Impacto do treinamento aeróbico intradialítico sobre fatores de risco cardiovascular não tradicionais em hemodiálise
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Data
2017-02-17
Autores
Silva, Viviana Rugolo Oliveira e [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A doença renal crônica (DRC) é muito prevalente no Brasil. Pacientes com DRC possuem alta incidência de doenças cardiovasculares (DCV), que resultam no aumento da morbidade e mortalidade. O sedentarismo na DRC está diretamente ligado ao aparecimento de DCV. A atividade física pode trazer efeitos benéficos nos pacientes com DRC. Objetivos: Avaliar o impacto do treinamento aeróbico intradialítico sobre os fatores de risco cardiovascular não-tradicionais, em pacientes com DRC em hemodiálise (HD). Materiais e Métodos: Estudo clínico prospectivo, controlado e randomizado de intervenção fisioterápica, com análise de intenção de tratar. Trinta pacientes foram submetidos a teste ergométrico, avaliação da rigidez arterial, ao ecocardiograma e análise da reatividade endotelial, ultrassonografia de carótidas e exames laboratorias, inclusive análise da aldosterona sérica. O grupo de intervenção (GI), com quinze pacientes, foi submetido a treinamento aeróbico intradialítico, três vezes por semana, durante quatro meses. O grupo controle (GC), com quinze pacientes, não teve intervenção. Todos os pacientes foram reavaliados após o seguimento de quatro meses. Resultados: No GI, houve melhora da vasodilatação fluxo mediada (VFM- p=0,002), redução da hipertrofia do ventrículo esquerdo (HVE - p=0,006) e da aldosterona sérica (p= 0,016). Houve aumento da proteína C-Reativa (PCR) no GC (p=0,002). Conclusão: O presente protocolo de treinamento aeróbico intradialítico foi capaz de incrementar a função endotelial por intermédio da VFM, assim como reduzir a HVE e aldosterona sérica, fatores estes com possível impacto positivo sobre a redução dos fatores de risco cardiovascular não-tradicionais em portadores de DRC em HD.
Introduction: Chronic kidney disease (CKD) is very prevalent in Brazil. CKD patients have a high incidence of cardiovascular diseases (CVD) which increases their morbidity and mortality. Sedentary lifestyle in CKD is directly linked to the onset of CVD. Physical activity can bring beneficial effects to CKD patients. Aims: The aim of this study was assess the impact of aerobic training on non-traditional cardiovascular risk factors, in CKD patients on hemodialysis. Materials and Methods: This is a prospective, controlled and randomized clinical trial with analysis of intention to treat. Thirty patients underwent exercise treadmill test, arterial stiffness evaluation, echocardiography and analysis of endothelial reactivity, carotid ultrasound and laboratorial tests, including analysis of serum aldosterone. The intervention group (IG), with fifteen patients underwent aerobic exercise during the hemodialysis, three times a week for four months. The control group (CG), with fifteen patients had no intervention. All patients were reassessed after four months. Results: In IG, there was a statistically significant improvement in flow-mediated vasodilation (FVM - p = 0.002), reduction in left ventricular hypertrophy (p = 0.006) and serum aldosterone (p = 0.016). There was an increase of C Reactive protein in the CG (p=0.002). Conclusion: This aerobic training protocol was able to improve endothelial function with FMV enhanced, as well as reduce LVH and serum aldosterone, which could provide a positive impact on the reduction of non-traditional cardiovascular risk factors in CKD patients on hemodialysis.
Introduction: Chronic kidney disease (CKD) is very prevalent in Brazil. CKD patients have a high incidence of cardiovascular diseases (CVD) which increases their morbidity and mortality. Sedentary lifestyle in CKD is directly linked to the onset of CVD. Physical activity can bring beneficial effects to CKD patients. Aims: The aim of this study was assess the impact of aerobic training on non-traditional cardiovascular risk factors, in CKD patients on hemodialysis. Materials and Methods: This is a prospective, controlled and randomized clinical trial with analysis of intention to treat. Thirty patients underwent exercise treadmill test, arterial stiffness evaluation, echocardiography and analysis of endothelial reactivity, carotid ultrasound and laboratorial tests, including analysis of serum aldosterone. The intervention group (IG), with fifteen patients underwent aerobic exercise during the hemodialysis, three times a week for four months. The control group (CG), with fifteen patients had no intervention. All patients were reassessed after four months. Results: In IG, there was a statistically significant improvement in flow-mediated vasodilation (FVM - p = 0.002), reduction in left ventricular hypertrophy (p = 0.006) and serum aldosterone (p = 0.016). There was an increase of C Reactive protein in the CG (p=0.002). Conclusion: This aerobic training protocol was able to improve endothelial function with FMV enhanced, as well as reduce LVH and serum aldosterone, which could provide a positive impact on the reduction of non-traditional cardiovascular risk factors in CKD patients on hemodialysis.
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Palavras-chave
Diálise renal, Exercício, Hipetrofia ventricular esquerda, Aldosterona, Doenças cardiovasculares