Associação do grau de albuminúria com nível de atividade física e capacidade funcional em portadores de diabetes mellitus
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Data
2018-02-22
Autores
Daniel, Juliana Maria Rodrigues
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução. A doença renal crônica (DRC) representa um grave problema de saúde pública, que tem afetado milhões de pessoas em todo o mundo, gerando impacto negativo tanto na qualidade, como na quantidade de vida de seus portadores. É causada em grande parte dos casos pela nefropatia diabética. É possível destacar o declínio funcional como importante fator para elevação das taxas de morbidade e mortalidade. Desta forma, é possível ressaltar a importância da reabilitação física para saúde destas pessoas. Contudo há a necessidade de maior esclarecimento sobre as repercussões do treinamento físico em relação à proteinúria, que constitui indicador adverso de lesão renal na DRC. Objetivo. Avaliar a associação entre atividade física e capacidade funcional com albuminúria em portadores de diabetes mellitus. Materiais e métodos. Foi realizado um estudo transversal, com casuística composta por pacientes diabéticos, de todas as unidades de saúde de Itaí, com idade mínima de 18 anos, com algum grau de albuminúria, avaliados através do uso de fita reagente e quantificada pelo exame de urina 24 horas, o nível de atividades físicas foi avaliado com uso do questionário internacional de atividades física IPAQ, a capacidade funcional foi avaliada através da execução do teste de caminhada de seis minutos (TC6), o índice de dispneia pela escala modificada de Borg e a rigidez arterial foi aferida através da velocidade de onda de pulso (VOP), índice de amplificação e pressão arterial central. Para análise dos dados os indivíduos foram divididos em três grupos em conformidade ao grau de albuminúria, sendo <10mg/24h, entre 10mg/24h e <30mg/24h e igual ou maior que 30mg/24h. As variáveis categóricas foram expressas por números absolutos e porcentagem e comparadas pelo teste do qui-quadrado. As variáveis contínuas e de distribuição paramétrica foram comparadas pela análise de variância de uma via e expressas em média e desvio padrão. As variáveis contínuas e de distribuição não paramétrica foram comparadas pela análise de variância para dados não paramétricos (Kruskal-Wallis) e expressos em mediana e intervalo interquartílico. A significância estatística foi definida ao nível de 0,05. Resultados: Foram analisados 215 pacientes diabéticos, destes 52 apresentaram algum grau de proteinúria e 37 concluíram as avaliações propostas. Não houve associação entre o nível de atividade física e capacidade funcional com pior albuminúria. Dos índices de rigidez arterial, apenas a pressão arterial central teve associação com nível de albuminúria (para pressão arterial sistólica central; p=0,01 e para pressão arterial sistólica central diastólica; p=0,03 respectivamente). Conclusão: Não houve associação entre o nível de atividade física e capacidade funcional com pior albuminúria em portadores de diabetes mellitus. Dos índices de rigidez arterial, apenas a pressão arterial central teve associação com nível de albuminúria. Portanto, os dados do presente trabalho não corroboram a ideia de que a albuminúria possa ser um efeito colateral da atividade física desses pacientes.
Chronic kidney disease (CKD) is a serious public health problem that has affected millions of people worldwide, negatively impacting both the quality and quantity of life of its patients. It is caused in large part by diabetic nephropathy. It is possible to highlight functional decline as an important factor for raising morbidity and mortality rates. In this way, it is possible to emphasize the importance of the physical rehabilitation for health of these people. However, there is a need for greater clarification about the repercussions of physical training on proteinuria, which is an adverse indicator of renal damage in CKD. Goal. To assess the association between physical activity and functional capacity with albuminuria in patients with diabetes mellitus. Materials and methods: A cross-sectional study was carried out with a sample of diabetic patients from all health units of Itaí, with a minimum age of 18 years, with some degree of albuminuria, evaluated through the use of reagent tape and quantified by the urine test 24 hours , the level of physical activity was assessed using the IPAQ international physical activity questionnaire, functional capacity was assessed by performing the six-minute walk test (6MWT), the dyspnea index using the modified Borg scale, and arterial stiffness was measured by pulse wave velocity (VOP), amplification index, and central arterial pressure. For data analysis, subjects were divided into three groups according to the degree of albuminuria, being <10mg / 24h, between 10mg / 24h and <30mg / 24h and equal to or greater than 30mg / 24h. Categorical variables were expressed by absolute numbers and percentage and compared by the chi-square test. The continuous and parametric distribution variables were compared by one-way analysis of variance and expressed in mean and standard deviation. Continuous and nonparametric variables were compared by analysis of variance for non-parametric data (Kruskal-Wallis) and expressed in median and interquartile range. Statistical significance was set at the 0.05 level. Results: A total of 215 diabetic patients were analyzed, 52 of them presented some degree of proteinuria and 37 completed the proposed evaluations. There was no association between the level of physical activity and functional capacity with worse albuminuria. Of the arterial stiffness indexes, only central arterial pressure was associated with albuminuria level (for central systolic blood pressure, p = 0.01 and for central diastolic systolic blood pressure, p = 0.03 respectively). Conclusion: There was no association between the level of physical activity and functional capacity with worse albuminuria in patients with diabetes mellitus. Of the arterial stiffness indexes, only the central arterial pressure was associated with albuminuria level. Therefore, the data of the present study do not corroborate the idea that albuminuria could be a side effect of the physical activity of these patients.
Chronic kidney disease (CKD) is a serious public health problem that has affected millions of people worldwide, negatively impacting both the quality and quantity of life of its patients. It is caused in large part by diabetic nephropathy. It is possible to highlight functional decline as an important factor for raising morbidity and mortality rates. In this way, it is possible to emphasize the importance of the physical rehabilitation for health of these people. However, there is a need for greater clarification about the repercussions of physical training on proteinuria, which is an adverse indicator of renal damage in CKD. Goal. To assess the association between physical activity and functional capacity with albuminuria in patients with diabetes mellitus. Materials and methods: A cross-sectional study was carried out with a sample of diabetic patients from all health units of Itaí, with a minimum age of 18 years, with some degree of albuminuria, evaluated through the use of reagent tape and quantified by the urine test 24 hours , the level of physical activity was assessed using the IPAQ international physical activity questionnaire, functional capacity was assessed by performing the six-minute walk test (6MWT), the dyspnea index using the modified Borg scale, and arterial stiffness was measured by pulse wave velocity (VOP), amplification index, and central arterial pressure. For data analysis, subjects were divided into three groups according to the degree of albuminuria, being <10mg / 24h, between 10mg / 24h and <30mg / 24h and equal to or greater than 30mg / 24h. Categorical variables were expressed by absolute numbers and percentage and compared by the chi-square test. The continuous and parametric distribution variables were compared by one-way analysis of variance and expressed in mean and standard deviation. Continuous and nonparametric variables were compared by analysis of variance for non-parametric data (Kruskal-Wallis) and expressed in median and interquartile range. Statistical significance was set at the 0.05 level. Results: A total of 215 diabetic patients were analyzed, 52 of them presented some degree of proteinuria and 37 completed the proposed evaluations. There was no association between the level of physical activity and functional capacity with worse albuminuria. Of the arterial stiffness indexes, only central arterial pressure was associated with albuminuria level (for central systolic blood pressure, p = 0.01 and for central diastolic systolic blood pressure, p = 0.03 respectively). Conclusion: There was no association between the level of physical activity and functional capacity with worse albuminuria in patients with diabetes mellitus. Of the arterial stiffness indexes, only the central arterial pressure was associated with albuminuria level. Therefore, the data of the present study do not corroborate the idea that albuminuria could be a side effect of the physical activity of these patients.
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doença renal crônica, diabetes mellitus, atividades físicas, albuminúria, chronic kidney disease, diabetes mellitus, physical activity and albuminuria.