Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da Uninove |
Texto Completo: | http://bibliotecatede.uninove.br/handle/tede/3308 |
Resumo: | Introduction: Chronic kidney disease (CKD) is a public health problem, with a worldwide prevalence of 9.1%. In Brazil, hemodialysis (HD) is generally performed by about 90% of patients with CKD. However, this dialysis modality does not remove toxic substances (uremic toxins) with medium molecular weight or linked to proteins. The accumulation of uremic toxins in HD patients has been associated with increased inflammation, poor quality of life, bone mineral disease (BMD) and cardiovascular disease (CVD). Inflammation is one of the main pathophysiological mechanisms of CVD and BMD in the population with CKD undergoing dialysis, especially on HD. Recently, hemodiafiltration (HDF) has been described as a dialysis modality that can promote greater clearance of medium molecular weight or protein-bound uremic toxins; suggesting that HDF could reduce the adverse effects of inflammation, BMD, and CVD. However, although HDF has been reported to be a modality that improves the removal of uremic toxins, there are few studies evaluating the effect of HDF in the removal of protein-bound uremic toxins (indoxyl sulfate (IS), p-Cresylsulfate (PCS) and indole acetic acid (IAA) and its impact on inflammatory, endothelial and bone mineral metabolism mechanisms in the elderly population. Objective: to evaluate the effects of HDF on the serum concentration of uremic toxins, biomarkers of inflammation, endothelial and bone mineral disorder, in elderly patients with CKD. Methods: Thirty-one elderly patients ≥65 years old who started dialysis for HDF were selected for convenience. We evaluated at baseline and after 6 months: urea, creatinine, sodium, potassium, glucose, albumin, C-reactive protein (CRP), calcium, phosphorus, parathormone (PTH), 25 hydroxy vitamin D (25(OH)D and beta-2 microglobulin (B2M), by automated methods using commercial kits. interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), interleukin-10 (IL-10), fibroblast growth factor 23 (FGF-23), sclerostin (SOST) and osteopontin (OPN) by enzyme-linked immunosorbent assay (ELISA) using commercial kits. IS, PCS and IAA by high-performance liquid chromatography (HPLC) Results: After 6 months of treatment with HDF, we observed that the patients showed significant reduction in serum concentration of IS levels (p <0.01) and significant increase in serum concentrations of B2M, urea, creatinine, and calcium. We did not observe significant differences between the other variables. Conclusion: this study showed that HDF reduced serum levels of the uremic toxin indoxyl sulfate in the elderly population. The impact of this reduction in the elderly population on clinical outcomes must be evaluated in future studies. |
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Dalboni, Maria Aparecidahttp://lattes.cnpq.br/9818040147487320Dalboni, Maria Aparecidahttp://lattes.cnpq.br/9818040147487320Elias, Rosilene Mottahttp://lattes.cnpq.br/9742090948110017Passarelli, Marisahttp://lattes.cnpq.br/7324507764759039Dal Corso, Simonehttp://lattes.cnpq.br/9690847988531306Custódio, Melani Ribeirohttp://lattes.cnpq.br/3390801574622152http://lattes.cnpq.br/4193282111499721Morales Júnior, Armando2024-04-08T19:55:46Z2021-12-15Morales Júnior, Armando. Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica. 2021. 74 f. Tese( Programa de Mestrado em Medicina) - Universidade Nove de Julho, São Paulo.http://bibliotecatede.uninove.br/handle/tede/3308Introduction: Chronic kidney disease (CKD) is a public health problem, with a worldwide prevalence of 9.1%. In Brazil, hemodialysis (HD) is generally performed by about 90% of patients with CKD. However, this dialysis modality does not remove toxic substances (uremic toxins) with medium molecular weight or linked to proteins. The accumulation of uremic toxins in HD patients has been associated with increased inflammation, poor quality of life, bone mineral disease (BMD) and cardiovascular disease (CVD). Inflammation is one of the main pathophysiological mechanisms of CVD and BMD in the population with CKD undergoing dialysis, especially on HD. Recently, hemodiafiltration (HDF) has been described as a dialysis modality that can promote greater clearance of medium molecular weight or protein-bound uremic toxins; suggesting that HDF could reduce the adverse effects of inflammation, BMD, and CVD. However, although HDF has been reported to be a modality that improves the removal of uremic toxins, there are few studies evaluating the effect of HDF in the removal of protein-bound uremic toxins (indoxyl sulfate (IS), p-Cresylsulfate (PCS) and indole acetic acid (IAA) and its impact on inflammatory, endothelial and bone mineral metabolism mechanisms in the elderly population. Objective: to evaluate the effects of HDF on the serum concentration of uremic toxins, biomarkers of inflammation, endothelial and bone mineral disorder, in elderly patients with CKD. Methods: Thirty-one elderly patients ≥65 years old who started dialysis for HDF were selected for convenience. We evaluated at baseline and after 6 months: urea, creatinine, sodium, potassium, glucose, albumin, C-reactive protein (CRP), calcium, phosphorus, parathormone (PTH), 25 hydroxy vitamin D (25(OH)D and beta-2 microglobulin (B2M), by automated methods using commercial kits. interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), interleukin-10 (IL-10), fibroblast growth factor 23 (FGF-23), sclerostin (SOST) and osteopontin (OPN) by enzyme-linked immunosorbent assay (ELISA) using commercial kits. IS, PCS and IAA by high-performance liquid chromatography (HPLC) Results: After 6 months of treatment with HDF, we observed that the patients showed significant reduction in serum concentration of IS levels (p <0.01) and significant increase in serum concentrations of B2M, urea, creatinine, and calcium. We did not observe significant differences between the other variables. Conclusion: this study showed that HDF reduced serum levels of the uremic toxin indoxyl sulfate in the elderly population. The impact of this reduction in the elderly population on clinical outcomes must be evaluated in future studies.Introdução: A doença renal crônica (DRC) é um problema de saúde pública, com prevalência mundial de 9,1%. No Brasil a hemodiálise (HD) em geral é realizada por cerca de 90% dos doentes renais crônicos. Entretanto, esta modalidade dialítica não remove substâncias tóxicas (toxinas urêmicas) com peso molecular médio ou ligadas a proteínas. O acúmulo de toxinas urêmicas nos pacientes em HD tem sido associado a maior inflamação, pior qualidade de vida, doença mineral óssea (DMO) e doença cardiovascular (DCV). A inflamação é um dos principais mecanismos fisiopatológicos da DCV e DMO na população com DRC em tratamento dialítico, principalmente em HD. Recentemente, a hemodialfiltração (HDF) tem sido descrita como modalidade dialítica que pode promover maior depuração de toxinas urêmicas com peso molecular médio ou ligadas a proteínas, sugerindo-se que a HDF poderia reduzir os efeitos adversos da inflamação, DMO e DCV. Entretanto, embora tenha sido relatado que a HDF é uma modalidade que melhora a remoção de toxinas urêmicas, existem poucos estudos avaliando o efeito da HDF na remoção de toxinas urêmicas ligadas a proteínas (indoxil sulfato (IS), p-Cresil sulfato (PCS) e ácido indol acético (IAA)) e sobre seu impacto nos mecanismos inflamatórios, endoteliais e do metabolismo mineral ósseo na população idosa. Objetivo: Avaliar os efeitos da HDF sobre a concentração sérica de toxinas urêmicas, biomarcadores de inflamação, endoteliais e do distúrbio mineral ósseo, em pacientes idosos com DRC. Métodos: Foram selecionados por conveniência 31 pacientes idosos ≥65 anos que iniciaram tratamento dialítico por HDF. Foram avaliados no momento basal e após 6 meses: uréia, creatinina, sódio, potássio, glicose, albumina, proteína C reativa (PCR), cálcio, fósforo, paratôrmonio (PTH), 25 hidroxi vitamina D (25(OH)D e beta-2 microglobulina (B2M), por métodos automatizados através de kits comerciais. interleucina-6 (IL-6), fator de necrose tumoral alfa (TNF-α), interleucina-10 (IL-10), fator de crescimento de fibroblastos 23 (FGF-23), esclerostina (SOST) e osteopontina (OPN), por ensaio imunoenzimático (ELISA) através de kits comerciais. IS, PCS e IAA por cromatografia líquida de alta performance (HPLC). Resultados: Após 6 meses de tratamento por HDF, observamos que os pacientes apresentaram redução significante da concentração sérica dos níveis de IS (p<0,01) e aumento significante nas concentrações séricas de B2M, ureia, creatinina e cálcio. Não observamos diferenças significantes entre as demais variáveis. Conclusão: Este estudo mostrou que a HDF reduziu os níveis séricos da toxina urêmica indoxil sulfato na população idosa. O impacto desta redução em população idosa sobre desfechos clínicos deve ser avaliado em estudos futuros.Submitted by Nadir Basilio (nadirsb@uninove.br) on 2024-04-08T19:55:46Z No. of bitstreams: 1 Armando Morales Júnior.pdf: 2213755 bytes, checksum: 615bd1c2e83fa6ba2b717a1205e405aa (MD5)Made available in DSpace on 2024-04-08T19:55:46Z (GMT). No. of bitstreams: 1 Armando Morales Júnior.pdf: 2213755 bytes, checksum: 615bd1c2e83fa6ba2b717a1205e405aa (MD5) Previous issue date: 2021-12-15application/pdfporUniversidade Nove de JulhoPrograma de Mestrado em MedicinaUNINOVEBrasilSaúdedoença renal crônicahemodiafiltraçãotoxinas urêmicasinflamaçãodistúrbio mineral ósseochronic kidney diseasehemodiafiltrationuremic toxinsinflammationbone mineral disordeCIENCIAS DA SAUDEEfeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônicaEffect of Hemodiafiltration (HDF) on inflammation, endothelial injury and bone mineral disorder in elderly patients with chronic kidney diseaseinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis8765449414823306929600info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da Uninoveinstname:Universidade Nove de Julho (UNINOVE)instacron:UNINOVEORIGINALArmando Morales Júnior.pdfArmando Morales Júnior.pdfapplication/pdf2213755http://localhost:8080/tede/bitstream/tede/3308/2/Armando+Morales+J%C3%BAnior.pdf615bd1c2e83fa6ba2b717a1205e405aaMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82165http://localhost:8080/tede/bitstream/tede/3308/1/license.txtbd3efa91386c1718a7f26a329fdcb468MD51tede/33082024-04-08 16:55:46.022oai:localhost: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Biblioteca Digital de Teses e Dissertaçõeshttp://bibliotecatede.uninove.br/PRIhttp://bibliotecatede.uninove.br/oai/requestbibliotecatede@uninove.br||bibliotecatede@uninove.bropendoar:2024-04-08T19:55:46Biblioteca Digital de Teses e Dissertações da Uninove - Universidade Nove de Julho (UNINOVE)false |
dc.title.por.fl_str_mv |
Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica |
dc.title.alternative.eng.fl_str_mv |
Effect of Hemodiafiltration (HDF) on inflammation, endothelial injury and bone mineral disorder in elderly patients with chronic kidney disease |
title |
Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica |
spellingShingle |
Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica Morales Júnior, Armando doença renal crônica hemodiafiltração toxinas urêmicas inflamação distúrbio mineral ósseo chronic kidney disease hemodiafiltration uremic toxins inflammation bone mineral disorde CIENCIAS DA SAUDE |
title_short |
Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica |
title_full |
Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica |
title_fullStr |
Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica |
title_full_unstemmed |
Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica |
title_sort |
Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica |
author |
Morales Júnior, Armando |
author_facet |
Morales Júnior, Armando |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Dalboni, Maria Aparecida |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/9818040147487320 |
dc.contributor.referee1.fl_str_mv |
Dalboni, Maria Aparecida |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/9818040147487320 |
dc.contributor.referee2.fl_str_mv |
Elias, Rosilene Motta |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/9742090948110017 |
dc.contributor.referee3.fl_str_mv |
Passarelli, Marisa |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/7324507764759039 |
dc.contributor.referee4.fl_str_mv |
Dal Corso, Simone |
dc.contributor.referee4Lattes.fl_str_mv |
http://lattes.cnpq.br/9690847988531306 |
dc.contributor.referee5.fl_str_mv |
Custódio, Melani Ribeiro |
dc.contributor.referee5Lattes.fl_str_mv |
http://lattes.cnpq.br/3390801574622152 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4193282111499721 |
dc.contributor.author.fl_str_mv |
Morales Júnior, Armando |
contributor_str_mv |
Dalboni, Maria Aparecida Dalboni, Maria Aparecida Elias, Rosilene Motta Passarelli, Marisa Dal Corso, Simone Custódio, Melani Ribeiro |
dc.subject.por.fl_str_mv |
doença renal crônica hemodiafiltração toxinas urêmicas inflamação distúrbio mineral ósseo |
topic |
doença renal crônica hemodiafiltração toxinas urêmicas inflamação distúrbio mineral ósseo chronic kidney disease hemodiafiltration uremic toxins inflammation bone mineral disorde CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
chronic kidney disease hemodiafiltration uremic toxins inflammation bone mineral disorde |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE |
description |
Introduction: Chronic kidney disease (CKD) is a public health problem, with a worldwide prevalence of 9.1%. In Brazil, hemodialysis (HD) is generally performed by about 90% of patients with CKD. However, this dialysis modality does not remove toxic substances (uremic toxins) with medium molecular weight or linked to proteins. The accumulation of uremic toxins in HD patients has been associated with increased inflammation, poor quality of life, bone mineral disease (BMD) and cardiovascular disease (CVD). Inflammation is one of the main pathophysiological mechanisms of CVD and BMD in the population with CKD undergoing dialysis, especially on HD. Recently, hemodiafiltration (HDF) has been described as a dialysis modality that can promote greater clearance of medium molecular weight or protein-bound uremic toxins; suggesting that HDF could reduce the adverse effects of inflammation, BMD, and CVD. However, although HDF has been reported to be a modality that improves the removal of uremic toxins, there are few studies evaluating the effect of HDF in the removal of protein-bound uremic toxins (indoxyl sulfate (IS), p-Cresylsulfate (PCS) and indole acetic acid (IAA) and its impact on inflammatory, endothelial and bone mineral metabolism mechanisms in the elderly population. Objective: to evaluate the effects of HDF on the serum concentration of uremic toxins, biomarkers of inflammation, endothelial and bone mineral disorder, in elderly patients with CKD. Methods: Thirty-one elderly patients ≥65 years old who started dialysis for HDF were selected for convenience. We evaluated at baseline and after 6 months: urea, creatinine, sodium, potassium, glucose, albumin, C-reactive protein (CRP), calcium, phosphorus, parathormone (PTH), 25 hydroxy vitamin D (25(OH)D and beta-2 microglobulin (B2M), by automated methods using commercial kits. interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), interleukin-10 (IL-10), fibroblast growth factor 23 (FGF-23), sclerostin (SOST) and osteopontin (OPN) by enzyme-linked immunosorbent assay (ELISA) using commercial kits. IS, PCS and IAA by high-performance liquid chromatography (HPLC) Results: After 6 months of treatment with HDF, we observed that the patients showed significant reduction in serum concentration of IS levels (p <0.01) and significant increase in serum concentrations of B2M, urea, creatinine, and calcium. We did not observe significant differences between the other variables. Conclusion: this study showed that HDF reduced serum levels of the uremic toxin indoxyl sulfate in the elderly population. The impact of this reduction in the elderly population on clinical outcomes must be evaluated in future studies. |
publishDate |
2021 |
dc.date.issued.fl_str_mv |
2021-12-15 |
dc.date.accessioned.fl_str_mv |
2024-04-08T19:55:46Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Morales Júnior, Armando. Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica. 2021. 74 f. Tese( Programa de Mestrado em Medicina) - Universidade Nove de Julho, São Paulo. |
dc.identifier.uri.fl_str_mv |
http://bibliotecatede.uninove.br/handle/tede/3308 |
identifier_str_mv |
Morales Júnior, Armando. Efeito da Hemodiafiltração (HDF) sobre inflamação, lesão endotelial e distúrbio mineral ósseo em pacientes idosos com doença renal crônica. 2021. 74 f. Tese( Programa de Mestrado em Medicina) - Universidade Nove de Julho, São Paulo. |
url |
http://bibliotecatede.uninove.br/handle/tede/3308 |
dc.language.iso.fl_str_mv |
por |
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por |
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8765449414823306929 |
dc.relation.confidence.fl_str_mv |
600 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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dc.publisher.none.fl_str_mv |
Universidade Nove de Julho |
dc.publisher.program.fl_str_mv |
Programa de Mestrado em Medicina |
dc.publisher.initials.fl_str_mv |
UNINOVE |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Saúde |
publisher.none.fl_str_mv |
Universidade Nove de Julho |
dc.source.none.fl_str_mv |
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instname_str |
Universidade Nove de Julho (UNINOVE) |
instacron_str |
UNINOVE |
institution |
UNINOVE |
reponame_str |
Biblioteca Digital de Teses e Dissertações da Uninove |
collection |
Biblioteca Digital de Teses e Dissertações da Uninove |
bitstream.url.fl_str_mv |
http://localhost:8080/tede/bitstream/tede/3308/2/Armando+Morales+J%C3%BAnior.pdf http://localhost:8080/tede/bitstream/tede/3308/1/license.txt |
bitstream.checksum.fl_str_mv |
615bd1c2e83fa6ba2b717a1205e405aa bd3efa91386c1718a7f26a329fdcb468 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 |
repository.name.fl_str_mv |
Biblioteca Digital de Teses e Dissertações da Uninove - Universidade Nove de Julho (UNINOVE) |
repository.mail.fl_str_mv |
bibliotecatede@uninove.br||bibliotecatede@uninove.br |
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1811016891312898048 |