Associação do nível de atividade física com hiperagregabilidade plaquetária em pacientes com doença renal crônica em diálise
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2024-02-28
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Universidade Estadual Paulista (Unesp)
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Introdução: A Doença renal crônica (DRC) consiste na perda progressiva e irreversível das funções renais e está associada a morbidade e mortalidade, com prevalência em portadores de doenças cardiovasculares, com síndrome metabólica e alterações nos fatores hemodinâmicos. O renal crônico em diálise pode sofrer alterações na hemostasia as quais contribuem para complicações hemorrágicas e trombóticas. A hemodiálise (HD) pode favorecer a ativação da agregação plaquetária, e o sedentarismo pode influenciar a saúde destes pacientes, os benefícios da atividade física na hiperagregabilidade plaquetária em pacientes com DRC em tratamento dialítico ainda são desconhecidos. Objetivo principal: Avaliar a associação do nível de atividade física com o grau da hiperagregabilidade plaquetária em pacientes com DRC em diálise e como objetivos específicos, descrever o comportamento da agregabilidade plaquetária nos pacientes selecionados de maneira a não haver interferências farmacológicas e hemodinâmicas. Método: Realizado estudo transversal prospectivo, para avaliar associação da agregabilidade plaquetária através da reagente adenosina difosfato (ADP), com o nível de atividade física quantificada pelo International physical activity questionnaire (IPAQ). Resultados: Foram selecionados 63 para o estudo, com idade média foi de 54 anos, onde 41% apresentaram hiperagregabilidade plaquetária. Os dados demográficos e clínicos foram homogêneos entre os grupos e classificação do IPAQ e não apresentou diferença estatística entre os grupos. Nos dados bioquímicos apenas a glicemia 94±28,8 mg/dL vs 116±38,6mg/dL (p=0,017), ferritina 124±138,9 ηg/mL vs 338±412,2 ηg/mL (p=0,013), saturação de transferrina 7,2±10,9% vs 16,5±20,11% (p=0,037); aspartato aminotransferase/ transaminase glutâmico-oxalacética (AST/TGO) 17±6,1 U/L vs 20±5,3U/L (p=0,015) apresentaram significância estatística e após análise múltipla, das variáveis clínicas ao Delta ADP apenas AST/TGO apresentou associação estatisticamente significante. Conclusão: Não foi constatada associação entre o IPAQ e maior intensidade de agregabilidade plaquetária. A alta proporção de hiperagregabilidade em nossos pacientes contrasta com a reconhecida tendência ao sangramento na uremia.
Introduction: Chronic kidney disease CKD consists of the progressive and irreversible loss of kidney functions and is associated with morbidity and mortality, with prevalence in patients with cardiovascular and metabolic diseases and hemodynamic factors. Chronic renal patients on dialysis may suffer changes in hemostasis, which contribute to hemorrhagic and thrombotic complications. Hemodialysis (HD) can favor the activation of platelet aggregation, and a sedentary lifestyle can influence the health of these patients. The benefits of physical activity on platelet hyperaggregability in patients with CKD undergoing dialysis are still unknown. Objective: To evaluate the association between the level of physical activity and the degree of platelet hyperaggregability in patients with CKD on dialysis and, as specific objectives, to describe the behavior of platelet aggregability in selected patients so as to avoid pharmacological and hemodynamic interference. Method: Prospective cross-sectional study was carried out to evaluate the association of platelet aggregability by ADP with the level of physical activity quantified by the International physical activity questionnaire (IPAQ). Results: 63 patients were selected for the study, with an average age of 54 years, with 41% showing platelet hyperaggregability. Demographic and clinical data were homogeneous between groups and IPAQ classification and there was no statistical difference between groups. Biochemical data glycemia 94±28.8 mg/dL vs 116±38.6mg/dL (p=0.017), ferritin 124±138.9 ηg/mL vs 338±412.2 ηg/mL (p=0.013), transferrin saturation 7.2±10.9% vs 16.5±20.11% (p=0.037); aspartate aminotransferase/ glutamic-oxalacetic transaminase (AST/TGO) 17±6.1 U/L vs 20±5.3U/L (p=0.015),.). After multiple analysis, of the clinical variables to Delta ADP, only AST/TGO showed a statistically significant association. Conclusion: No association was found between IPAQ and greater intensity of platelet aggregability. Despite being higher than expected in a significant proportion of our patients, this differs paradoxically from the bleeding tendency that is documented in uremia.
Introduction: Chronic kidney disease CKD consists of the progressive and irreversible loss of kidney functions and is associated with morbidity and mortality, with prevalence in patients with cardiovascular and metabolic diseases and hemodynamic factors. Chronic renal patients on dialysis may suffer changes in hemostasis, which contribute to hemorrhagic and thrombotic complications. Hemodialysis (HD) can favor the activation of platelet aggregation, and a sedentary lifestyle can influence the health of these patients. The benefits of physical activity on platelet hyperaggregability in patients with CKD undergoing dialysis are still unknown. Objective: To evaluate the association between the level of physical activity and the degree of platelet hyperaggregability in patients with CKD on dialysis and, as specific objectives, to describe the behavior of platelet aggregability in selected patients so as to avoid pharmacological and hemodynamic interference. Method: Prospective cross-sectional study was carried out to evaluate the association of platelet aggregability by ADP with the level of physical activity quantified by the International physical activity questionnaire (IPAQ). Results: 63 patients were selected for the study, with an average age of 54 years, with 41% showing platelet hyperaggregability. Demographic and clinical data were homogeneous between groups and IPAQ classification and there was no statistical difference between groups. Biochemical data glycemia 94±28.8 mg/dL vs 116±38.6mg/dL (p=0.017), ferritin 124±138.9 ηg/mL vs 338±412.2 ηg/mL (p=0.013), transferrin saturation 7.2±10.9% vs 16.5±20.11% (p=0.037); aspartate aminotransferase/ glutamic-oxalacetic transaminase (AST/TGO) 17±6.1 U/L vs 20±5.3U/L (p=0.015),.). After multiple analysis, of the clinical variables to Delta ADP, only AST/TGO showed a statistically significant association. Conclusion: No association was found between IPAQ and greater intensity of platelet aggregability. Despite being higher than expected in a significant proportion of our patients, this differs paradoxically from the bleeding tendency that is documented in uremia.
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Uremia, Doença renal crônica, Diálise renal, Agregabilidade plaquetária, Atividade física, Agregação plaquetária, Exercícios físicos, Hemodiálise, Insuficiência renal crônica