenesis of diabetic kidney disease. The PGE2 receptor EP3 has been repeatedly shown to be upregulated during diabetes. Physiologically, EP3 is best recognized to act as a diuretic by antagonizing arginine-vasopressin (AVP)-mediated water reabsorption. Incidentally, the first renal manifestation of diabetes is polyuria, which may trigger a cascade of events leading to DN. We hypothesize that EP3 contributes to polyuria and kidney dysfunction during diabetes. We injected EP3-/- mice with streptozotocin (STZ) and evaluated their renal function 12-weeks post injection. EP3-/- STZ mice exhibit attenuated polyuria while exhibiting increased urine osmolality suggesting enhanced water reabsorption. Western blots reveal that EP3-/- STZ mice have increased expression of aquaporin-1 and aquaporin-2 as well as reduced urinary AVP excretion compared to STZ mice. However, salt transporters were equivalently increased in STZ and EP3-/- STZ mice. In vitro microperfusion shows that EP3 completely abrogates AVP-mediated water reabsorption in STZ cortical collecting ducts. Furthermore, EP3-/- STZ mice showed blunted renal COX-2 expression as well as reduced renal hypertrophy, glomerular hyperfiltration, and albuminuria. Taken together, the data suggests that EP3 contributes to polyuria during diabetes by inhibiting expression of aquaporins. Additionally, EP3 seems to contribute to renal COX-2 induction during diabetes. The lack of an increase in renal COX-2 protein levels in EP3-/- STZ mice may be protective by preventing further renal damage.