Publications by authors named "Carmen Tzanno-Martins"

17 Publications

  • Page 1 of 1

Effects of dynamic and isometric resistance training protocols on metabolic profile in hemodialysis patients: a randomized controlled trial.

Appl Physiol Nutr Metab 2021 Mar 2. Epub 2021 Mar 2.

Universidade Catolica de Brasilia, 28106, Physical Education, Taguatinga, DF, Brazil.

To compare the effect of dynamic (DRT) and isometric (IRT) resistance training on glycemic homeostasis, lipid profile, and nitric oxide (NO) in hemodialysis (HD) patients. Patients were randomly distributed into three groups: control (CTL; n=65), DRT (n=65), and IRT (n=67). Patients were tested for fasting blood glucose, glycated hemoglobin, oral glucose tolerance test, insulin resistance, lipid profile, leptin, insulin, adiponectin, C-reactive protein, and NO were assessed pre- and post-intervention period. Patients underwent to strength and body composition assessments. Subjects allocated in both DRT and IRT groups took part in a 24-week resistance training program, three times per week. Each training session was approximately one hour before dialysis and consisted of 3 sets of 8-12 repetitions at low intensity. Total workload was higher in the DRT as compared with the IRT. This heightened workload related to better glycemic homeostasis in HD patients as measured by regulation of insulin, adiponectin, and leptin, while improvement of triglycerides, free-fat mass, and muscle strength. Additionally, NO levels were increased on DRT group. NO was significantly correlated with glucose intolerance (r=-0.42, p=0.0155) and workload (r=0.46, p=0.0022). The IRT group only improved strength (p<0.05). 24-week of DRT improved glycemic homeostasis, lipid profile, and NO in HD patients. Although IRT seems to play an important role in increasing strength, DRT might be a better choice to promote metabolic adjustments in HD patients. Clinical Trial http://www.ensaiosclinicos.gov.br/rg/RBR-3gpg5w/; nº RBR-3gpg5w Novelty Bullets: -DRT might be a better choice for metabolic improvements in CKD patients. -Exercise-training might treat metabolic imbalance in CKD patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1139/apnm-2020-0900DOI Listing
March 2021

Low-load resistance training with blood flow restriction prevent renal function decline: The role of the redox balance, angiotensin 1-7 and vasopressin.

Physiol Behav 2021 Mar 16;230:113295. Epub 2020 Dec 16.

Post-Graduate Program of Physical Education of Catholic University of Brasilia, Federal District, Brazil-71966-700. Electronic address:

Aims: We sought to investigate the effect of resistance training (RT) and low-load RT with moderate blood flow restriction (RT+BFR) on blood pressure, exercise pressor response, redox balance and vasoactive peptides, body composition and muscle strength in patients with stage two of chronic kidney disease (CKD).

Methods: We conducted a 6-month randomized controlled exercise intervention in 90 male and female hypertensive CKD patients (58±9 years with estimated glomerular filtration rate (eGFR; of 66.1 ± 1.2 mL/kg/1.73m). Participants were randomized to one of three groups (n = 30/group); control group (CTL), RT, and RT+BFR. RT and RT+BFR performed three weekly training sessions using similar periodization for six months (two-month mesocycles), but of different intensities.

Results: There was similarly effects between RT and RT+BFR in reducing systolic and diastolic blood pressure during daytime and 24hour period (RT: 10.4%; RT+BFR: 10.3% of decrease), fat mass, F-isoprostanes, asymmetric dimethylarginine (ADMA) and vasopressin (p<0.05 pre-vs post). Also promoted the increase of angiotensin 1-7, nitric oxide (NO), catalase, Trolox equivalent and muscle strength (p<0.05). Both training models attenuated the decline of estimated glomerular filtration rate (p<0.0001 vs CTL). However, only RT+BFR was associated with lower discomfort during exercise (p<0.0001 pre-vs post). Statistical significance was considered with p < 0.05.

Conclusion: These findings suggest low-load RT+BFR as a promising non-pharmacological strategy to control blood pressure, oxidative stress, vasoactive peptides, and consequently, attenuate the decrease of the eGFR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.physbeh.2020.113295DOI Listing
March 2021

Kidney supportive care: an update of the current state of the art of palliative care in CKD patients.

J Bras Nefrol 2020 Sep 4. Epub 2020 Sep 4.

Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.

Chronic kidney disease (CKD) has become a public health burden worldwide for its increasing incidence and prevalence, high impact on the health related quality of life (HRQoL) and life expectancy, and high personal and social cost. Patients with advanced CKD, in dialysis or not, suffer a burden from symptoms very similar to other chronic diseases and have a life span not superior to many malignancies. Accordingly, in recent years, renal palliative care has been recommended to be integrated in the traditional care delivered to this population. This research provides an updated overview on renal palliative care from the relevant literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/2175-8239-JBN-2020-0017DOI Listing
September 2020

Palliative Renal Care and the Covid-19 Pandemic.

J Bras Nefrol 2020 Aug;42(2 suppl 1):44-46

Sociedade Brasileira de Nefrologia, Comitê de Cuidado Paliativo Renal da São Paulo, SP, Brasil.

Introduction: Palliative care is an approach aimed at relieving suffering, controlling symptoms and seeking to improve quality of life. It must be offered in conjunction with standard treatment for any disease that threatens the continuation of life, such as a Covid-19 infection.

Discussion: The bioethical principles and strategies used by palliative medicine can assist nephrologists in the care of patients with renal dysfunction, who face the difficulties of isolation at the beginning and follow-up of dialysis in outpatient treatment, and those who are at risk for a more serious disease progress. Some of them: - a Shared decision making, which enables the patient and family to participate as facilitators in the systematization of the team's reasoning, in addition to respecting the principle of autonomy; - Symptom Management: which should be a priority to ensure relief of suffering even in times of social isolation; - Communication skills: making it possible to alleviate suffering in announcing bad news or complex decisions through communication techniques;; - Bereavement assistance: which in acute situations such as the pandemic, causing unexpected losses, the importance of sympathy from healthcare professionals becomes even greater.

Conclusion: The principles of palliative care are essential to face the challenges of a planet-wide crisis, which raises human suffering in all dimensions, and which requires the construction of strategies that can keep patients assisted, comfortable and with measures proportional to their clinical condition and preferences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/2175-8239-JBN-2020-S111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479977PMC
August 2020

Covid-19 pandemic: from carnival masks to surgical masks.

J Bras Nefrol 2020 Jul-Sep;42(3):361-365

Grupo CHR, São Paulo, SP, Brasil.

Given the high transmissibility of SARS-CoV-2, COVID-19 pandemic has a huge impact on our health system. Even in developed countries, strategic resources soon become insufficient. Although people over 60 and with comorbidities are at greater risk of developing severe forms, younger people may also require precious and scarce care. Hence, the World Health Organization recommend tests - PCR and serological tests - for detecting infected people on a large scale. The most common symptoms are fever, fatigue, dry cough, anorexia, myalgia, and dyspnea, with tomographic pulmonary findings being frequent even in asymptomatic cases. The Brazilian Society of Nephrology has published guidelines for the management of hypertensive, diabetic, dialysis, and transplant patients. In its alerts, care and precautions in dialysis units are also being detailed, both for the health team and for the patients. Although important renal manifestations are not yet evident in the admission of positive cases, recent studies with renal patients and performed in nephrology services are listed here. This pandemic lead us to learn from its progress in order to face new challenges in dialysis clinics, transplant services, and intensive care services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/2175-8239-JBN-2020-0078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657039PMC
November 2020

Resistance training improves sleep quality, redox balance and inflammatory profile in maintenance hemodialysis patients: a randomized controlled trial.

Sci Rep 2020 07 16;10(1):11708. Epub 2020 Jul 16.

Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil.

Patients in maintenance hemodialisys (HD) present sleep disorders, increased inflammation, unbalanced redox profiles, and elevated biomarkers representing endothelial dysfunction. Resistance training (RT) has shown to mitigate the loss of muscle mass, strength, improve inflammatory profiles, and endothelial function while decreasing oxidative stress for those in HD. However, the relation between those factors and sleep quality are inadequately described. The aim of this study was to verify the effects of 3 months of RT on sleep quality, redox balance, nitric oxide (NO) bioavailability, inflammation profile, and asymmetric dimethylarginine (ADMA) in patients undergoing HD. Our primary goal was to describe the role of RT on sleep quality. Our secondary goal was to evaluate the effect of RT on NO, metabolism markers, and inflammatory and redox profiles as potential mechanisms to explain RT-induced sleep quality changes. Fifty-five men undergoing maintenance hemodialysis were randomized into either a control (CTL, n = 25) and RT group (RTG; n = 30). Participants in the RT group demonstrated an improvement in sleep pattern, redox, inflammatory profiles, and biomarkers of endothelial function (NO and ADMA). This group also increased muscle strength (total workload in RT exercises of upper and lower limbs). These findings support that RT may improve the clinical status of HD patients by improving their sleep quality, oxidative and inflammatory parameters.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-68602-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367305PMC
July 2020

Brazilian chronic dialysis survey 2017.

J Bras Nefrol 2019 Apr-Jun;41(2):208-214. Epub 2019 Mar 28.

Sociedade Brasileira de Nefrologia, São Paulo, SP, Brasil.

Introduction: Having national data on chronic dialysis is essential in treatment planning.

Objective: To present data of the survey from the Brazilian Society of Nephrology on patients with chronic kidney disease on dialysis in July 2017.

Methods: Data was collected from dialysis units in Brazil. The data collection was done using a questionnaire completed online by the dialysis units.

Results: Two hundred and ninety-one centers (38.4%) answered the questionnaire. In July 2017, the estimated total number of dialysis patients was 126,583. National estimates of prevalence and incidence rates of dialysis patients per million population (pmp) were 610 (range: 473 in the North region and 710 in the Midwest) and 194, respectively. The incidence rate of new dialysis patients with diagnosis of diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19.9%. Of the prevalent patients, 93.1% were on hemodialysis and 6.9% on peritoneal dialysis, with 31,226 (24%) on the waiting list for renal transplantation. Venous catheter was used as access in 22.6% of patients on hemodialysis. The prevalence rate of positive serology for hepatitis C continued with a tendency to decrease (3.3%).

Conclusion: The absolute number of patients and rates of incidence and prevalence on dialysis continued to increase; the mortality rate tended to rise. There were obvious regional and state discrepancies in these rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/2175-8239-JBN-2018-0178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699436PMC
February 2020

Hepatitis C in Hemodialysis Units: diagnosis and therapeutic approach.

J Bras Nefrol 2019 Oct-Dec;41(4):539-549

Universidade Federal do Paraná, Curitiba, PR, Brasil.

According to data from the last census of the Brazilian Society of Nephrology (SBN), the prevalence of hepatitis C virus (HCV) in Brazilian hemodialysis units (HU) is 3.3%, about three times higher than what is reported for the Brazilian general population. Often, professionals working in HU are faced with clinical situations that require rapid HCV diagnosis in order to avoid horizontal transmission within the units. On the other hand, thanks to the development of new antiviral drugs, the cure of patients with HCV, both in the general population and in patients with chronic kidney disease and the disease eradication, appear to be very feasible objectives to be achieved in the near future . In this scenario, SBN and the Brazilian Society of Hepatology present in this review article a proposal to approach HCV within HUs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/2175-8239-JBN-2018-0177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979573PMC
May 2020

Reflections on End-of-Life Dialysis.

J Bras Nefrol 2018 Jul-Sep;40(3):209-212

Sociedade Brasileira de Nefrologia, São Paulo, SP, Brasil.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/2175-8239-jbn-2018-00030003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533958PMC
September 2019

EPIC Trial: education programme impact on serum phosphorous control in CKD 5D patients on hemodialysis.

J Bras Nefrol 2017 Oct-Dec;39(4):398-405

Universidade de São Paulo, Instituto de Ciências Biomédicas, Departamento de Farmacologia, São Paulo - SP, Brazil.

Introduction: In stage 5D chronic kidney disease (CKD 5D) patients, the encouragement of treatment adherence by health professionals is a significant clinical challenge.

Objectives: This study evaluates the impact of a nutritional education programme on hyperphosphatemia, utilizing the transtheoretical model of behavior change (TMBC).

Subjects And Methods: A prospective interventional study comprising 179 CKD 5D patients with hypophosphatemia. The 4-month educational programme took place during dialysis sessions. Demographic and laboratory data were evaluated, whilst the TMBC was utilized both pre- and post-intervention.

Results: 132 patients showed a positive change and significant reduction in phosphate levels, whilst 47 patients showed a negative change and little reduction in phosphate levels. Positive changes were identified at different levels of literacy. 117/179 participants had ongoing treatment with sevelamer throughout the trial period. 61 patients with intact parathyroid hormone (iPTH) < 300pg/ml showed phosphate level reductions, whilst 118 patients with iPTH > 300 pg/ml also showed a decrease in phosphate levels.

Conclusions: Nutritional education programmes can achieve excellent results when appropriately applied. An education programme may be effective across different literacy levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/0101-2800.20170072DOI Listing
September 2018

Brazilian Chronic Dialysis Survey 2016.

J Bras Nefrol 2017 Jul-Sep;39(3):261-266

Sociedade Brasileira de Nefrologia.

Introduction: National chronic dialysis data are important for the treatment planning.

Objective: To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2016.

Methods: A survey based on data of dialysis centers from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis centers.

Results: 309 (41%) of the dialysis units in the country answered the questionnaire. In July 2016, the total estimated number of patients on dialysis was 122,825. The estimated prevalence and incidence rates of chronic maintenance dialysis were 596 (range: 344 in the North region and 700 in the Southeast) and 193 patients per million of population (pmp), respectively. The annual incidence rate of patients with diabetic nephropathy was 79 pmp. The annual gross mortality rate was 18.2%. For prevalent patients, 92% were on hemodialysis and 8% on peritoneal dialysis, and 29,268 (24%) were on a waiting list of renal transplant. A venous catheter was the vascular access for 20.5% of the hemodialysis patients. The prevalence rates of positive serology for hepatitis B and C showed a tendency to reduce from 2013 (1.4% and 4.2%, respectively) to 2016 (0.7% and 3.7%, respectively).

Conclusion: The absolute number and the prevalence and incidence rates of patients on dialysis continue to rise steadily; the gross mortality rate remained stable. Regional inequities are evident in these rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/0101-2800.20170049DOI Listing
July 2018

Brazilian Chronic Dialysis Census 2014.

J Bras Nefrol 2016 Mar;38(1):54-61

Sociedade Brasileira de Nefrologia, Brazil.

Introduction: National chronic dialysis data have had impact in the treatment planning.

Objective: To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2014.

Methods: A survey based on data of dialysis units from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis units.

Results: Three hundred twelve (44%) of the dialysis units in the country answered the questionnaire. In July 2014, the total estimated number of patients on dialysis was 112,004. The estimated prevalence and incidence rates of chronic maintenance dialysis were 552 (range: 364 in the North region and 672 in the Southeast) and 180 patients per million population (pmp), respectively. The annual incidence rate of patients with diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19%. For prevalent patients, 91% were on hemodialysis and 9% on peritoneal dialysis, 32,499 (29%) were on a waiting list of renal transplant, 37% were overweight/obese, 29% were diabetics, 16% had PTH levels > 600 pg/ml and 26% hemoglobin < 10 g/dl. A venous catheter was the vascular access for 17% of the hemodialysis patients.

Conclusion: During 2011-2014 the prevalence and incidence rates of patients on dialysis tended to increase, while the gross mortality rate remained stable. In 2014, diabetes was the primary renal disease in 42% of the new dialysis patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/0101-2800.20160009DOI Listing
March 2016

Bariatric and metabolic surgery and microvascular complications of type 2 diabetes mellitus.

J Bras Nefrol 2015 Jul-Sep;37(3):399-409

Hospital Alemão Oswaldo Cruz, BR.

Introduction: Metabolic dysregulation is the defining characteristic of type 2 diabetes mellitus (T2DM) and may lead to microvascular complications, specifically retinopathy, nephropathy and neuropathy. Medical treatment and lifestyle interventions targeting risk factors for microvascular complications can yield therapeutic gains, particularly retinopathy and nephropathy. Bariatric/metabolic surgery is superior to the best medical treatment in several randomized controlled trials. Consequently, evidence of the effect of bariatric/metabolic surgery on microvascular complications is now emerging in the literature.

Methods: A search of the recent published evidence base on the effects of bariatric/metabolic surgery on microvascular complications reveals further evidence that supports the efficacy of surgery in preventing the incidence and progression of albuminuria and preserving renal functional decline.

Discussion: Data on retinopathy are ambivalent representing the potential in some cases for an influence of reactive hypoglycaemia over the retina but the majority of data emphasize that the metabolic control can halt the progression of the eye disease. A significant gap in the literature remains in relation to the effects of surgery on diabetic neuropathy, although some information sheds a light on the benefits secondary to the surgical metabolic control.

Conclusion: Overall, although data so far is exciting, there is a pressing need for prospective randomized controlled trials examining long-term microvascular outcomes following bariatric/metabolic surgery in patients with T2DM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/0101-2800.20150061DOI Listing
August 2017

Altered KLOTHO and NF-κB-TNF-α Signaling Are Correlated with Nephrectomy-Induced Cognitive Impairment in Rats.

PLoS One 2015 11;10(5):e0125271. Epub 2015 May 11.

Molecular Neuropharmacology Laboratory, Department of Pharmacology, Institute of Biomedical Science, University of São Paulo, São Paulo, Brazil.

Renal insufficiency can have a negative impact on cognitive function. Neuroinflammation and changes in klotho levels associate with chronic kidney disease (CKD) and may play a role in the development of cognitive impairment (CI). The present study evaluates the correlation of cognitive deficits with neuroinflammation and soluble KLOTHO in the cerebral spinal fluid (CSF) and brain tissue of nephrectomized rats (Nx), with 5/6 renal mass ablation. Nx and sham Munich Wistar rats were tested over 4 months for locomotor activity, as well as inhibitory avoidance or novel object recognition, which started 30 days after the surgery. EMSA for Nuclear factor-κB and MILLIPLEXMAP or ELISA kit were used to evaluate cytokines, glucocorticoid and KLOTHO levels. Nx animals that showed a loss in aversive-related memory and attention were included in the CI group (Nx-CI) (n=14) and compared to animals with intact learning (Nx-M n=12 and Sham n=20 groups). CSF and tissue samples were collected 24 hours after the last behavioral test. The results show that the Nx-groups have increased NF-κB binding activity and tumor necrosis factor-alpha (TNF-α) levels in the hippocampus and frontal cortex, with these changes more pronounced in the Nx-CI group frontal cortex. In addition, the Nx-CI group showed significantly increased CSF glucocorticoid levels and TNF-α /IL-10 ratio compared to the Sham group. Klotho levels were decreased in Nx-CI frontal cortex but not in hippocampus, when compared to Nx-M and Sham groups. Overall, these results suggest that neuroinflammation mediated by frontal cortex NF-κB, TNF-α and KLOTHO signaling may contribute to Nx-induced CI in rats.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0125271PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427267PMC
February 2016

Nutritional and epidemiological aspects of patients with chronic renal failure undergoing hemodialysis from Brazil, 2010.

J Bras Nefrol 2012 Jul-Sep;34(3):206-15

Grupo CINE-HDC-RENALCLASS.

Introduction: The Nutrition Committee of the Brazilian Society of Nephrology (SBN) held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention.

Objective: To describe epidemiological and nutritional aspects of hemodialysis patients.

Method: Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected.

Results: 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%), Diabetic Nephropathy (24.6%), unknown/undiagnosed causes (19.9%), Glomerulopathies (13.6%) and others (11.2%). Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years.

Conclusion: This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/0101-2800.20120001DOI Listing
December 2013

Comparison of cognitive function between patients on chronic hemodialysis who carry out assisted physical activity and inactive ones.

J Bras Nefrol 2011 Mar;33(1):27-30

Centro Integrado de Nefrologia, Home Dialysis Center, SP-- Brazil.

Physical inactivity is a determinant of clinical disorders and psychological problems in patients with chronic kidney disease patients. In two satellite clinics, a program of physical activity (PA) was offered to 86 patients undergoing hemodialysis. Of those, 49 patients entered the PA program spontaneously and 37 remained inactive. After six months, a satisfaction self-reported questionnaire and the Modified Mini-Mental State (3MS) Examination for assessment of cognitive function were applied. Cognition was compared between inactive patients and those participating in the PA program for at least three months. Regardless of age and duration of dialysis, patients showed a cognitive deficit greater than expected. In the general group, better cognitive function was observed in active patients as compared to the inactive ones (p < 0.05). When separated by age groups, active patients over the age of 60 years had better results than the inactive ones (p < 0.05). We concluded that patients with better cognitive responses are more physically active and/or physical activity contributes to better cognitive function.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2011