Efeitos da redução da concentração de sódio de diálise sobre o volume de água corporal e marcadores inflamatórios em pacientes com insuficiência renal crônica em tratamento hemodialítico
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Data
2011-02-25
Autores
Beduschi, Gabriela de Carvalho [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O risco de morte por doenças cardiovasculares (DCV) em pacientes tratados por hemodiálise (HD) crônica é 10 a 20 vezes maior que o da população geral. Muitos mecanismos têm sido propostos para a gênese das DCV nesses pacientes, como hipervolemia, hipertensão arterial, dislipidemia e elevação do produto cálcio-fósforo, sendo que atualmente a inflamação tem sido apontada como fator de risco independente e associada óbito por essas doenças. Recentemente, a possibilidade da expansão de volume ser uma das causas de inflamação foi considerada e nesse caso, o edema da parede intestinal poderia favorecer a translocação de endotoxinas com conseqüente inflamação. Sabidamente, o acúmulo de volume extracelular na doença renal crônica está associado à retenção de sódio e assim, a redução da concentração de sódio na solução de HD poderia reduzir o volume extracelular e atenuar o estado inflamatório. O objetivo do estudo foi avaliar os efeitos da redução da concentração de sódio na solução de HD sobre a evolução do volume de água corporal e marcadores inflamatórios. Foram incluídos pacientes adultos, tratados regularmente por hemodiálise, com níveis séricos da proteína C reativa (PCR) igual ou maior que 0,7 mg/dl, que foram randomizados em dois grupos: grupo A, constituído de 20 pacientes tratados com a redução da concentração de sódio na solução de HD de 138 mEq/l para 135 mEq/l e grupo B, controle, com 18 pacientes. Na primeira, 8ª e 16ª semanas foram determinados marcadores inflamatórios, bioquímicos, hematológicos, nutricionais, e a quantificação da prescrição dialítica. Quanto às características basais não houve diferenças significantes entre os grupos. Durante o estudo, o grupo A apresentou diminuição significante dos níveis séricos fator de necrose tumoral-α (TNF-α) e interleucina-6 (IL-6) e no grupo B não houve...
The death risk by cardiovascular diseases (CVD) treated in hemodialysis (HD) patients is 10 a 20 times greater than general population. Several pathways have been proposed to explain the CVD origin in these patients, such as hypervolemia, hypertension, lipid disorders and high calcium x phosphorus product; and actually inflammation is considered an independent risk factor associated to death by CVD. Recently, it has been proposed that volume overload could be a cause of inflammation, thus bowel wall edema could favor bacterial endotoxin translocation resulting in systemic inflammation. The extracellular volume overload in chronic kidney diseases is associated to sodium accumulation, thus the reduction of sodium concentration in the HD solutions could reduce the extracellular volume and consequently to attenuate the inflammatory state. The aim of this study was to evaluate the effects of reduction of dialysate sodium concentrations on markers of body water and inflammation. Adult patients on regular HD and C-reactive protein levels ≥ 0, 7 mg/dl were included and randomized in two groups: A, with 20 patients treated by reduction of dialysate sodium concentration from 138 mEq/l to 135 mEq/l and B, control group, with 18 patients. In the first, 8th and 16th weeks inflammatory, biochemical, hematologic, nutritional markers and HD delivers doses were determined. The baseline characteristics were similar between groups. During the study period, there were significant reduction in the serum tumor necrosis factor (TNF-α) e interleukin-6 (IL-6) in the group A, while in group B these markers did not varied significantly. In the treated group there were increase of frequency of muscle cramps and hypotensive episodes, but there were not significant changes in volume markers as well as other laboratory tests. Indeed, the patients were redistributed, in two new groups according to the presence... (Complete abstract click electronic access below)
The death risk by cardiovascular diseases (CVD) treated in hemodialysis (HD) patients is 10 a 20 times greater than general population. Several pathways have been proposed to explain the CVD origin in these patients, such as hypervolemia, hypertension, lipid disorders and high calcium x phosphorus product; and actually inflammation is considered an independent risk factor associated to death by CVD. Recently, it has been proposed that volume overload could be a cause of inflammation, thus bowel wall edema could favor bacterial endotoxin translocation resulting in systemic inflammation. The extracellular volume overload in chronic kidney diseases is associated to sodium accumulation, thus the reduction of sodium concentration in the HD solutions could reduce the extracellular volume and consequently to attenuate the inflammatory state. The aim of this study was to evaluate the effects of reduction of dialysate sodium concentrations on markers of body water and inflammation. Adult patients on regular HD and C-reactive protein levels ≥ 0, 7 mg/dl were included and randomized in two groups: A, with 20 patients treated by reduction of dialysate sodium concentration from 138 mEq/l to 135 mEq/l and B, control group, with 18 patients. In the first, 8th and 16th weeks inflammatory, biochemical, hematologic, nutritional markers and HD delivers doses were determined. The baseline characteristics were similar between groups. During the study period, there were significant reduction in the serum tumor necrosis factor (TNF-α) e interleukin-6 (IL-6) in the group A, while in group B these markers did not varied significantly. In the treated group there were increase of frequency of muscle cramps and hypotensive episodes, but there were not significant changes in volume markers as well as other laboratory tests. Indeed, the patients were redistributed, in two new groups according to the presence... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Insuficiencia renal cronica, Hemodialise, Sodio - Efeito fisiologico, Inflammation
Como citar
BEDUSCHI, Gabriela de Carvalho. Efeitos da redução da concentração de sódio de diálise sobre o volume de água corporal e marcadores inflamatórios em pacientes com insuficiência renal crônica em tratamento hemodialítico. 2011. 47 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2011.